Abstract Background Mass gatherings like the UEFA European Football Championship in Germany pose a challenge for public health, elevating the risk of infectious disease outbreaks. The Robert Koch Institute (RKI) is performing intensified surveillance during this event, including data from emergency departments (ED). So far, no standardised process for signal detection, their assessment and communication exists for ED surveillance. Methods We reviewed the literature to identify an appropriate signal detection method for ED surveillance. We tested different aggregation levels of the ED data, to ensure sufficient quality with sparse categories. After consulting with international experts, we defined a standardized process for signal assessment. We developed an interactive dashboard to investigate anomalies by further analysing the ED data. Results We used the Farrington Flexible algorithm, but expanded its functionality to perform daily instead of weekly monitoring. Aggregating to federal state level or in five age categories provided enough daily data for the algorithm. During the assessment, identified signals will be automatically scored based on pre-defined criteria (e.g. excess number of cases, reoccurrence in previous days). Signals with a high score will be forwarded to an epidemiological assessment, where they are manually evaluated based on standardised questions (e.g. expected seasonality, disease severity). Surveillance experts at RKI discuss them further and decide the course of communication and possible further measures. We developed an interactive dashboard in which signal detection and assessment is visualized. Conclusions Syndromic surveillance using ED data is used as an information source for early warning during a mass sporting event in Germany. Signal detection enables the identification of potential outbreaks, while the standardized assessment process ensures an efficient way to prioritize and steer communication efforts across public health services. Key messages • Syndromic surveillance using signal detection has previously proven valuable to detect potential outbreaks of infectious diseases during mass gatherings. • A standardised signal assessment process including an automatic and manual component ensures a sustainable and efficient way to prioritize possible incidents and steer public health communication.
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