Public Health Syndromic Surveillance Systems

  • Hsinchun Chen
  • Daniel Zeng
  • Ping Yan
Part of the Integrated Series in Information Systems book series (ISIS, volume 21)


In this chapter, we summarize the key local, state, national, and international syndromic surveillance systems and related ongoing research programs of interest covered in our study. This summary provides the needed background information and application contexts. It also offers a current snapshot of syndromic surveillance practice in general. Note that as our primary focus is on public health surveillance, closely-related issues such as response planning and resource allocations strategies after an event is confirmed (e.g., Carley et al., 2003) are beyond the scope of this study.

For each system surveyed, we list its main contributors and stakeholders. We also include an overall system/project description, relevant data sources, syndromes monitored, data analysis and outbreak detection methods implemented, frequency of data collection and analysis, whether a GIS component is used, and its deployment strategy and status.


Exponential Weight Move Average Syndromic Surveillance Public Health Surveillance Gastrointestinal Illness Outbreak Detection 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Begier, E.M., Sockwell, D., Branch, L.M., Davies-Cole, J.O., Jones, L.H., Edwards, L., Casani, J.A., and Blythe, D. 2003. "The National Capitol Region's Emergency Department Syndromic Surveillance System: Do Chief Complaint and Discharge Diagnosis Yield Different Results?" Emerg Infect Dis [serial on the Internet] (9:3).Google Scholar
  2. Bradley, C.A., Rolka, H., Walker, D., and Loonsk, J. 2005. "BioSense: Implementation of a National Early Event Detection and Situational Awareness System," MMWR (CDC) (54(Suppl)), pp. 11–20.Google Scholar
  3. Bravata, D.M., McDonald, K., Owens, D.K., Buckeridge, D., Haberland, C., and Rydzak, C. 2002. "Bioterrorism Preparedness and Response: Use of Information Technologies and Decision Support Systems," Evidence Report/Technology Assessment No (59).Google Scholar
  4. Brillman, J.C., Burr, T., Forslund, D., Joyce, E., Picard, R., and Umland, E. 2005. "Modeling Emergency Department Visit Patterns for Infectious Disease Complaints: Results and Application to Disease Surveillance," BMC Medical Informatics and Decision Making (5:4).PubMedCrossRefGoogle Scholar
  5. Buckeridge, D., Burkom, H., Campbell, M., Hogan, W., and Moore, A. 2005a. "Algorithms for Rapid Outbreak Detection: A Research Synthesis," Journal of Biomedical Informatics (38), pp. 99–113.PubMedCrossRefGoogle Scholar
  6. Buckeridge, D., Graham, J., O'Connor, J., Choy, M.K., Tu, S.W., and Musen, M. 2002. "Knowledge-Based Bioterrorism Surveillance," American Medical Informatics Association Symposium, San Antonio, TX.Google Scholar
  7. Burkom, H., Elbert, E., Feldman, A., and Lin, J. 2004. "Role of Data Aggregation in Biosurveillance Detection Strategies with Applications from Essence," MMWR (CDC) (53(Suppl)), pp. 67–73.Google Scholar
  8. Carley, K., Fridsma, D., Casman, E., Altman, N., Chang, J., Kaminsky, B., Nave, D., and Yahja, A. 2003. "Biowar: Scalable Multi-Agent Social and Epidemiological Simulation of Bioterrorism Events."Google Scholar
  9. CDC. 2006a. "Early Aberration Reporting System." Retrieved Feb 15, 2006, from
  10. Chang, W., Zeng, D., and Chen, H. 2005. "Prospective Spatio-Temporal Data Analysis for Security Informatics," In proceedings of the 8th IEEE International Conference on Intelligent Transportation Systems, Vienna, Austria.Google Scholar
  11. Chen, H., and Xu, J. 2006. "Intelligence and Security Informatics," Annual Review of Information Science and Technology (ARIST) (40), pp. 229–299.CrossRefGoogle Scholar
  12. Cho, J., Kim, J., Yoo, I., Ahn, M., Wang, S., Hur, T., Park, I., and Jeong, E. 2003. "Syndromic Surveillance Based on the Emergency Department in Korea," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2), p. 124.Google Scholar
