@article{Edwin_Indar_2017, title={A Novel Hotel-based Syndromic Surveillance System for the Caribbean Region}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7670}, DOI={10.5210/ojphi.v9i1.7670}, abstractNote={<div style="left: 72px; top: 256.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.08137);" data-canvas-width="51.022666666666666">Objective</div><div style="left: 84px; top: 268.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.97952);" data-canvas-width="303.99399999999997">To describe the Caribbean Public Health Agency’s (CARPHA)</div><div style="left: 72px; top: 281.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0415);" data-canvas-width="317.6393333333334">Tourism and Health Information System (THiS), a web-based</div><div style="left: 72px; top: 295.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00842);" data-canvas-width="315.0655333333333">syndromic surveillance system to increase the capacity of Caribbean</div><div style="left: 72px; top: 308.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.959589);" data-canvas-width="316.1206666666666">countries to monitor the health of visitors and staff in hotels, and</div><div style="left: 72px; top: 321.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.986316);" data-canvas-width="314.4376666666665">detect potential infectious disease outbreaks for early and coordinated</div><div style="left: 72px; top: 335.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00196);" data-canvas-width="104.18733333333336">public health response.</div><div style="left: 72px; top: 360.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.11794);" data-canvas-width="66.10733333333333">Introduction</div><div style="left: 84px; top: 372.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04355);" data-canvas-width="303.48173333333335">The tourism industry is highly vulnerable to Health, Safety, and</div><div style="left: 72px; top: 385.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0252);" data-canvas-width="315.60839999999996">Environmental Sanitation (HSE) threats. The Caribbean is the most</div><div style="left: 72px; top: 399.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02364);" data-canvas-width="312.0225333333333">tourism dependent region in the world, with over 54.2 million stay-</div><div style="left: 72px; top: 412.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.985904);" data-canvas-width="314.43766666666636">over and cruise ship arrivals in 2015, generating revenues of $US29.6</div><div style="left: 72px; top: 425.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.981978);" data-canvas-width="314.51133333333325">billion and contributing to 15% of the Gross Domestic Product (GDP)</div><div style="left: 72px; top: 439.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02549);" data-canvas-width="315.3205333333333">and 2,255,000 jobs [1]. Tourists and staff are at an increased risk of</div><div style="left: 72px; top: 452.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.990219);" data-canvas-width="314.4274666666663">acquiring infectious diseases, given the mass-gathering of individuals</div><div style="left: 72px; top: 465.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00133);" data-canvas-width="314.83433333333335">with varying levels of susceptibility and often times in close quarters</div><div style="left: 72px; top: 479.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.984853);" data-canvas-width="314.43086666666653">in hotels and cruise ships. To prevent the spread of infectious diseases</div><div style="left: 72px; top: 492.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.994729);" data-canvas-width="316.6057333333333">in these settings, early warning and response to potential public</div><div style="left: 72px; top: 505.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.999822);" data-canvas-width="314.71079999999984">health threats is essential. To increase the capacity of countries in the</div><div style="left: 72px; top: 519.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00308);" data-canvas-width="314.8683333333334">Caribbean monitor and protect the health of tourists and staff in their</div><div style="left: 72px; top: 532.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00334);" data-canvas-width="314.8978">hotel establishments, THiS was designed as an early warning system</div><div style="left: 72px; top: 545.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00211);" data-canvas-width="146.04133333333334">for infectious disease outbreaks.</div><div style="left: 72px; top: 571.273px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.07312);" data-canvas-width="46.59133333333333">Methods</div><div style="left: 84px; top: 583.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.996766);" data-canvas-width="304.6116666666665">CARPHA launched the Regional Tourism Health Information,</div><div style="left: 72px; top: 596.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02891);" data-canvas-width="317.6404666666666">Monitoring and Response System in 2016 with donor funding</div><div style="left: 72px; top: 609.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.984283);" data-canvas-width="316.10253333333327">received from the Inter-American Development Bank (IDB). The</div><div style="left: 72px; top: 623.