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

Affiliations of the authors: Children's Hospital Informatics Program, Division of Emergency Medicine, Center for Biopreparedness at Children's Hospital Boston, Children's Hospital Boston, Harvard Medical School, Boston, MA (KDM); Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN (JMO, SG); The Real-time Outbreak and Disease Laboratory, Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA (MMW); Department of Medical Education and Biomedical Informatics, School of Medicine, University of Washington, Seattle, WA (WBL); Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA (PS); Division of Epidemiology, New York City Department of Public Health, New York, NY (FM); Walter Reed Army Institute of Research, Silver Spring, MD (JAP); University of Utah and Intermountain Health Care, Salt Lake City, UT (PHG); Bioterrorism Preparedness and Response Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (TT, LH); Quest Diagnostics Incorporated, Teterboro, NJ (EK); Palo Alto Veterans Health Care System, Palo Alto, CA, and Stanford Medical Informatics, Stanford University, Stanford, CA (DLB); Acute Communicable Diseases Unit, Los Angeles County Public Health, Los Angeles, CA (RDA)

Correspondence and reprints: Kenneth D. Mandl, MD, MPH, Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; e-mail: <kenneth_mandl{at}harvard.edu>.

Received for publication: 03/05/03; accepted for publication: 09/28/03.

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.

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