  13. Chretien, J.-P., Burkom, H.S., Sedyaningsih, E.R., Larasati, R.P., Lescano, A.G., Mundaca, C.C., Blazes, D.L., Munayco, C.V., Coberly, J.S., Ashar, R.J., and Lewis, S.H. 2008. "Syndromic Surveillance: Adapting Innovations to Developing Settings," PLoS Med (5:3), pp. 0367–0372.CrossRefGoogle Scholar
  14. Clothier, H.J., Fielding, J.E., and Kelly, H.A. 2006. "An Evaluation of the Australian Sentinel Practice Research Network (ASPREN) Surveillance for Influenza-Like Illness." Retrieved May 11, 2006, from
  15. Cooper, G.F., Dash, D.H., Levander, J.D., Wong, W.K., Hogan, W.R., and Wagner, M.M. 2004. "Bayesian Biosurveillance of Disease Outbreaks," Twentieth Conference on Uncertainty in Artificial Intelligence, Banff, Alberta, Canada, pp. 94–103.Google Scholar
  16. Crubézy, M., O'Connor, Pincus, Z., and Musen, M.A. 2005. "Ontology-Centered Syndromic Surveillance for Bioterrorism," IEEE Intelligent Systems (20:5), pp. 26–35.CrossRefGoogle Scholar
  17. Das, D., Weiss, D., and Mostashari, F. 2003. "Enhanced Drop-in Syndromic Surveillance in New York City Following September 11, 2001," J Urban Health (80:1(suppl)), pp. 176–188.Google Scholar
  18. Dembek, Z., Carley, K., Siniscalchi, A., and Hadler, J. 2004. "Hospital Admissions Syndromic Surveillance - Connecticut, September 2001–November 2003," MMWR (CDC) (53(Suppl)), pp. 50–52.Google Scholar
  19. Doroshenko, A., Cooper, D., Smith, G., Gerard, E., Chinemana, F., Verlander, N., and Nicoll, A. 2005. "Evaluation of Syndromic Surveillance Based on National Health Service Direct Derived Data - England and Wales," MMWR (54(Suppl)), pp. 117–122.PubMedGoogle Scholar
  20. Drociuk, D., Gibson, J., and Hodge, J.J. 2004. "Health Information Privacy and Syndromic Surveillance Systems," MMWR (CDC) (53(Suppl)), pp. 221–225.Google Scholar
  21. Edge, V.L., Lim, G.H., Aramini, J.J., Sockett, P., and Pollari, F.L. 2003. "Development of an Alternative Surveillance Alert Program (ASAP): Syndromic Surveillance of Gastrointestinal Illness Using Pharmacy Over-The-Counter Sales," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2), p. i138.Google Scholar
  22. Emergisoft. 2006. "Emergisoft's ED Sydromic Surveillance Solutions," Retrieved June 12, 2006, from
  23. Espino, J.U., Wagner, M.M., Szczepaniak, C., Tsui, F.-C., Su, H., Olszewski, R., Liu, Z., Chapman, W.W., Zeng, X., Ma, L., Lu, Z., and Dara, J. 2004. "Removing a Barrier to Computer-Based Outbreak and Disease Surveillance-the Rods Open Source Project," MMWR (CDC) (53(Suppl)), pp. 34–41.Google Scholar
  24. EWORS. 2006. "Early Warning Outbreak Recognition System (EWORS)." Retrieved April 12, 2006, from
  25. Ford, D., Kaufman, J.H., Thomas, J., Eiron, I., and Hammer, M. 2005. "Spatiotemporal Epidemiological Modeler - a Tool for Spatiotemporal Modeling of Infectious Agents across the United States." Retrieved Oct 10, 2006, from
  26. Goplin, J., Feist, M., and Miller, T. 2007. "Variation of Chief Complaint-Based Respiratory Symptom Data in One Hospital's Nurse Advice Call Center and Emergency Department," Advances in Disease Surveillance (2), p. 105.Google Scholar
  27. Goss, L., Carrico, R., Hall, C., and Humbaugh, K. 2003. "A Day at the Races: Communitywide Syndromic Surveillance During the 2002 Kentucky Derby Festival," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2), p. i124.Google Scholar
  28. Hamby, T. 2006. "New Jersey Experience and Protocol Development." Biosurveillance Information Exchange Working Group.Google Scholar
  29. Heffernan, R., Mostashari, F., Das, D., Besculides, M., Rodriguez, C., Greenko, J., Steiner-Sichel, L., Balter, S., Karpati, A., Thomas, P., Phillips, M., Ackelsberg, J., Lee, E., Leng, J., Hartman, J., Metzger, K., Rosselli, R., and Weiss, D. 2004. "New York City Syndromic Surveillance Systems," MMWR (CDC) (53(Suppl)), pp. 23–27.Google Scholar
