Surveillance strategies for the detection of disease outbreaks in the Pacific islands: Meta-analysis of published literature, 2010-2019.

OBJECTIVE: Due to their tropical location, development status and the limited capacity of health systems, Pacific island counties and territories are particularly susceptible to infectious disease outbreaks; but evidence as to the optimal way in which outbreaks are detected is scarce. In this review we synthesise evidence from literature about how outbreaks are detected in Pacific island countries and territories and critique factors identified as inhibiting surveillance practice. METHOD: For this systematic review we searched electronic databases Embase, Global Health, MEDLINE and MEDLINE Epub from 1-January-2010 and 31-March-2019 for reports describing infectious disease outbreaks occurring in the Pacific islands. Reports were included if they reported the method by which an outbreak was detected or the time between an outbreak's onset and its detection. We extracted information about the report type and authors, the outbreak and its method/s of detection, and pertinent issues inhibiting surveillance practice. RESULTS: Of 860 articles identified, 37 reports describing 39 outbreaks met the inclusion criteria. Most outbreaks (n=30) were identified through formal event-based surveillance; six through syndromic surveillance; and two by ad-hoc notification from the community. Barriers to early outbreak detection included population isolation; lack of resources and infrastructure to support surveillance implementation and signal investigation; and broader health system factors such as preparedness planning and availability of laboratory services. CONCLUSION: Most surveillance-related gain in the Pacific islands may be made through building formal event-based surveillance systems and streamlining reporting processes to facilitate outbreak notification. This observation is pertinent given the focus on establishing and expanding syndromic surveillance approaches for outbreak detection in the islands over the last decade.