Establishing and validating syndromic surveillance of gastrointestinal infections using routine emergency department data, Germany, 2019–2023

Gastrointestinal infections in Germany account for 24.5 million outpatient visits annually. To enhance outbreak detection and trend monitoring, we developed and validated a syndrome definition for syndromic surveillance of gastrointestinal infections in emergency departments. We selected presenting complaints (Canadian Emergency Department Information System) and diagnoses (ICD-10) to develop the syndrome definition. Validation involved cross-correlation analysis of syndromic and laboratory-based surveillance trends (norovirus-gastroenteritis, rotavirus-gastroenteritis, campylobacteriosis and salmonellosis notifications). We included emergency departments from the German AKTIN registry with continuous data transmission (01/2019-06/2023). Our novel syndrome definition combined complaints (diarrhoea, vomiting, nausea) and diagnoses (intestinal infectious diseases). Across 864,353 visits in 7 emergency departments, 2.1% (n = 18,158) were gastrointestinal infection cases. Of those, 57% (n = 10,424) were female; 23% were aged 0-19 years (n = 4108); and 23% 20-39 years (n = 4116). Trends were similar between surveillance systems. Cross-correlation was 0.73 (95%-confidence interval 0.61-0.85; p < 0.001) at lag - 1, indicating a 1-week relative reporting delay of laboratory-based surveillance. Coherent trends and significant cross-correlation validated our syndrome definition. This novel automated syndromic surveillance complements laboratory-based surveillance while offering improved timeliness and reduced workload. Therefore, it was implemented in Germany's national routine surveillance of emergency departments.

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Journal
Scientific Reports
Published
2025-11-03
DOI
https://doi.org/10.1038/s41598-025-13675-z
Primary Topic
Data-Driven Disease Surveillance
Type
article
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article

Establishing and validating syndromic surveillance of gastrointestinal infections using routine emergency department data, Germany, 2019–2023

Achim Dörre, Caroline Grupp, Madlen Schranz, Felix Patricius Hans et al.
Scientific Reports
Data-Driven Disease Surveillance
article

Establishing and validating syndromic surveillance of gastrointestinal infections using routine emergency department data, Germany, 2019–2023

Achim Dörre, Caroline Grupp, Madlen Schranz, Felix Patricius Hans, Felix Walcher, Philipp Kümpers, Sabine Blaschke, T Händl, Sebastian Wolfrum, Christoph Duesberg, Raphael W. Majeed, Bernhard Kumle, Markus Wehler, Volker Burst, Rainer Röhrig, Jonathan H. J. Baum, Frank Hanses, Alexander Kombeiz, Katharina Heldt, Lucas Triefenbach, Jonas Bienzeisler, Domagoj Schunk, Eric Handmann, Carsten Mach, Jürgen Bauer, Kirsten Habbinga, Hendrik Wilking, T. Sonia Boender, Heike Höger-Schmidt, Markus Baacke, Susanne Drynda, Markus Zimmermann, Saskia Ehrentreich, Hardy Wenderoth, Eckard Hamelmann, Tobias Hofmann, Hans‐Jörg Busch, Christian Wrede, Joachim Riße, Bernadett Erdmann, Benjamin Lucas, Ronny Otto, Friedrich Reichert, Matthias Klein, Harald Dormann, Jörg Christian Brokmann, Rupert Grashey, Alexander Dinse-Lambracht, Amrei Heining, Michael Bernhard, Tobias Schilling, Wiebke Schirrmeister, A. Gries, Thomas Peschel, Thomas Henke, Marina V. Karg, Clemens Kill, Wolfgang Stahl, Jan Kleinekorth, Christoph Lewejohann, Jürgen Neubauer, Norbert Pfeufer, Hartmut Stefani, Bernd Uirich
article en

Abstract

Gastrointestinal infections in Germany account for 24.5 million outpatient visits annually. To enhance outbreak detection and trend monitoring, we developed and validated a syndrome definition for syndromic surveillance of gastrointestinal infections in emergency departments. We selected presenting complaints (Canadian Emergency Department Information System) and diagnoses (ICD-10) to develop the syndrome definition. Validation involved cross-correlation analysis of syndromic and laboratory-based surveillance trends (norovirus-gastroenteritis, rotavirus-gastroenteritis, campylobacteriosis and salmonellosis notifications). We included emergency departments from the German AKTIN registry with continuous data transmission (01/2019-06/2023). Our novel syndrome definition combined complaints (diarrhoea, vomiting, nausea) and diagnoses (intestinal infectious diseases). Across 864,353 visits in 7 emergency departments, 2.1% (n = 18,158) were gastrointestinal infection cases. Of those, 57% (n = 10,424) were female; 23% were aged 0-19 years (n = 4108); and 23% 20-39 years (n = 4116). Trends were similar between surveillance systems. Cross-correlation was 0.73 (95%-confidence interval 0.61-0.85; p < 0.001) at lag - 1, indicating a 1-week relative reporting delay of laboratory-based surveillance. Coherent trends and significant cross-correlation validated our syndrome definition. This novel automated syndromic surveillance complements laboratory-based surveillance while offering improved timeliness and reduced workload. Therefore, it was implemented in Germany's national routine surveillance of emergency departments.

Scientific ReportsVol. 15(1)
Bielefeld University (DE), Hochschule Bielefeld (DE), University of Münster (DE), Robert Koch Institute (DE), Paracelsus Medical University (AT), University Medical Center Freiburg (DE), University Hospital Augsburg (DE), Merseburg University of Applied Sciences (DE), Nordhausen University of Applied Sciences (DE), LMU Klinikum (DE), University Hospital Regensburg (DE), Humboldt-Universität zu Berlin (DE), Krankenhaus der Barmherzigen Brüder Trier (DE), Düsseldorf University Hospital (DE), Universitäres Kinderwunschzentrum Lübeck (DE), Klinikum Aschaffenburg (DE), Ostalb-Klinikum Aalen (DE), Evangelisches Krankenhaus Bielefeld (DE), Klinikum Magdeburg (DE), Klinikum Oldenburg (DE), Olgahospital (DE), Klinikum Braunschweig (DE), Universitäts Hautklinik Kiel (DE), Universitätsmedizin Göttingen (DE), Essen University Hospital (DE), Universitätsklinikum Aachen (DE), Pius Hospital Oldenburg (DE), Klinikum Fürth (DE), Schwarzwald-Baar Klinikum (DE), University Hospital Magdeburg (DE), Fraunhofer Project Centre Wolfsburg (DE), Evangelisches Krankenhaus Oldenburg (DE), Kernkraftwerk Gundremmingen (DE), GGD Amsterdam (NL), Centrum für Integrierte Onkologie (DE), St. Joseph-Krankenhaus (DE), Amsterdam University Medical Centers (NL), Helios Hospital Berlin-Buch (DE), Klinikum Stuttgart (DE), Klinikum Chemnitz (DE), Garmisch-Partenkirchen Medical Center (DE), Heinrich Heine University Düsseldorf (DE), European Centre for Disease Prevention and Control (SE), Friedrich Schiller University Jena (DE), Ludwig-Maximilians-Universität München (DE), University of Amsterdam (NL), RWTH Aachen University (DE), Bethel University (US), Heidenhain (Germany) (DE), Leipzig University (DE), Otto-von-Guericke-Universität Magdeburg (DE)
Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Bundesministerium für Bildung und Forschung, Bundesministerium für Gesundheit, Robert Koch Institut
Openalex Percentile: Top 57%
Data-Driven Disease Surveillance
DOIOpen Access PDFOpenAlex
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