Final evaluation report

Work Package 3, Deliverable 5

Prepared by Kåre Mølbak, Luise Müller and Anne Mazick

January 2014

This report arises from the project Triple S-AGE which has received funding from the European Union, in the framework of the Health Program. The sole responsibility lies with the author(s) of this report and the Executive Agency

is not responsible for any use that may be made of information contained herein.

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1 Introduction The Public Health Action Programme Triple S (Syndromic Surveillance Survey, Assessment towards Guidelines for Europe, grant agreement GA 2009.11.12) was a European project carried out from 2010 to 2013. The overall aim was to develop guidelines to strengthen public health surveillance and rapid response to prevent and assess health threat impact. This will increase the European capacity for real-time or near-real time surveillance and monitoring of the health burden of expected and unexpected health related events. The project was co-financed by the European Commission and included twenty-four organisations from thirteen countries. Four objectives have been identified for the project in the Grant Agreement:

- To provide MS, ECDC and relevant bodies with an overview of the available systems of SyS in Europe

- To support harmonisation of main data sources for morbidity syndromic surveillance - To support the development and implementation of SyS systems at MS level according to MS needs

and expectations. - To develop synergies between SyS (animal and human SyS) and promote dialogue and

complementarity between systems, sentinel networks and specific disease surveillance networks. To reach these objectives, Triple S reviewed and analysed European syndromic surveillance systems (SyS). This included inventories of past, existing and proposed SyS, along with several country visits for an in-depth understanding of selected systems. The project also provided scientific and technical guidance for the development and implementation of SyS for both human and animal health, according to the needs and expectations of the member states. One of the main outputs was a proposal for an EU strategy for Syndromic Surveillance and the development of guidelines for member states to allow future early warning systems to be developed and assessed. The Triple S project has been organised in work packages, and the outcomes of these were widely disseminated by means of presentations at national and international meetings, various publications and a website. The evaluation team, Work Package 3, was responsible for monitoring the projects’ progress. i.e. reviewing progress against milestones etc. The evaluation team was also responsible for formal progress evaluations during the project phase including a mid-term evaluation report, which was prepared in February 2012. The aim of the final evaluation report, which is deliverable 6 of the project plan, is to assess that the project was implemented and carried out according to the plan and to verify if the objectives of the work packages and of the overall project have been met. This evaluation report briefly discusses the significance of the project to. It is, on the other hand, much too early to evaluate any long term and sustainable impact of the project. Only time will tell whether if the major deliverables including the proposal for an EU strategy for Syndromic Surveillance and the Guidelines for member states will make a difference for European Public Health.

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2 Methods We based this evaluation on a review of relevant deliverables from the Triple S project including reports, publications and meeting minutes. The meeting minutes and reports used for this review are available on the restricted Triple-S website.

2.1 Progress monitoring The overall tool used for monitoring the progress of the Triple-S project was a progress bar listing different milestones, progress indicators, deliverables and other tasks for each work package of the project. This tool was available for work package leaders and partners on the restricted part of the Triple-S website. The status of the different tasks was updated at regular intervals by the work package leaders. Milestones, indicators and deliverables that guided the evaluation were primarily the following:

Development of a dedicated website

Announcement of the project with news items, leaflets and a website

Development of guidelines for country visits (D2)

Guidelines for assessment of data sources (D2)

Report of country visits (D3)

Inventory of existing systems including human data sources (D4) and veterinary syndromic (D7) surveillance systems (SyS)

Guidelines for implementing SyS (D8)

Proposal for EU strategy (D9)

Publications

Case study meetings

Workshops and meetings held Members of the evaluation team took part in most Triple-S meetings and conferences and reviewed internal and external documents.

2.2 Stakeholder survey A survey was conducted among participants of the ECDC advisory forum meeting the 7th – 8th of December 2011 with a brief self-administered questionnaire on the knowledge of existing SyS in the home country, usefulness of SyS and the added value compared to traditional surveillance systems. The work package leaders drafted and discussed this survey during the second plenary meeting November 2011. The evaluation team presented the outcome at the final plenary meeting in Rome 2013 where it served as one of many inputs for guiding discussions about SyS.

