An early warning and response system for hand, foot and mouth Disease in China, 2011-2012

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Background: A China Infectious Disease Automated-alert and Response System (CIDARS) has been increasingly utilized nationwide for early outbreak detection and rapid response for infectious diseases in China. Hand, foot and mouth disease (HFMD) is a common childhood illness caused by enterovirus. Over the last two years, over 3.79 million HFMD cases with clinical diagnosis have been reported in China. Aims: This study aims to evaluate the performance of CIDARS for HFMD outbreak detection, and determine whether CIDARS can act as a good tool to detect the outbreaks of HFMD in China. Methods: A cross-sectional study on case-based and event-based HFMD surveillance systems was conducted. The detection timeliness and the size of HFMD outbreak was compared before and after CIDARS was used. The sensitivity and timeliness of detection of CIDARS were investigated. Results: 106,005 signals of HFMD among 2,608 counties were generated by CIDARS from May 2010 to April 2012, with an average of 5.6 signals per 100 days in each county. 98.6% signals were responded by local public health institutes, and 90.78% of them were responded in 24 hours. 574 outbreaks were detected in CIDARS, with the sensitivity of detecting all reported outbreaks was 92.73%, and the average time to detection outbreak were 2.1 days. With CIDARS support, the magnitude of HFMD outbreak was smaller and reporting timeliness was better than that of without CIDARS support. Conclusions: Our study showed that CIDARS had a good sensitivity and timeliness for HFMD outbreaks detection.The early warning system could benefit to HFMD outbreak report at early stage and facilitate rapid response.

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