Syndromic detectability of haemorrhagic fever outbreaks

Emma E Glennon; Freya L Jephcott; Alexandra Oti; Colin J Carlson; Fausto A Bustos Carillo; C Reed Hranac; Edyth Parker; James L N Wood; Olivier Restif

The copyright holder for this preprint . https://doi.org/10.1101/2020.03.28.20019463 doi: medRxiv preprint we nonetheless find that they are important for both the sensitivity and specificity of 301 syndromic surveillance approaches. Additionally, few studies describing the presentation of 302 syndromes describe heterogeneity in their presentation. We accounted for this heterogeneity 303 by introducing wider clinical feature distributions for those syndromes which represent 304 pooled aetiological agents (e.g., ascribing high heterogeneity to "diarrhoeal diseases," which 305 includes a range of pathogens, and moderate heterogeneity to most clinical features of EVD, 306 which may be caused by several distinct filovirus species). However, more consistent and 307 comprehensive reporting of clinical feature prevalence across strains and settings would 308 enable stronger accounting for heterogeneity in disease presentation. Furthermore, an advantage of our approach is its ability to exploit-rather than work 326 against-the uncertainty inherent in syndromic data from diseases with heterogeneous 327 presentations. Critically, this allows detection of diseases at population levels even before 328 any individual-level diagnosis occurs (e.g., before the development of tests for rare/novel 329 pathogens or in settings with insufficient diagnostic capacity). 330