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Estimating the burden of heat illness in England during the 2013 summer heatwave using syndromic surveillance
  1. Sue Smith1,
  2. Alex J Elliot1,
  3. Shakoor Hajat2,
  4. Angie Bone3,
  5. Gillian E Smith1,
  6. Sari Kovats2
  1. 1Real-time Syndromic Surveillance Team, Public Health England, Birmingham, UK
  2. 2NIHR Health Protection Research Unit in Environmental Change and Health, Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Extreme Events and Health Protection, Public Health England, London, UK
  1. Correspondence to Dr Alex J Elliot, Real-time Syndromic Surveillance Team, Public Health England, 6th Floor, 5 St Philip's Place, Birmingham B3 2PW, UK; alex.elliot{at}


Background The burden of heat illness on health systems is not well described in the UK. Although the UK generally experiences mild summers, the frequency and intensity of hot weather is likely to increase due to climate change, particularly in Southern England. We investigated the impact of the moderate heatwave in 2013 on primary care and emergency department (ED) visits using syndromic surveillance data in England.

Methods General practitioner in hours (GPIH), GP out of hours (GPOOH) and ED syndromic surveillance systems were used to monitor the health impact of heat/sun stroke symptoms (heat illness). Data were stratified by age group and compared between heatwave and non-heatwave years. Incidence rate ratios were calculated for GPIH heat illness consultations.

Results GP consultations and ED attendances for heat illness increased during the heatwave period; GPIH consultations increased across all age groups, but the highest rates were in school children and those aged ≥75 years, with the latter persisting beyond the end of the heatwave. Extrapolating to the English population, we estimated that the number of GPIH consultations for heat illness during the whole summer (May to September) 2013 was 1166 (95% CI 1064 to 1268). This was double the rate observed during non-heatwave years.

Conclusions These findings support the monitoring of heat illness (symptoms of heat/sun stroke) as part of the Heatwave Plan for England, but also suggest that specifically monitoring heat illness in children, especially those of school age, would provide additional early warning of, and situation awareness during heatwaves.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

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