  30. Hope, K., Merritt, T., Eastwood, K., Main, K., Durrheim, D., Muscatello, D., Todd, K., and Zheng, W. 2008. "The Public Health Value of Emergency Department Syndromic Surveillance Following a Natural Disaster," Commun Dis Intell (32:1), pp. 92–94.Google Scholar
  31. Hutwagner L, Thompson W, Seeman GM, and T, T. 2003. "The Bioterrorism Preparedness and Response Early Aberration Reporting System (EARS)," J Urban Health (80(2 suppl 1)), pp. 89–96.Google Scholar
  32. Johnson, J.M. 2006. "To Ignore or Not to Ignore?" - Follow-up to Statistically Significant Signals." Biosurveillance Information Exchange Working Group.Google Scholar
  33. Johnson, J.M., Hicks, L., McClean, C., and Ginsberg, M. 2005. "Leveraging Syndromic Surveillance During the San Diego Wildfires, 2003," MMWR (CDC) (54(Suppl)), p. 190.Google Scholar
  34. Karras, B.T. 2005. "Syndromic Surveillance Information Collection - King County (SSIC-KC) for Bioterrorism Detection." Retrieved July 10, 2006, from
  35. Kleinman, K., Lazarus, R., and Platt, R. 2004. "A Generalized Linear Mixed Models Approach for Detecting Incident Cluster/Signals of Disease in Small Areas, with an Application to Biological Terrorism (with Invited Commentary)," American Journal of Epidemiology (159), pp. 217–224.PubMedCrossRefGoogle Scholar
  36. Lazarus, R., Kleinman, K., Dashevsky, I., DeMaria, A., and Platt, R. 2001. "Using Automated Medical Records for Rapid Identification of Illness Syndromes (Syndromic Surveillance): The Example of Lower Respiratory Infection," BMC Public Health (1:9).PubMedCrossRefGoogle Scholar
  37. Lober, W.B., Karras, B.T., and Wagner, M.M. 2002. "Roundtable on Bioterrorism Detection: Information System-Based Surveillance," Journal of American Medical Informatics Association (9), pp. 105–115.CrossRefGoogle Scholar
  38. Lombardo, J., Burkom, H., Elbert, E., Magruder, S.F., Lewis, S.H., Loschen, W., Sari, J., Sniegoski, C., Wojcik, R., and Pavlin, J. 2003. "A Systems Overview of the Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II)," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2), pp. 32–42.Google Scholar
  39. Lombardo, J., Burkom, H., and Pavlin, J. 2004. "Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE II), Framework for Evaluating Syndromic Surveillance Systems," Syndromic surveillance: report from a national conference, 2003. MMWR 2004 (53(Suppl)), pp. 159–165.Google Scholar
  40. Lu, H.-M., Zeng, D., Trujillo, L., Komatsu, K., and Chen, H. 2008. "Ontology-Enhanced Automatic Chief Complaint Classification for Syndromic Surveillance," Journal of Biomedical Informatics (41:2), pp. 340–356.PubMedCrossRefGoogle Scholar
  41. Ma, H., Rolka, H., Mandl, K., Buckeridge, D., Fleischauer, A., and Pavlin, J. 2005. "Implementation of Laboratory Order Data in Biosense Early Event Detection and Situation Awareness System," MMWR (CDC) (54(Suppl)), pp. 27–30.Google Scholar
  42. Ma, J., Zeng, D., and Chen, H. 2006. "Spatial-Temporal Cross-Correlation Analysis: A New Measure and a Case Study in Infectious Disease Informatics," ISI 2006, San Diego, CA: Springer Lecture Notes in Computer Science, pp. 542–547.Google Scholar
  43. Meynard, J.-B., Chaudet, H., Texier, G., Ardillon, V., Ravachol, F., Deparis, X., Jefferson, H., Dussart, P., Morvan, J., and Boutin, J.-P. 2008. "Value of Syndromic Surveillance within the Armed Forces for Early Warning During a Dengue Fever Outbreak in French Guiana in 2006," BMC Medical Informatics and Decision Making (8:29).PubMedCrossRefGoogle Scholar
  44. Miller, S., Fallon, K., and Anderson, L. 2003. "New Hampshire Emergency Department Syndromic Surveillance System " Journal Journal of Urban Health (80(Suppl)), p. 118.CrossRefGoogle Scholar
