This paper describes the design and application of a new statistical method for real-time syndromic surveillance, used by Public Health England. The Rising Activity, Multi-level Mixed effects, Indicator Emphasis (RAMMIE) statistical method was developed and tested alongside existing methods before being applied to a suite of syndromic surveillance in operation in England. The RAMMIE method has proved to be a reliable, effective method for generating automated alarms for syndromic surveillance. The multi-level models have enabled local models to be created for the first time across all systems and models have proved themselves to be robust across all the signals.
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