2.3 Actions of Triple-S each objective of the project The actions of the Triple-S project to reach the four objectives (through the process indicators, outcomes indicators and output indicators) have been summarised in a table.

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3 Results

3.1 Progress monitoring The work packages have followed the plan of the project and have completed nearly all deliverables and milestones (at least in mature draft format). Some deliverables have been postponed, and the entire project duration was extended by a period of four months in order to include a workshop on SyS at the 6th Public Health Conference in Brussels, November 2013 (see Grant agreement, amendment no 4). Final reports are still pending. 3.1.1.1 Work package 1 –Coordination of the project WP1 has successfully

Completed and submitted the technical report for year 1 with input from all partners. This report was approved by EAHC on December 16, 2011.

Completed and submitted the financial report for year 1 with financial reporting provided by all partners. EAHC has accepted the report and no comments were made

Completed and submitted the technical report for year 2 with input from all partners. This report was approved by EAHC without comment and the second payment from the European Commission has been received on December 2012 .

Completed and submitted the financial report for year 2 with financial reporting provided by all partners.

Co-ordinated plenary meetings and workshops o Kick-off meeting, 22 to 25 November 2010, Luxembourg o 2nd Plenary meeting, 28 November 28 to 1 December, 2011, Budapest o Final project meeting, 8 to 10 April 2013, Rome o Workshop on SyS guidelines, 25 to 27 June 2012, Brussels o Workshop: “Improving public health information systems across Europe: Which contribution of

Syndromic Surveillance”, 14 November 2013, Brussels

Organised 19 conference calls with work package leaders o 8 April 2009 o 29 September 2010 o 8 November 2010 o 21 January 2011 o 30 March 2011 o 25 March 2011 o 7 September 2011 o 24 October 2011 o 12 January 2012 o 14 March 2012 o 16 May 2012 o 26 June 2012 o 9 October 2012 o 4 December 2012 o 5 February 2013 o 27 May 2013 o 19 June 2013 o 3 October, 2013 o 4 November 2013

One challenge in the coordination of the project has been the changes of partners and staff during the first year. The project had a new project leader by February 2011, Anne Fouillet. Three of the associated partners

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have changed name due to internal restructuration (Afssa to Anses in 2011, Univmed to AMU in 2012 and HPA to PHE in 2013), and there has been withdrawal of one associated partner (GEOMED), incorporation of a new associated partner (Maastricht University) which includes the staff from GEOMED. These changes were formalised in amendments to the Grant agreement. 3.1.2 Work package 2 – Dissemination of the project WP2 has successfully

Completed a dissemination plan

Set up the Triple-S website: www.syndromicsurveillance.eu with a public and private section.

Co-ordinated the production of a project leaflet and logo

Made the following news items o Press releases announcing the project (six languages) o News item in Eurosurveillance April 2011 (Eurosurveillance, Volume 16, Issue 17,

28 April 2011 “European institutes for disease prevention and control collaborate to improve public health surveillance.”)

o News item on the EAHC web site May 2011 o Comment in Lancet 2011 (Assessment of syndromic surveillance in Europe.

Lancet. 2011 Nov 26; 378(9806):1833-4. Triple S Project.)

Issued eight internal newsletters

Made a fact sheet template and five fact sheets

o 1: What is syndromic surveillance and what are the Triple-S guidelines? o 2: Examples of syndromic surveillance uses in Europe o 3: The Triple-S guidelines for syndromic surveillance o 4: Inventory of syndromic surveillance systems and initiatives in Europe o 5: About data sources for syndromic surveillance

Made a progress bar available at the restricted part of the website for evaluation of the project

In addition, Triple S has produced a number of papers, presentations and posters. These are listed at the end of this report. 3.1.3 Work package 3 – Evaluation WP3 has successfully

Created the progress bar tool for the evaluation

Performed a stakeholder and member study on the awareness of SyS

Prepared the midterm evaluation report (D5)

Prepared the present report with contributions from other partners

Prepared the report “Evaluation of increased awareness of Syndromic Surveillance Systems in Europe. Identification of needs and expectations of potential users of guidelines and the proposal for a European strategy for syndromic surveillance. A stakeholder survey.” Including contributions from Marta Sala-Soler and Céline Dupuy.

