The application of a novel 'rising activity, multi-level mixed effects, indicator emphasis' (RAMMIE) method for syndromic surveillance in England

Motivation: Syndromic surveillance is the real-time collection and interpretation of data to allow the early identification of public health threats and their impact, enabling public health action. The 'rising activity, multi-level mixed effects, indicator emphasis' method was developed to provide a single robust method enabling detection of unusual activity across a wide range of syndromes, nationally and locally. Results: The method is shown here to have a high sensitivity (92%) and specificity (99%) compared to previous methods, whilst halving the time taken to detect increased activity to 1.3 days. Availability and implementation: The method has been applied successfully to syndromic surveillance systems in England providing realistic models for baseline activity and utilizing prioritization rules to ensure a manageable number of 'alarms' each day.