OJPHI: Vol. 5
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Journal ID (publisher-id): OJPHI
ISSN: 1947-2579
Publisher: University of Illinois at Chicago Library
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©2013 the author(s)
open-access: This is an Open Access article. Authors own copyright of their articles appearing in the Online Journal of Public Health Informatics. Readers may copy articles without permission of the copyright owner(s), as long as the author and OJPHI are acknowledged in the copy and the copy is used for educational, not-for-profit purposes.
Electronic publication date: Day: 4 Month: 4 Year: 2013
collection publication date: Year: 2013
Volume: 5E-location ID: e77
Publisher Id: ojphi-05-77

The Distribution of Infectious Related Symptoms in an Internet-based Syndromic Surveillance System in Rural China
Qi Zhao1
Fuqiang Yang2
Lars Palm3
Hui Yuan2
Weirong Yan4
Biao Xu*1
1School of Public Health, Fudan University, Shanghai, China;
2Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China;
3Future Position X, Gavle, Sweden;
4Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
*Biao Xu, E-mail: bxu@shmu.edu.cn


To describe the distribution of the infectious related symptoms in an internet-based syndromic surveillance system reported by doctors in village health stations, township and county hospitals in rural Jiangxi Province, China, and to identify the major infectious diseases for syndromic surveillance in different levels of health facility.


Syndromic surveillance system, which collects non-specific syndromes in the early stages of disease development, has great advantages in promoting early detection of epidemics and reducing the burden of disease confirmation (1). It is especially effective for surveillance in resource-poor settings, where laboratory confirmation is not possible or practical (2). Integrating syndromic surveillance with traditional case report system may generate timely, effective and sensitive information for early warning and control of infectious diseases in rural China (3). A syndromic surveillance system (ISSC) has been implemented in rural Jiangxi Province of China since August 2011.


Doctors and health workers in the healthcare surveillance units of ISSC, including village health station, township hospital and county hospital, used an internet-based electronic system to collect information of daily outpatients, which included 10 categories of infectious disease related symptoms, i.e., cough, fever, sore throat, diarrhea, headache, rash, nausea/vomit, mucocutaneous hemorrhage, convulsion and disturbance of consciousness. The data from August 1st to December 31st 2011 were extracted from database and analyzed using SPSS 16.0. The combination of symptoms was also analyzed to identify patients with the syndrome of influenza-like illness (ILI) and fever-gastrointestinal syndrome (FGS). ILI were composed by fever (>=38 degree centigrade) plus cough or fever plus sore throat, and FGS were defined as fever plus vomit or diarrhea.


Two county hospitals (CH), 4 township hospitals (TH) and 50 village health stations (VHS) were selected as surveillance unites in the pilot study during 2011/8/1 to 2011/12/31. In total, 152270 outpatient visits were reported, and 35395 patients had a chief complain of at least one surveillance symptom. Of these symptomatic patients, 24130 (68.2%) were from VHS, 4995 (14.1%) from TH and 6810 (19.2%) from CH. The proportion of patients with targeting symptom accounted for 15.5%, 66.4% and 23.9% of total outpatients in CH, TH and VHS respectively. The first 3 reported symptoms were cough (61.8%), fever (28.4%), and sore throat (23.4%), whereas mucocutaneous hemorrhage, convulsion and disturbance of consciousness were the least frequently reported symptoms in all surveillance units. Overall 3582 ILI and 1160 FGS cases were reported accounting for 35% and 11% of fever cases respectively. Of the reported ILI and FGS cases, 75% ILI and 55.9% FGS cases were reported by health workers in the VHS.


Cough, fever and sore throat were the top surveillance symptoms, and the respiratory infectious diseases had more chance to be reported in syndromic surveillance system in rural Jiangxi Province. Training on infectious disease diagnosis especially respiratory diseases for village health workers should be enhanced since large numbers of patients are likely to visit the village health stations.


This study was funded by [European Union’s] [European Atomic Energy Community’s] Seventh Framework Programme ([FP7/2007–2013] [FP7/2007–2011]) under grant agreement no. [241900].

1.. Henning KJ. What is syndromic surveillance?MMWR Morb Mortal Wkly Rep 2004;53(Suppl):5–11.
2.. Siswoyo H, Permana M, Larasati RP, et al. EWORS: using a syndromic-based surveillance tool for disease outbreak detection in IndonesiaBMC Proceedings 2008;2(Suppl 3):S3.
3.. Reingold A. If syndromic surveillance is the answer, what is the questionBiosecur Bioterr 2003;1:1–5.
[Figure ID: f1-ojphi-05-77] Figure 1 

Distributions of symptomatic patients in different level health facilities of rural China

Article Categories:
  • ISDS 2012 Conference Abstracts

Keywords: Syndromic surveillance, rural, influenza-likes illness, fever-gastrointestinal syndrome.

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