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3.1.4 Work package 4 – Inventory WP4 has successfully

Completed a literature review for the identification of past or existing SyS systems both in human and animal health,

Developed two detailed questionnaires for past, existing and planned SyS in Europe, one for the inventory of human health systems, the other one for the inventory of animal health systems

Sent questionnaires to identified systems

Facilitated a meeting for the veterinary expert group, September 2011

Presented the results of the findings on existing and planned SyS at the 2nd plenary meeting in Budapest in 2011 and at the final meeting in Rome in 2013.

The inventories are supported by a fact sheet.

The outcome of the inventory of the human health projects and systems can be found at http://syndromicsurveillance.eu/systems-in-europe/humansys. It includes all SyS systems in Europe, including not only existing systems but also systems that are considered as pilot studies, systems that existed in the past, those that were created for a specific period of time (e.g., for a mass gathering event), and those that are planned for the future. The list was last updated 25 May 2013.

The outcome of the inventory of Veterinary projects and systems identified can be accessed at http://www.syndromicsurveillance.eu/systems-in-europe/vet-systems. A scientific article about the inventory has been published in the peer-reviewed journal Preventive Veterinary Medicine ( Dupuy C. et al., 2013).The inventory contains projects with very different status: some are operational systems, others are pilot projects, while some correspond to databases with syndromic information not yet used for surveillance. The list was last updated 21 July 2012.

3.1.5 Work package 5 – Site visits, knowledge transfer between member states, data source description

WP5 has successfully

Completed the country visit guidelines

Completed briefing documents for visiting teams

Facilitated and participated in the country visits o United Kingdom 13-16 June 2011 o France 12-15 September 2011 o Sweden 9 November 20111 o Denmark 10 November 2011 o Hungary 1 December 2011 o Italy 20-23 March 2012. o Belgium and The Netherlands 27-29 June 2012 o The SIDARTHa network, Germany and Austria, 8-10 May 2012

After each country visit an evaluation has been conducted. The agenda for the following site visits was adapted and modified based on the experience and feedback. Detailed information from the field trips are available from the restricted part of the Triple-S website

Evaluation of the first visits was presented at the second plenary meeting

Guidelines for the assessment of data sources was finalised in April 2013. This constitutes the 3rd part of D2.deliverable has been postponed with the agreement of EAHC. These guidelines shall support future users of SyS systems to assess existing

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data sources in their area for the potential to be used for SyS. The guidelines are based on a systematic literature review and on the information obtained during the country visits that were also organised as part of WP 5.

The guidelines for the assessment of data sources are supported by a fact sheet.

3.1.6 Work package 6 – Guidelines for implementing syndromic surveillance systems in Europe WP6 has successfully

Organized a workshop on the guidelines at the 2nd plenary meeting in Budapest in which project partners were asked to join a working group for the guidelines.

WP6 has produced a number of documents to facilitate the work on the guidelines including a document on the structure of the guidelines, writing suggestions for the working groups, creation of a timetable of dates for the tasks and an overall plan for the working groups.

To ensure that the guidelines meet the needs of potential users, Triple S conducted a survey aimed at identifying the expectations of future users of these guidelines. This survey was launched in January 2012 and a summary of results is available in the report presenting the stakeholder survey conducted by the WP3.

Based on these considerations as well as discussions at the Budapest meeting and the 2012 workshop in Brussels, draft guidelines was prepared by WP6 and presented at the final meeting in Rome 2013.

