Establishing a National Syndromic Surveillance System among Asylum Seekers
Authors: Hooiveld Mariette , Mollers Madelief , Van Rooden Stephanie , Verheij Robert A. , Hahné Susan 
Published: May 2017

ObjectiveFacing challenges to establish a new national syndromicsurveillance system in the Netherlands for infectious diseases amongasylum seekers.IntroductionMost European countries are facing a continuous increased influxof asylum seekers [1]. Poor living conditions in crowded shelters andrefugee camps increase the risk for - outbreaks of - infectious diseasesin this vulnerable population. In line with ECDC recommendations[2], we aim to improve information on infectious diseases amongasylum seekers by establishing a new syndromic surveillance systemin the Netherlands. This system will complement the notifiabledisease system for infectious diseases.The aim of the syndromic surveillance system is to improve thedetecting of outbreaks of infectious diseases in asylum seekers’centres in an early stage of development to be able to take adequateand timely measures to prevent further spread, and to collectinformation on the burden of infection within this population.MethodsPrimary health care for asylum seekers in the Netherlands isorganized nationally by the Asylum Seekers Health Centre, withgeneral practitioners providing care in each reception centre. Generalpractitioners (GPs) act as gatekeepers for specialized, secondaryhealth care and the GP is the first professional to consult for healthproblems. Therefore, electronic health records (EHR) kept by GPsprovide a complete picture of this population. These EHRs containdata on diagnoses/symptoms and treatment of asylum seekers, usingthe International Classification of Primary Care (ICPC). This data isrecorded routinely, as part of the health care process. During summer2016, about 30,000 asylum seekers were housed in about 60 receptioncentres across the Netherlands.ResultsThe governance structure was layed down in a collaborationagreement between the Asylum Seekers Health Centre, the nationalinstitute of public health RIVM and NIVEL. To ensure privacy ofthe asylum seekers, a privacy protocol has been drawn, taking intoaccount strict privacy regulations in the Netherlands. The informationsystem provider of the health care centre developed an extraction toolthat automatically generates weekly data extracts from the electronichealth records system to a Trusted Third Party (TTP). Beforetransferring the data to NIVEL, the TTP removes directly identifyingpatient information, indirectly identifying information like date ofbirth is replaced by quarter and year, and the personal identificationnumber is replaced by a pseudonym. At NIVEL, all data is storedin a relational database, from which weekly research extracts aregenerated for infectious disease surveillance at RIVM after applyinga second pseudonymisation step (two-way pseudonimisation) [3].First data extracts are being expected mid-October 2016, after whichdata quality will be evaluated. Weekly, or daily, consultations rateswill be calculated based on the number of cases meeting predefineddefinitions, stratified by immigration centre, age group, sex andnationality. Numerators will be based on the number of populationhoused in the immigration centres.ConclusionsWith the cooperation of a national health care centre, providingprimary care to asylum seekers housed at several locations, and theinformation system provider of the health care centre, EHRs can beused for syndromic surveillance, taking into account strict privacyregulations. The new surveillance system will be evaluated after oneyear, focusing on data quality, usefulness, and the added value aboveto the notification of diseases.