Research Article: Enhanced surveillance during a public health emergency in a resource-limited setting: Experience from a large dengue outbreak in Solomon Islands, 2016-17

Date Published: June 7, 2018

Publisher: Public Library of Science

Author(s): Adam T. Craig, Cynthia A. Joshua, Alison R. Sio, Bobby Teobasi, Alfred Dofai, Tenneth Dalipanda, Kate Hardie, John Kaldor, Anthony Kolbe, Kevin K. Ariën.


Between August-2016 and April-2017, Solomon Islands experienced the largest and longest-running dengue outbreak on record in the country, with 12,329 suspected cases, 877 hospitalisations and 16 deaths. We conducted a retrospective review of related data and documents, and conducted key informant interviews to characterise the event and investigate the adaptability of syndromic surveillance for enhanced and expanded data collection during a public health emergency in a low resource country setting. While the outbreak quickly consumed available public and clinical resources, we found that authorities were able to scale up the conventional national syndrome-based early warning surveillance system to support the increased information demands during the event demonstrating the flexibility of the system and syndromic surveillance more broadly. Challenges in scaling up included upskilling and assisting staff with no previous experience of the tasks required; managing large volumes of data; maintaining data quality for the duration of the outbreak; harmonising routine and enhanced surveillance data and maintaining surveillance for other diseases; producing information optimally useful for response planning; and managing staff fatigue. Solomon Islands, along with other countries of the region remains vulnerable to outbreaks of dengue and other communicable diseases. Ensuring surveillance systems are robust and able to adapt to changing demands during emergencies should be a health protection priority.

Partial Text

The Solomon Islands (SI), a low-income country ranked 156 of 188 nations in human development [1,2], is located in the south-west Pacific Ocean, approximately 1,800 km north-east of Australia (Fig 1). Disease outbreaks are common in SI with a number of epidemics challenging the country in recent years, including a rubella outbreak in 2012–13 with 13 cases [3]; a rotavirus outbreak in 2014 with over 4,000 cases [4]; a measles outbreak in 2014 affecting 4,563 cases [5]; a Zika virus case in 2015 [6,7]; a cluster of meningococcal disease in 2015 with five paediatric cases [8]; and a dengue virus serotype 3 (DENV-3) outbreak in 2013 with more than 7,000 cases [9].

We report the investigation, findings and response to the largest and longest-running dengue outbreak recorded in SI. As information on past dengue outbreaks in the Pacific islands is incomplete comparing the size of this outbreak with others was not possible, however, given the scale and duration of this dengue outbreak it appears to have been one of the most significant to have occurred in the region.

The SI remains vulnerable to outbreaks of dengue and other outbreak-prone communicable diseases. This case study demonstrates that SSSs can–relatively easily–be expanded and enhanced during an outbreak situation in a low-resource setting, however, issues of data quality and timeliness must be managed. During prolonged outbreaks fatigue amongst surveillance staff should be expected. Providing daily, rather than weekly, surveillance data on suspected dengue cases would be more useful for response planning and may lead to better public health outcomes. Incorporating mobile technology into surveillance practice may aide more timely data capture which, coupled with geo-coding ability and automated analysis, will likely enhance outbreak informatics and target control activities. Further efforts to determine the extent to which the response to the DENV-2 emergency reduced and prevented transmission is required.




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