The guidelines cover all aspects of performing syndromic surveillance (SyS), from data collection, reporting and analysis to communication strategy and evaluation of a SyS System. The issues are covered in specific sections with concrete examples, templates, checklists, and links to free tools/software. To support harmonization of main data sources for morbidity syndromic surveillance and help people clarify where their SyS system would fit, the guidelines has been structured such as the document is practical and illustrated, provides information on how to develop or improve SyS systems and lists “minimum requirements of systems”. The comparability of data among different systems in different countries or locations is also addressed.

The guidelines is supported by a fact sheet

WP6 has successfully developed a draft document on a European Policy for SyS. The policy document was discussed at the Final project meeting in Rome 2013. After revision, a mature draft was presented and further discussed at the 2013 Workshop in Brussels.

The Guidelines and the proposal for the strategy for a European syndromic surveillance have been presented during the ISDS conference in December 2013 in New Orleans (USA).

3.2 Meetings and meeting minutes Three plenary meetings have been held. The first one was the kick-off meeting in Luxemburg on 22-25 November 2010. The second one was in Budapest on 28 November – 1 December, 2011, which focused on the guidelines. The third one was the final and very successful meeting in Rome April 2013. Conference calls have been held on a regular basis approximately every second month. In all, 19 conference calls were held. All meetings and telephone conferences have been documented by minutes.

3.3 Communication The overall communication between work package leaders and partners are open and constructive. No risks to the project progress have been identified in the internal communication. The external communication with website, participation in conferences and publishing in scientific papers have showed great interest in the

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project e.g. with the statistics that 5,500 visits have been paid to the website by approximately 3,300 unique visitors from March 1st 2011 up until December 31st 2013, according to Google Analytics.

3.4 Stakeholder survey 24/26 persons from 24 different European countries answered the questionnaire. In general, the majority (83%) of the participants stated that they found SyS useful and 71% reported that they had SyS in their countries. More in-depth analyses has been presented in a separate report.

3.5 Summary of the Triple-S actions for reaching the four objectives of the project Item Triple S-AGE actions

Objective 1: To provide MS, ECDC and relevant bodies with an overview of the available systems

of SyS in Europe.

Process

indicator

Inventory of

existing systems

(routine or pilot)

available.

The human and animal health inventory reports of past, existing and pilot

systems are available one the Triple S-AGE website, as well as the list of

contact for each identified systems

Output

indicator

Overview of

existing system

The literature review and inventory reports have drawn an overview of

the existing systems in 2012. The lists of human and animal systems

have been updated during the project.

Outcomes

indicators

Pertinent

information

available in

case of need

Detailed information on each system has been collected, covering all

steps of a syndromic surveillance system: name and contact point for the

system, data source(s) used, detail on data collection and analysis,

information on communication process.

The nine country visits allowed having an in-depth understanding of the

visited systems.

Dissemination activities, in particular through the Triple S-AGE website

with information available on the public part and communication in

European and international conference (EUPHA, conference of the

International society for syndromic surveillance (ISDS), presentation to

the ECDC advisory forum, …) contribute to share information to MS,

ECDC and relevant bodies.

Finally, surveys conducted for collecting awareness of syndromic

surveillance and the survey to identify the needs and expectations of

stakeholders about the guidelines have contributed Triple S-AGE

partners to produce documents in adequation with their needs.

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Item Triple S-AGE actions

Objective 2: To support harmonisation of main data sources for morbidity Syndromic Surveillance.

Process

indicator

Nine countries

to be visited by

a team of

associated and

collaborative

partners

The nine country visits covered systems with various data sources both

for human and animal health (Emergency departments, GP’s networks,

telephone helplines, ambulance dispatches, web requests, Vet clinics,

slaughterhouses,…). These visits contributed to share information

between experts having long or short experience in SyS.

Output

indicator

assessment of

SyS on

morbidity will be

done

Guidelines for assessment of data sources, based on a important

literature review and on the nine country visits have been written. The

usefulness, strengths and weaknesses have been explored for the main

usual data sources, based on nine evaluation criteria.

