Surveillance of ambulance dispatch data as a tool for early warning

Early detection of disease outbreaks is essential for authorities to initiate and conduct an appropriate response. A need for an outbreak detection that monitored data predating laboratory confirmations was identified, which prompted the establishment of a novel symptom surveillance system. The surveillance system monitors approximately 80% of the Danish population by applying an outbreak detection algorithm to ambulance dispatch data. The system also monitors both regional and national activity and has a built-in, switch-on capacity for implementing symptom surveillance reporting in case of an alert. In an evaluation with outbreak scenarios it was found that decreasing the outbreak detection sensitivity from a prediction limit of 95% to one of 99% moderately reduced the time to detection, but considerably diminished the number of false alerts. The system was able to detect an increased activity of influenza-like illness in December 2003 in a timely fashion. The system has now been implemented in the national disease surveillance programme.