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03157);" data-canvas-width="315.6775333333333">overall objective of THMRS project from 2016-2018 is to improve</div><div style="left: 72px; top: 636.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00983);" data-canvas-width="315.0508">participating country’s capacity to provide cost-effective and quality</div><div style="left: 72px; top: 649.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00675);" data-canvas-width="316.9752">health, food safety and environmental solutions to HSE threats.</div><div style="left: 72px; top: 663.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.963967);" data-canvas-width="315.9563333333332">As part of the THMRS project, the development of a hotel-based</div><div style="left: 72px; top: 676.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.981229);" data-canvas-width="316.31559999999985">syndromic surveillance system for early warning and response to</div><div style="left: 72px; top: 689.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00217);" data-canvas-width="157.37466666666668">infectious diseases was developed.</div><div style="left: 84px; top: 703.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03763);" data-canvas-width="303.4907999999999">THiS was developed in collaboration with six participating IDB</div><div style="left: 72px; top: 716.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.983056);" data-canvas-width="316.20000000000016">countries: Barbados, Bahamas, Belize, Guyana, Jamaica, Trinidad</div><div style="left: 72px; top: 729.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.98735);" data-canvas-width="314.45466666666675">and Tobago. The implementation plan (2016-2018) with each country</div><div style="left: 72px; top: 743.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00241);" data-canvas-width="98.838">involved three stages:</div><div style="left: 84px; top: 756.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03183);" data-canvas-width="305.3879999999999">1) Project Operations, Coordination, Management (including</div><div style="left: 72px; top: 769.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00692);" data-canvas-width="134.39066666666668">Advocacy, and Endorsement)</div><div style="left: 84px; top: 783.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.997971);" data-canvas-width="304.8304000000003">2) Development of the project outputs: gap analysis and best</div><div style="left: 72px; top: 796.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04813);" data-canvas-width="318.00199999999995">practices; development of surveillance guidelines and training</div><div style="left: 72px; top: 809.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00132);" data-canvas-width="113.01600000000002">modules, HSE Standards</div><div style="left: 84px; top: 823.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02441);" data-canvas-width="303.3457333333333">3) Implementation in participating countries (i.e. technical visits,</div><div style="left: 72px; top: 836.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03186);" data-canvas-width="315.6446666666667">ongoing technical coordination): Preparation, Buy-in, Training and</div><div style="left: 72px; top: 849.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00163);" data-canvas-width="33.98866666666666">Launch</div><div style="left: 84px; top: 863.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.990434);" data-canvas-width="300.0023999999999">The web-based design of THiS enables the collection of real-</div><div style="left: 72px; top: 876.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03317);" data-canvas-width="312.2242666666663">time data which will inform health service delivery decisions/</div><div style="left: 72px; top: 889.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.026);" data-canvas-width="315.66733333333343">policies, strengthen national and regional health monitoring efforts,</div><div style="left: 72px; top: 903.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.955826);" data-canvas-width="315.6775333333332">and trigger a rapid coordinated response to outbreaks, and prevent</div><div style="left: 72px; top: 916.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.974782);" data-canvas-width="312.0927999999999">escalation of tourism HSE incidents. The system involves a web-</div><div style="left: 72px; top: 929.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04148);" data-canvas-width="315.58573333333345">based questionnaire with a series of 11 short questions that ask the</div><div style="left: 72px; top: 943.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04201);" data-canvas-width="315.83279999999985">user for basic non-identifiable demographic information as well as</div><div style="left: 72px; top: 956.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.980541);" data-canvas-width="314.21439999999984">symptoms. The reported symptoms are used by the system to generate</div><div style="left: 72px; top: 969.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00225);" data-canvas-width="314.7414">six syndromes: Gastroenteritis, Undifferentiated Fever, Hemorrhagic</div><div style="left: 408px; top: 255.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.994975);" data-canvas-width="316.5513333333332">Fever, Fever with Neurologic symptoms. Fever with Respiratory</div><div style="left: 408px; top: 268.