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ISDS 2012 Conference Abstracts

Syndromic Surveillance from a Local Perspective – 
A Review of the Literature
Don Olson*, Kevin Konty, Rob Mathes and Marc Paladini

New York City Department of Health and Mental Hygiene, Long Island City, NY, USA

Objective
Review of the origins and evolution of the field of syndromic sur-

veillance. Compare the goals and objectives of public health surveil-
lance and syndromic surveillance in particular. Assess the science and
practice of syndromic surveillance in the context of public health and
national security priorities. Evaluate syndromic surveillance in prac-
tice, using case studies from the perspective of a local public health
department.

Introduction
Public health disease surveillance is defined as the ongoing sys-

tematic collection, analysis and interpretation of health data for use
in the planning, implementation and evaluation of public health, with
the overarching goal of providing information to government and the
public to improve public health actions and guidance [1,2]. Since the
1950s, the goals and objectives of disease surveillance have remained
consistent [1]. However, the systems and processes have changed dra-
matically due to advances in information and communication tech-
nology, and the availability of electronic health data [2,3]. At the
intersection of public health, national security and health information
technology emerged the practice of syndromic surveillance [3].

Methods
To better understand the current state of the field, a review of the

literature on syndromic surveillance was conducted: topics and key-
words searched through PubMed and Google Scholar included bio-
surveillance, bioterrorism detection, computerized surveillance,
electronic disease surveillance, situational awareness and syndromic
surveillance, covering the areas of practice, research, preparedness
and policy. This literature was compared with literature on traditional
epidemiologic and public health surveillance. Definitions, objectives,
methods and evaluation findings presented in the literature were as-
sessed with a focus on their relevance from a local perspective, par-
ticularly as related to syndromic surveillance systems and methods
used by the New York City Department of Health and Mental Hy-
giene in the areas of development, implementation, evaluation, pub-
lic health practice and epidemiological research.

Results
A decade ago, the objective of syndromic surveillance was focused

on outbreak and bioterrorism early-event detection (EED). While
there have been clear recommendations for evaluation of syndromic
surveillance systems and methods, the original detection paradigm
for syndromic surveillance has not been adequately evaluated in prac-
tice, nor tested by real world events (ie, the systems have largely not
‘detected’ events of public health concern). In the absence of rigor-
ous evaluation, the rationale and objectives for syndromic surveil-

lance have broadened from outbreak and bioterrorism EED, to in-
clude all causes and hazards, and to encompass all data and analyses
needed to achieve “situational awareness”, not simply detection. To
evaluate current practices and provide meaningful guidance for local
syndromic surveillance efforts, it is important to understand the emer-
gence of the field in the broader context of public health disease sur-
veillance. And it is important to recognize how the original stated
objectives of EED have shifted in relation to actual evaluation, rec-
ommendation, standardization and implementation of syndromic sys-
tems at the local level.

Conclusions
Since 2001, the field of syndromic surveillance has rapidly ex-

panded, following the dual requirements of national security and pub-
lic health practice. The original objective of early outbreak or
bioterrorism event detection remains a core objective of syndromic
surveillance, and systems need to be rigorously evaluated through
comparison of consistent methods and metrics, and public health out-
comes. The broadened mandate for all-cause situation awareness
needs to be focused into measureable public health surveillance out-
comes and objectives that are consistent with established public
health surveillance objectives and relevant to the local practice of
public health [2].

Keywords
evaluation; biosurveillance; situational awareness; syndromic sur-
veillance; local public health

Acknowledgments

This work was carried out in conjunction with a grant from the Alfred P.
Sloan Foundation (#2010-12-14). We thank the members of the New York
City Department of Health and Mental Hygiene Syndromic Surveillance
Unit.

References

1. Langmuir AD. Evolution of the Concept of Surveillance in the United
States. Proc Roy Soc Med. 1971;64:681-4.

2. Smith PF, Hadler JL, Stanbury M, Rolfs RT, Hopkins RS; CSTE Sur-
veillance Strategy Group. “Blueprint Version 2.0”: Updating Public
Health Surveillance for the 21st Century. J Public Health Manag Pract.
2012; July 2 [Epub ahead of print].

3. Mostashari F, Hartman J. Syndromic surveillance: a local perspective.
J Urban Health 2003;80(2 Suppl 1):i1-7.

*Don Olson
E-mail: drolson@gmail.com

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e82, 2013