Without Syndromic Surveillance Systems, some things can get really hard to see

So the slow reaction of Germany and other European countries has been bad, in the case of a known but unusual infection. How bad would it be in case of an unknown novel pathogen? A lot worse, I would guess.  It is a shame that this article, in Nature, blames everything EXCEPT the lack of a syndromic surveillance system:

Microbe Outbreak Panics Europe
Spread of rare strain raises questions over surveillance of infectious diseases.

By Marian Turner of Nature magazine


Confronted with what has become one of the world’s most severe outbreaks of Escherichia coli, physicians and scientists in Germany say that the country’s fractured health-management system has failed to handle the crisis properly. They are calling for major reforms so that outbreaks are reported sooner and more modern technology is used to help identify their source, in order to bring health emergencies under control more quickly.


Hospitals recorded the first cases on 1 May, according to the Robert Koch Institute (RKI), the German federal agency for disease surveillance in Berlin. Yet it was not until 22 May that the first report of an unusual number of EHEC infections in Germany arrived at the European Centre for Disease Prevention and Control in Stockholm. This was unusually long–it typically takes 14 days to detect an outbreak, says Angelika Fruth from the RKI.

Several factors conspired to cause the delay. EHEC infections are not common in adults–so physicians might have initially diagnosed a Salmonella or viral infection. The microbe also behaves differently to typical EHEC strains when cultured for diagnosis, which hampered scientists trying to identify it. And under the German health system, local authorities only report such infections weekly to state governments–which then have another week to tell the RKI. It was not until 25 May that the rare E. coli strain O104:H4 was named as the culprit.

Despite all the obstacles, the outbreak could have been identified earlier, says Flemming Scheutz, head of the World Health Organization Collaborative Centre for Reference and Research on Escherichia and Klebsiella in Copenhagen. The polymerase chain reaction (PCR) could have been used to amplify the microbe’s genes, he says, enabling scientists to identify it in hours rather than the days it took to culture and test bacteria from patients’ stool samples. “PCR testing for bacteria is already in routine use in livestock and food, and hospitals already have the technical platforms to do PCR,” says Scheutz, “but these tests just aren’t used regularly in people.”

Fruth agrees that a PCR protocol would be highly desirable. However, even though it is as cheap as culture-based techniques, it is not funded as a standard test for cases of diarrhea by the German health-care system, she notes.

Faster reporting would also help next time there is an outbreak. The US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, introduced a rapid-surveillance platform called PulseNet following an outbreak of a different EHEC strain, called O157:H7, in 1993. The system rapidly compares the molecular fingerprints of suspected bacterial infections in food or humans with those of known pathogens. The results are uploaded to a national database, which allows real-time tracking of the infection clusters in an outbreak.

If this goes on, and becomes more contentious, it will be interesting to see the quality of the public health reporting. eee_efff will watch and read the public health reporting on this issue, and advise if something gets interesting.


Without Syndromic Surveillance Systems, some things can get really hard to see

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