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00188);" data-canvas-width="129.39266666666668">symptoms, Fever with Rash.</div><div style="left: 420px; top: 281.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.957352);" data-canvas-width="303.89539999999965">Data entry persons include hotel staff, physicians, and the case.</div><div style="left: 408px; top: 295.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.957429);" data-canvas-width="315.79200000000014">Access to anlaytic dashboards of the aggregated data is limited to</div><div style="left: 408px; top: 308.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.04286);" data-canvas-width="315.5517333333335">registered hotel staff (i.e. Managers), the Ministry of Health of the</div><div style="left: 408px; top: 321.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00159);" data-canvas-width="271.3313333333334">country where the hotel reporting is located, and CARPHA.</div><div style="left: 420px; top: 335.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01275);" data-canvas-width="303.1485333333333">The limited level of baseline data for syndromes in the Caribbean</div><div style="left: 408px; top: 348.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.991159);" data-canvas-width="316.2623333333332">region means that statistical aberration detection mechanisms for</div><div style="left: 408px; top: 361.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00433);" data-canvas-width="314.9091333333332">most syndromes will not be available until THiS collects at least one</div><div style="left: 408px; top: 375.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00656);" data-canvas-width="314.93519999999995">year’s worth of data. However, for acute gastroenteritis, until a more</div><div style="left: 408px; top: 388.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.956483);" data-canvas-width="316.0537999999999">accurate threshold can be generated, a cut-off of 3% ill (staff and</div><div style="left: 408px; top: 401.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.984869);" data-canvas-width="314.38666666666666">guests) will be used for alerting potential outbreaks. This is scheduled</div><div style="left: 408px; top: 415.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01036);" data-canvas-width="315.0304">to be live and functional beginning in hotel facilities in Trinidad and</div><div style="left: 408px; top: 428.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00581);" data-canvas-width="190.43400000000003">Tobago at the beginning of October 2016.</div><div style="left: 420px; top: 441.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03084);" data-canvas-width="303.46246666666667">By the end of 2016, THiS will be operating in facilities in all six</div><div style="left: 408px; top: 455.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.983965);" data-canvas-width="314.262">participating countries, allowing for the collection of baseline data for</div><div style="left: 408px; top: 468.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.02812);" data-canvas-width="315.7013333333334">syndromes occurring among tourists and staff in hotel-settings, and</div><div style="left: 408px; top: 481.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.961765);" data-canvas-width="315.89173333333355">providing a mechanism to detect and response to emerging public</div><div style="left: 408px; top: 495.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01099);" data-canvas-width="157.68066666666672">health threats early and efficiently.</div><div style="left: 408px; top: 520.606px; font-size: 11.3333px; font-family: sans-serif; transform: scaleX(1.10259);" data-canvas-width="68.01133333333334">Conclusions</div><div style="left: 420px; top: 532.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.0599);" data-canvas-width="306.2413999999999">Establishing this system is critical to improving countries’</div><div style="left: 408px; top: 545.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.969364);" data-canvas-width="316.0288666666667">capacities to support the overall health surveillance system of the</div><div style="left: 408px; top: 559.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.03967);" data-canvas-width="317.79346666666663">tourism-dependent Caribbean economies, enabling countries to</div><div style="left: 408px; top: 572.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.01107);" data-canvas-width="316.9366666666666">collect real-time data which will inform health service delivery</div><div style="left: 408px; top: 585.901px; font-size: 11.3333px; font-family: serif; transform: scaleX(0.989382);" data-canvas-width="314.4750666666667">decisions/policies, strengthen national and regional health monitoring</div><div style="left: 408px; top: 599.234px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00608);" data-canvas-width="314.91933333333327">efforts to trigger a rapid coordinated response to outbreaks and other</div><div style="left: 408px; top: 612.567px; font-size: 11.3333px; font-family: serif; transform: scaleX(1.00199);" data-canvas-width="211.85399999999998">crises and thus prevent tourism HSE incidents.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Edwin, Jonathan and Indar, Lisa}, year={2017}, month={May} }