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Syndromic Surveillance of Infectious Diseases in Taiwan ---
Before and After the Challenges of Severe Acute Respiratory Syndrome (SARS)
Chwan-Chuen King,1 F-Y.
Shih,1,8 M-Y. Yen,2 F-C. Hu,1 J-S. Wu,1,3 F-K. Chang,3 L-W. Lin,3 J-Y. Yang, H-Y. Chen,3 T-S. Wu,1 D-J. Wang,3 K-T. Chen,3 H-T. Yu,4 C-A. Hsiung,4 S-W. Lu,3 C-M. Chang,3 S-T. Lin,2 C-J. Fu,6 C-M.
Huang,2 M-S. Ho,5 H. Chang,7 J-H. Chou,3 S-J. Twu,4 I-J. Su,3 M. Marx,9 H. Sobel10
1National Taiwan University, Taipei, Taiwan; 2Taipei Municipal Jen-Ai Hospital, Taipei, Taiwan; 3Center for Disease Control, Taipei, Taiwan; 4National Health Research Institute, Taipei, Taiwan;
5Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; 6Taipei Municipal WanFang Hospital, Taipei, Taiwan; 7Taipei City Government Department of Health, Taipei, Taiwan; 8National Taiwan University Hospital, Taipei, Taiwan;
9New York City Department of Health and Mental Hygiene, New York, New York;
10World Health Organization, Geneva, Switzerland
Corresponding author: Chwan-Chuen King, Institute of Epidemiology, College of Public Health, National Taiwan University, 1 Jen-Ai Road Section 1, Taipei, Taiwan (100). E-mail: a1234567@ccms.ntu.edu.tw.
Abstract
Introduction: Timely and sensitive outbreak detection is a high priority of syndromic surveillance. Early
detection enables officials to allocate limited public health resources to contain outbreaks and thereby decrease morbidity
and mortality.
Objectives: This study retrospectively evaluated Taiwan's respiratory syndromic surveillance system
(RSSS), established in July 2000, for its ability to detect severe acute respiratory syndrome (SARS).
Methods: Reporting through RSSS was encouraged for patients aged >5 years with unexplained cough,
respiratory distress, pulmonary edema, or other severe symptoms. Their specimens were collected for laboratory testing
of suspected etiologic agents.
Results: Among 112 reported acute respiratory syndrome cases during January 1--August
5,2003, etiologic agents were identified for 26 cases, and only four SARS cases and one case co-infected with SARS-associated coronavirus
(SARS Co-V) and Mycoplasma were detected. Only five (0.75%) of 664 probable SARS cases were captured
through RSSS. The first SARS case, reported on March 14, 2003, was not detected by RSSS, reflecting the system's low sensitivity. RSSS did not detect a SARS case until March 17, 2003, after awareness had been raised by
media reports.
Conclusions: Because RSSS was both insensitive and rarely used before the SARS outbreak, and because
public health administrators urgently needed daily updated case numbers and laboratory results, Taiwan instituted
an Internet-based reporting and a day-to-day medical follow-up form immediately after the peak of
hospital-associated SARS. Emergency department-based syndromic surveillance was established in July 2003, and different hospital data sets are being integrated into the system to facilitate detection of future outbreaks of emerging infectious diseases.
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