Outcomes

indicators

Comparable

SyS results on

morbidity

between MS

Guidelines for structuring the visits help to collect the same information for

each visited system, facilitating the comparison of results. For the same

reason, the inventory questionnaires were similar for human and

veterinarian systems.

Guidelines for designing and implementing a SyS system, common for

animal and human health systems and providing recommendations and

minimum requirements, contribute to ensure harmonised systems in

Europe. Futhermore, the proposal for a strategy in Europe aims at

harmonising and comparing findings from the different European systems.

Objective 3: To support the development and implementation of SyS systems at MS level according

to MS needs and expectations.

Process

indicator

case study

meetings, nine

country visits

The 8 country visits allowed to present how the visited systems have been

implemented and how the systems run. The visits were followed by

groups with experts in animal and human health having both long and

short experience in SyS, for knowledge transfer. Different stakeholders

(data providers, epidemiologists, statisticians, decision makers, IT,…)

were met during the visits for covering all aspects of a system.

Output

indicator

case studies

identified and

presented

In complement to the numerous case studies presented during the nine

country visits (use for seasonal epidemics, like flu, gastroenteritis,

environmental events (heat-waves, floods, …), mass gathering, …),

presentations have been done during the plenary meetings (for ex.:

Olympic games in London in 2012 during the final meeting)

Outcomes

indicators

Increase

knowledge

about SyS in

Europe (Interest

and limits)

Literature review, through the guidelines for assessment of data sources,

the country visits and the inventory reports contributed to provide a large

overview of the existing systems, providing also comparison criteria for

evaluation of their interests and limits.

The proactive country visits have also facilitated the knowledge transfers

between the experts of the European Network

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Item Triple S-AGE actions

Objective 4:

To develop synergies between SyS (animal and human SyS) and promote dialogue

and complementarity between SyS systems, sentinel networks & specific disease

surveillance networks

Process

indicator

workshops and

meetings held

During the project, experts from human and animal health systematically

participated and worked together. Experts from the two fields

participated to the country visits and meetings.

Part of the veterinarian workshop in Sept. 2011 met human and animal

health experts for discussing of synergies between the two fields.

During country visits, experts from the sentinel and specific surveillance

networks were met for exploring how syndromic and specific

surveillance systems communicate and share their information.

Output

indicator

guidelines and

proposed

strategy

Similar questionnaires were developed for facilitating comparison of

results from the two inventories. Guidelines for designing and

implementing syndromic surveillance system were commonly written for

the two fields, mixing human and veterinarian examples.

The proposal for the European strategy for syndromic surveillance

includes both human and animal health systems.

Outcomes

indicators

quicker

exchange of

information and

therefore

possibility to

react in less

time in case of

outbreaks

Country visits and workshop helped discussion between syndromic and

specific systems and between animal and human systems. These

meeting shown how these different systems have complementary

information that can help to be more reactive.

Dissemination activities, though the Triple S-AGE website and

communication in European and international conference contribute to

share information with other networks.

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4 Discussion and concluding remarks

Overall, the project progressed according to plan and achieved the planned deliverables; in some cases actually more than that. Some delays were noted, but this was inevitable, as the preparation of for example guidelines and policy documents needs careful consideration and discussions. Otherwise, there is a risk of outcomes of poor quality and poor acceptability as well as applicability. In agreement with EC, the project period was extended without additional costs. This extension provided more time for reflection and new opportunities for dissemination. It is important to keep in mind that over the recent years, the emphasis on syndromic surveillance systems has changed from automated, early alert and detection, to situational awareness and response (see for example Paterson and Durrheim, J Epidemiol Global Health 2013; 2: 41-7). The development of concepts and thoughts in Triple S has reflected this important development. This adaptation may be crucial for optimising the usefulness of SyS. As documented in the publication list, the dissemination of the Triple-S project has been impressive. However, we still need to harvest the most important outcomes. The real difference made by Triple-S – such as stimulating the implementation of new systems in Europe – will come later. However, it is fair to say at this moment that the merits are not limited to the deliverables, indicators and milestones of the project, but relates to the fact that Triple-S created a network between experts and public health professionals working in different sectors, including both human and veterinary public health. This network included organisations and institutions, but also other European networks such as SIDARTHa and EuroMOMO. In that sense, Triple-S was and will continue to be an asset for European Public Health. Moreover, link with the international society for syndromic surveillance (ISDS) has been done all over the project, enabling to share experience with international systems and also to disseminate Triple-S results to European and international countries.

