Research Article| Volume 67, ISSUE 5, P378-384, November 2013

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Evaluation of a national microbiological surveillance system to inform automated outbreak detection



      Evaluate data available from a national voluntary reporting system and describe the data processing necessary to enable the development and application of outbreak detection methods in healthcare settings.


      Evaluation was performed on an extract of data reported between March 2007 and May 2012. Reporting delays were calculated and analysed at the trust, regional and national levels. Negative binomial regression analysis was performed to detect any changes in laboratory reporting within this time.


      167 hospital laboratories have reported to the voluntary reporting system. 1,705,126 reports were made in the five-year study period. There is large variation in how laboratories report to the system. Under half (44.9%) report in a timely manner, with >90% of infections reported within three weeks of the specimen date. Overall, there was a significant increase of 17.5% in reporting after October 2010 (95% CI 13.8–21.4%, p < 0.001) and an improvement in reporting delay, when new statutory reporting regulations were introduced.


      The outbreak detection algorithm used at the national and regional level requires further modification to optimise outbreak detection for individual hospitals. For any prospective outbreak detection system to perform optimally it is imperative that laboratories ensure that the data they submit is complete, consistent and timely.


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      1. The health protection (notification) regulations. 2010 (London, UK. Available at:)
      2. Laboratory reporting to the Health Protection Agency: guide for diagnostic laboratories. Health Protection Agency, London, UK2010
        • Farrington C.P.
        • Andrews N.J.
        • Beale A.D.
        • Catchpole M.A.
        A statistical algorithm for the early detection of outbreaks of infectious disease.
        J R Statist Soc A. 1996; 159: 547-563
        • Hulth A.
        • Andrews N.
        • Ethelberg S.
        • Dreesman J.
        • Faensen D.
        • van Pelt W.
        • et al.
        Practical usage of computer-supported outbreak detection in five European countries.
        Euro Surveill. 2010; 15: 1-6
        • Noufaily A.
        • Enki D.G.
        • Farrington P.
        • Garthwaite P.
        • Andrews N.
        • Charlett A.
        An improved algorithm for outbreak detection in multiple surveillance systems.
        Stat Med. 2012; 32: 1206-1222
      3. Baby unit shut over MRSA outbreak (BBC News report; 16/10/07). Available at:

      4. Baby dies in Southmead Hospital pseudomonas outbreak (BBC News Report; 09/10/12). Available at:

      5. Hospital ‘failed’ to tackle bug (BBC News Report; 24/07/06). Available at:

        • Hacek D.M.
        • Cordell R.L.
        • Noskin G.A.
        • Peterson L.R.
        Computer-assisted surveillance for detecting clonal outbreaks of nosocomial infection.
        J Clin Microbiol. 2004; 42: 1170-1175
        • Huang S.S.
        • Yokoe D.S.
        • Stelling J.
        • Placzek H.
        • Kulldorff M.
        • Kleinman K.
        • et al.
        Automated detection of infectious disease outbreaks in hospitals: a retrospective cohort study.
        PLoS Med. 2010; 7: e1000238
        • Wright M.-O.B.M.
        • Perencevich E.N.M.
        • Novak C.M.
        • Hebden J.N.R.
        • Standiford H.C.M.
        • Harris A.D.M.
        Preliminary assessment of an automated surveillance system for infection control.
        Infect Control Hosp Epidemiol. 2004; 25: 325-332
        • Unkel S.
        • Farrington C.P.
        • Garthwaite P.H.
        • Robertson C.
        • Andrews N.
        Statistical methods for the prospective detection of infectious disease outbreaks: a review.
        J R Statist Soc A. 2012; 175: 49-82

      Linked Article

      • Infectious disease surveillance in China
        Journal of InfectionVol. 71Issue 6
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          In this journal, Freeman and colleagues described their evaluation of a national microbiological surveillance system for automated outbreak detection in England.1 The Chinese government had also established a similar surveillance system after the outbreak of severe acute respiratory syndrome in 2003. That system is comprised of a web-based disease reporting system and the National Infectious Diseases Monitoring Information System Database. These resources have helped to strengthen the Chinese infectious disease prevention and control strategies.
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