EWARS in a box: Supporting Syndromic Surveillance of La Mojana Flood Response, Colombia

Taller mojana

This article originally appeared in WHO's Monthly operational update on Health Emergencies, January 2023.

9 February 2023 Influenced by the La Niña phenomenon, La Mojana region of Colombia is currently experiencing the longest emergency in recent years. More than 155,888 people of 38,972 households in the departments of Antioquia, Córdoba, Bolívar and Sucre are in need of assistance as a result of atypical rains, floods and the related widespread displacement. 

In the department of Sucre itself, over 500 temporary emergency shelters (called “Cambuches”) have been identified, some of which are offering shelter for more than 2000 people.

This situation has produced significantly high risks of spread of communicable diseases in affected populations, especially of diarrhoeal and vector-borne diseases. It is against this backdrop that La Mojana’s regional health authorities mobilized WHO’s electronic early warning, alert and response system, EWARS in a box to detect outbreaks as part of the flood response, in December 2022. EWARS in a box has supported over 100 million emergency affected population across 31 countries since its inception in 2015. This rapid, user-friendly and flexible digital tool can be used in over 60 languages covering diverse communities globally to detect outbreaks early on.

In La Mojana, the National Institute of Health of Colombia collaborated with WHO’s three levels (PAHO/WHO Country Office, WHO/PAHO Regional Office and Headquarters) to rollout the early warning system in the temporary emergency shelters, with the aim of being swiftly notified of disease syndromes and events of public health importance and inform rapid response. 

Since its rollout, EWARS in a box has been supporting syndromic surveillance in La Mojana, enabling symptoms of epidemic-prone diseases to be detected early – prior to clinical or laboratory confirmation – especially in an operating environment that may experience delays in confirming outbreaks. Acute respiratory syndrome and acute diarrheal syndrome are the most commonly reported syndromes out of the 11 syndromes that EWARS’ electronic reporting is supporting. Syndromes notified in EWARS are received real-time at the National Institute of Health’s surveillance office, which then prompts epidemiologists and surveillance officers to take necessary actions, including confirmation.

To support the implementation of EWARS, the National Institute of Health, the PAHO/WHO Country Office for Colombia, and the PAHO Health Emergency Department (PHE) held a two-day training of trainers in December 2022, for 17 national and local surveillance officers and epidemiologists as well as field epidemiologists working as part of the flood response. 

A further two-day fieldwork was carried out with a team of 16 people, which targeted 650 people in more than 160 temporary emergency shelters and aimed at increasing their awareness of when and how to notify syndromes using the EWARS mobile application. 

While EWARS in a box helps with the early detection of communicable disease outbreaks, the system is also expected to improve activation and articulation of the care routes for the most vulnerable populations experiencing the impacts of the flood emergency. Moving forward, EWARS will continue to support La Mojana’s flood response in 2023 and will remain on standby for any other emergency in Colombia that demands disease early warning support.