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Dissemination activities

Publications

European project consortia of EuroMOMO (The European Mortality Monitoring project), Triple-S (Syndromic surveillance systems, towards guidelines for Europe), and SIDARTHa (European emergency data-based syndromic surveillance system). L.2. Workshop: Improving public health information systems across Europe: which contribution of syndromic surveillance? The European Journal of Public Health 2013;23(suppl 1). doi:10.1093.

Dupuy C, Bronner A, Perrin J-B, Calavas D, Fouillet A, Rago G, Kanieff M, Conti S. Syndromic surveillance in Europe: current situation in human and animal health and possible synergies. The European Journal of Public Health 2013;23(suppl 1). doi:10.1093 (.ppt presentation from workshop).

Elliot A, Morbey R, Hughes H, Harcourt S, Smith S, Loveridge P, Edeghere O, Ibbotson S, McCloskey B, Catchpole M, Smith G. Syndromic surveillance – a public health legacy of the London 2012 Olympic and Paralympic Games. The European Journal of Public Health 2013;23(suppl 1). doi:10.1093 (.ppt presentation from workshop).

Fouillet A, Medina S, Viso A, Caserio-Schönemann C, Medeiros H. Guidelines for implementing syndromic surveillance in Europe and proposal for a European syndromic surveillance strategy. The European Journal of Public Health 2013;23(suppl 1). doi:10.1093 (.ppt presentation from workshop).

Mølbak K, Mazick A. European monitoring of excess mortality for public health action (EuroMOMO). The European Journal of Public Health 2013;23. (suppl 1). doi:10.1093 (.ppt presentation from workshop).

Ziemann A, Fouillet A, Sala Soler M, Krafft T. Review of morbidity syndromic surveillance activities: Use and usefulness of different syndromic data sources in Europe and around the world. The European Journal of Public Health 2013;23(suppl 1). doi:10.1093 (.ppt presentation from workshop).

Dupuy C, Bronner A, Watson E, Wuyckhuise-Sjouke L, Reist M, Fouillet A, Calavas D, Hendrikx P, Perrin J-B. Inventory of veterinary syndromic surveillance initiatives in Europe (Triple-S project): Current situation and perspectives. Preventive Veterinary Medicine, 2013 Sep 1;111:220-229.

Triple S Project. Assessment of syndromic surveillance in Europe. Lancet, 2011 Nov 26;378(9806):1833-4.

Posters and presentations

Dupuy C, Bronner A, Perrin J-B, Calavas D, Hulth A, Ziemann A, Elliot A, Smith G, Chaudet H, Virtanen M, Reynolds A, Krafft T, Fouillet A. How to design and implement a syndromic surveillance system in animal health? Guidelines by the Triple-S project. Poster presentation at 2nd international conference on animal health surveillance, May 2014.

Dórea F, Dupuy C, Akkina J. Towards one health: Increasing awareness of animal health among public health stakeholders. Roundtable discussion at International Society for Disease Surveillance 12th annual conference, December 2013, (abstracts book, page 44).

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Medina S, Caserio-Schonemann C, Dupuy C, Hulth A, Medeiros H, Molback K, Krafft T, Ziemann A, Fouillet A. Comparing findings from syndromic surveillance systems at a European level. Oral presentation at International Society for Disease Surveillance 12th annual conference, December 2013, (abstracts book, page 109).

