A Novel Hotel-based Syndromic Surveillance System for the Caribbean Region
Authors: Edwin Jonathan , Indar Lisa 
Published: May 2017

ObjectiveTo describe the Caribbean Public Health Agency’s (CARPHA)Tourism and Health Information System (THiS), a web-basedsyndromic surveillance system to increase the capacity of Caribbeancountries to monitor the health of visitors and staff in hotels, anddetect potential infectious disease outbreaks for early and coordinatedpublic health response.IntroductionThe tourism industry is highly vulnerable to Health, Safety, andEnvironmental Sanitation (HSE) threats. The Caribbean is the mosttourism dependent region in the world, with over 54.2 million stay-over and cruise ship arrivals in 2015, generating revenues of $US29.6billion and contributing to 15% of the Gross Domestic Product (GDP)and 2,255,000 jobs [1]. Tourists and staff are at an increased risk ofacquiring infectious diseases, given the mass-gathering of individualswith varying levels of susceptibility and often times in close quartersin hotels and cruise ships. To prevent the spread of infectious diseasesin these settings, early warning and response to potential publichealth threats is essential. To increase the capacity of countries in theCaribbean monitor and protect the health of tourists and staff in theirhotel establishments, THiS was designed as an early warning systemfor infectious disease outbreaks.MethodsCARPHA launched the Regional Tourism Health Information,Monitoring and Response System in 2016 with donor fundingreceived from the Inter-American Development Bank (IDB). Theoverall objective of THMRS project from 2016-2018 is to improveparticipating country’s capacity to provide cost-effective and qualityhealth, food safety and environmental solutions to HSE threats.As part of the THMRS project, the development of a hotel-basedsyndromic surveillance system for early warning and response toinfectious diseases was developed.THiS was developed in collaboration with six participating IDBcountries: Barbados, Bahamas, Belize, Guyana, Jamaica, Trinidadand Tobago. The implementation plan (2016-2018) with each countryinvolved three stages:1) Project Operations, Coordination, Management (includingAdvocacy, and Endorsement)2) Development of the project outputs: gap analysis and bestpractices; development of surveillance guidelines and trainingmodules, HSE Standards3) Implementation in participating countries (i.e. technical visits,ongoing technical coordination): Preparation, Buy-in, Training andLaunchThe web-based design of THiS enables the collection of real-time data which will inform health service delivery decisions/policies, strengthen national and regional health monitoring efforts,and trigger a rapid coordinated response to outbreaks, and preventescalation of tourism HSE incidents. The system involves a web-based questionnaire with a series of 11 short questions that ask theuser for basic non-identifiable demographic information as well assymptoms. The reported symptoms are used by the system to generatesix syndromes: Gastroenteritis, Undifferentiated Fever, HemorrhagicFever, Fever with Neurologic symptoms. Fever with Respiratorysymptoms, Fever with Rash.Data entry persons include hotel staff, physicians, and the case.Access to anlaytic dashboards of the aggregated data is limited toregistered hotel staff (i.e. Managers), the Ministry of Health of thecountry where the hotel reporting is located, and CARPHA.The limited level of baseline data for syndromes in the Caribbeanregion means that statistical aberration detection mechanisms formost syndromes will not be available until THiS collects at least oneyear’s worth of data. However, for acute gastroenteritis, until a moreaccurate threshold can be generated, a cut-off of 3% ill (staff andguests) will be used for alerting potential outbreaks. This is scheduledto be live and functional beginning in hotel facilities in Trinidad andTobago at the beginning of October 2016.By the end of 2016, THiS will be operating in facilities in all sixparticipating countries, allowing for the collection of baseline data forsyndromes occurring among tourists and staff in hotel-settings, andproviding a mechanism to detect and response to emerging publichealth threats early and efficiently.ConclusionsEstablishing this system is critical to improving countries’capacities to support the overall health surveillance system of thetourism-dependent Caribbean economies, enabling countries tocollect real-time data which will inform health service deliverydecisions/policies, strengthen national and regional health monitoringefforts to trigger a rapid coordinated response to outbreaks and othercrises and thus prevent tourism HSE incidents.