From framework to field: Trinidad and Tobago begins implementing SARI sentinel surveillance

Port of Spain, 14 August 2026 (PAHO) - Trinidad and Tobago has taken steps to implement Severe Acute Respiratory Infection (SARI) sentinel surveillance on the ground, with joint site assessments recently conducted at Sangre Grande Hospital and Scarborough General Hospital.

The assessments build directly on work completed in 2024, when the Ministry of Health's Epidemiology Division developed national guidelines and standard operating procedures for integrated sentinel surveillance of respiratory viruses, aligned with the World Health Organization's Mosaic Respiratory Surveillance Framework. That work designated Sangre Grande Hospital and Scarborough General Hospital as the country's two sentinel sites, defined clear case definitions for Acute Respiratory Infection (ARI), Influenza-like Illness (ILI), and SARI, and set out the responsibilities of doctors, nurses, IPC staff, and laboratory personnel at each facility.

The recent site visits tested that framework against the day-to-day realities of each hospital, including patient flow, staffing capacity, specimen collection and transport, data systems, and training needs This process helped to identify the specific requirements at each site for implementing the guidelines effectively and represents an important next step in operationalizing the national framework at the two designated sentinel sites.

SARI sentinel surveillance is a cornerstone of early-warning systems for influenza, respiratory syncytial virus (RSV), SARS-CoV-2, and other respiratory pathogens. By systematically monitoring severe, hospitalized respiratory illness - and, where feasible, milder outpatient illness - health authorities gain a real-time picture of what is circulating and when it is time to act.

At Sangre Grande Hospital, the team mapped the Accident and Emergency (A&E) patient pathway, from pre-screening through triage to the frontline physician, and identified a low-burden way to flag potentially eligible patients earlier in that process - reducing the workload on physicians while improving case capture. Existing negative-pressure isolation rooms were confirmed as sufficient for managing suspect cases, while limited computer placement in the A&E pointed to a need for mobile devices so that IPC nurses can capture data at the point of care.

At Scarborough General Hospital, staff who had received training under the original 2024 groundwork requested a refresher rather than starting from zero. The assessment worked through practical questions specific to Tobago: where swabbing can safely take place given competing demands on isolation space, and how surveillance reporting can fit around the hospital's ongoing rollout of its electronic medical record system rather than compete with it. At Sangre Grande, the priority was to design a workflow that draws on existing infrastructure rather than requiring new, parallel processes.

Both assessments pointed to the same core requirement: structured staff sensitization across all involved cadres, paired with an efficient workflow that minimizes additional burden on frontline physicians, while placing IPC nurses at the centre of case follow-up, specimen coordination and data entry.

The implementation of SARI sentinel surveillance represents an important step in strengthening Trinidad and Tobago's capacity for the early detection and monitoring of respiratory disease threats. These site assessments have allowed us to translate the national framework into practical workflows that reflect the realities of each sentinel site. The information generated through this surveillance will strengthen our ability to identify changes in respiratory disease patterns and support timely, evidence-based public health action," Ministry of Health, Trinidad and Tobago.

Findings from both visits are now informing implementation plans specific to each hospital, covering staff training, updated intake documentation, confirmed swabbing space, and a data-capture approach suited to each site's existing systems. The intention is to fully establish surveillance at these two designated sites, consistent with the 2024 framework, before considering any further expansion.