Medina S, Sala-Soler M, Caserio-Schonemann C, Conti S, Dupuy C, Elliot A, Hulth A, Muller L, Ziemann A, Fouillet A. Guidelines to implement or improve Syndromic surveillance systems. Oral presentation at International Society for Disease Surveillance 12th annual conference, December 2013, (abstracts book, page 110).

Medina S. The experience of developing environmental-health dimensions of routine surveillance data systems. Presentation at a pre-conference to Environment and Health – Bridging South, North, East and West, August 2013.

Bronner A, Dupuy C, Perrin J-B, Dórea F. Syndromic surveillance in animal health: public, animal and food safety. A webinar organized by ISDS, July 2013.

Ziemann A, Krafft T, Sala Soler M, Fouillet A, Hulth A, Müller L, Conti S, Kanieff M, Dupuy C, Medina S. Use of different data sources for syndromic surveillance in Europe. Poster presented at International Meeting on Emerging Diseases and Surveillance, February 2013.

Dupuy C, Perrin J-B, Bronner A, Calavas D, Hendrikx P, Fouillet A. Synergies between human and animal health syndromic surveillance: Triple-S outputs. Poster presented at International Society for Disease Surveillance 10th annual conference, December 2012.

Cooper D. Towards Integrated Syndromic Surveillance in Europe? An ISDS webinar presentation, November 2012.

Fouillet A. European project Triple-S and syndromic surveillance. Presented at Eurovaccine.net, November 2012.

Ziemann A, Krafft T, Brand H, Sala Soler M, Fouillet A, Hulth A, Müller L, Molbak K, Conti S, Kanieff M, Rago G, Perrin JB, Dupuy C, Medina S, on behalf of the Triple-S project consortium. Identifying good practice for syndromic surveillance in Europe - a comparative study based on site visits in eight countries. Eur J Public Health (2012) 22 (suppl 2):79. Oral presentation at European Public Health Conference, November 2012.

Sala-Soler M, Fouillet A, Hulth A, Molbak K, Conti S, Krafft T, Medina S, Cooper D, Medeiros H, Viso AC. Triple-S Project: Syndromic Surveillance Survey in Europe. Poster presented at International Society for Disease Surveillance 10th annual conference, December 2011.

Fouillet A, Sala-Soler M, Conti S, Kanieff Mark, Rago G, Perrin JB, Dupuy C, Krafft T, Ziemann A, Viso AC. Inventory of syndromic surveillance systems in Europe by the Triple-S Project. Oral presentation at International Society for Disease Surveillance 10th annual conference, December 2011.

Poster introducing the project, presented at the Gastein Workshop on Health Security, October 2011 and at the European Public Health Conference, November 2011.

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Project reports

Inventory of human syndromic surveillance systems in Europe (.pdf)

Inventory of veterinary syndromic surveillance systems in Europe (.pdf)

Visit guidelines: Scientific guidelines for knowledge exchange on syndromic surveillance in Europe scientific(.pdf)

Visit guidelines: Administrative guidelines for country visits of syndromic surveillance systems in Europe (.pdf)

Guidelines for assessment of data sources (.pdf)

Other project reports are available at the restricted website

In press

Eurosurveillance: European institutes for disease prevention and control collaborate to improve public health surveillance

Executive Agency for Health and Consumers: Syndromic Surveillance Survey Assessment towards Guidelines for Europe (triple S-AGE)

Partners announcing the project

Environmental Protection Agency Emilia-Romagna Region, Italy: Triple-S: Sorveglianza dei rischi per la salute

French Institute for Public Health Surveillance: 24 instituts européens de veille sanitaire réunis pour améliorer la surveillance de la santé publique

International Society for Disease Surveillance: Triple S Project: Syndromic Surveillance Survey and Assessment towards Guidelines for Europe

Maastricht University: European institutes for disease prevention and control collaborate to improve public health surveillance

Statens Serum Institut, Denmark: Nyt europæisk netværk moderniserer overvågning af folkesundheden

Swedish Institute for Communicable Disease Control: Ett starkare smittskydd genom Europeiskt samarbete