Pandemic response in low‐resource settings requires effective syndromic surveillance

To the editor: Starbuck et al. have identified a significant gap in any future global response to a severe influenza pandemic. The threat of inadequate preparedness and limited public health responses in low-resource settings, leading to uncontrolled transmission is a real and unwelcome possibility during a pandemic. The authors recommend that detailed authoritative guidance should be developed for low-resource settings and that support should be given to governments in these settings to adapt and implement these guidelines. However, an appropriate public health response and effective management of cases depend primarily on early detection of suspected cases. This remains a major challenge in many developing countries, but syndromic surveillance offers a potential solution in these settings. A novel and visionary system, using a simple but standardised set of symptoms, was first developed by T. Jacob John in the early 1980s in Southern India. The system utilised a district-level disease surveillance system in a low-resource setting, to control and limit disease outbreaks through early detection. This approach was further adapted in a rural African setting with a focus on rural hospitals reporting presentations of nine core clinical syndromes, including cholera and meningitis-like disease to ensure early identification of infectious disease outbreaks