Implementing Syndromic Surveillance: A Practical Guide Informed by the Early Experience

Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.Bioterrorism preparedness has been the subject of concentrated national effort¹ that has intensified since the events of fall 2001.² In response to these events, the biomedical, public health, defense, and intelligence communities are developing new approaches to real-time disease surveillance in an effort to augment existing public health surveillance systems. New information infrastructure and methods to support timely detection and monitoring,^3,4,5,6,7 including the discipline of syndromic surveillance, are evolving rapidly. The term syndromic surveillance refers to methods relying on detection of clinical case features that are discernable before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. If the attack involved anthrax, for example, a syndromic surveillance system might detect a surge in influenza-like illness, thus, providing an early warning and a tool for monitoring an ongoing crisis.Unlike traditional systems that generally utilize voluntary reports from providers to acquire data, contemporary syndromic surveillance relies on an approach in which data are continuously acquired through protocols or automated routines. The real-time nature of these syndromic systems makes them valuable for bioterrorism-related outbreak detection, monitoring, and investigation. These systems augment the capabilities of the alert frontline clinician who, athough an invaluable resource for outbreak detection, is generally better at recognizing individual cases rather than patterns of cases over time and across a region. Syndromic surveillance technology may be useful not only for bioterrorism event detection, but also for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who may be planning deployment of such systems in their regions.