  45. Muscatello, D., Churches, T., Kaldor, J., Zheng, W., Chiu, C., and Correll, P. 2005. "An Automated, Broad-Based, near Realtime Public Health Surveillance System Using Presentations to Hospital Emergency Departments in New South Wales, Australia," BMC Public Health (5), pp. 141–152.PubMedCrossRefGoogle Scholar
  46. Naumova, E.N., O'Neil, E., and MacNeill, I. 2005. "INFERNO: A System for Early Outbreak Detection and Signature Forecasting," MMWR (CDC) (54(Suppl)), pp. 77–83.Google Scholar
  47. Nekomoto, T.S., Riggins, W.S., and Franklin, M. 2003. "Pilot Results: Syndromic Surveillance Utilizing Catalis Health Point-of-Care Technology in a Rural Texas Outpatient Clinic." Retrieved June 23, 2006, from
  48. Ohkusa, Y., Shigematsu, M., Taniguchi, K., and Okabe, N. 2005a. "Experimental Surveillance Using Data on Sales of Over-The-Counter Medications - Japan, November 2003 - April 2004," MMWR (CDC) (54(Suppl)), pp. 47–52.Google Scholar
  49. Pelat, C., Boëlle, P.-Y., Cowling, B.J., Carrat, F., Flahault, A., Ansart, S., and Valleron, A.-J. 2007. "Online Detection and Quantification of Epidemics," BMC Medical Informatics and Decision Making (7:29).PubMedCrossRefGoogle Scholar
  50. Platt, R., Bocchino, C., Caldwell, B., Harmon, R., Kleinman, K., Lazarus, R., Nelson, A.F., Nordin, J.D., and Ritzwoller, D.P. 2003. "Syndromic Surveillance Using Minimum Transfer of Identifiable Data: The Example of the National Bioterrorism Syndromic Surveillance Demonstration Program," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2).Google Scholar
  51. Reis, B.Y., Kohane, I.S., and Mandl, K.D. 2007. "An Epidemiological Network Model for Disease Outbreak Detection," PLoS Medicine (4:6), pp. 1019–1031.CrossRefGoogle Scholar
  52. Ritter, T. 2002. "Leaders: Lightweight Epidemiology Advanced Detection and Emergency Response System," SPIE, pp. 110–120.Google Scholar
  53. Siegrist, D., McClellan, G., Campbell, M., Foster, V., Burkom, H., Hogan, W., Cheng, K., Pavlin, J., and Kress, A. 2004. "Evaluation of Algorithms for Outbreak Detection Using Clinical Data from Five US Cities." Technical Report, Darpa Bio-Alirt Program.Google Scholar
  54. Sokolow, L.Z., Grady, N., Rolka, H., Walker, D., McMurray, P., English-Bullard, R., and Loonsk, J. 2005. "Deciphering Data Anomalies in Biosense," MMWR (CDC) (54(Suppl)), pp. 133–140.Google Scholar
  55. Suzuki, S., Ohyama, T., Taniguchi, K., Kimura, M., Kobayashi, J., Okabe, N., Sano, T., Kuwasaki, T., and Nakatani, H. 2003. "Web-Based Japanese Syndromic Surveillance for Fifa World Cup 2002," Journal of Urban Health: Bulletin of the New York Academy of Medicine (80:2), p. i123.Google Scholar
  56. Thurmond, M. 2006. "Global Foot-and-Mouth Disease Modeling and Surveillance." Arizona Biosurveillnace Workshop.Google Scholar
  57. Tsui, F.-C., Espino, J.U., Dato, V.M., Gesteland, P.H., Hutman, J., and Wagner, M.M. 2003. "Technical Description of Rods: A Real-Time Public Health Surveillance System," Journal of American Medical Informatics Association 2003 (10), pp. 399–408.CrossRefGoogle Scholar
  58. Uhde, K.B., Farrell, C., Geddie, Y., Leon, M., and Cattani, J. 2005. "Early Detection of Outbreaks Using the Biodefend? Syndromic Surveillance System - Florida, May 2002 - July 2004 " MMWR (CDC) (54(Suppl)), p. 204.Google Scholar
  59. Umland, E., Brillman, J., Koster, F., Joyce, E., Forslund, D., Picard, R., Burr, T., Sewell, C., Castle, S., and Bersell, K. 2003. "Fielding the Bio-Surveillance Analysis, Feedback, Evaluation and Response (B-Safer) System," BTR Albuquerque, NM, pp. 185–190.Google Scholar
  60. Vergu, E., Grais, R.F., Sarter, H., Fagot, J.-P., Lambert, B., Valleron, A.-J., and Flahault, A. 2006. "Medication Sales and Syndromic Surveillance, France," Emerging Infectious Diseases [serial on the Internet] (12:3), pp. 416–421.CrossRefGoogle Scholar
  61. Yih, W., Caldwell, B., and Harmon, R. 2004. "The National Bioterrorism Syndromic Surveillance Demonstration Program," MMWR (CDC) (53(Suppl)), pp. 43–46.Google Scholar
  62. Zelicoff, A. 2002. "The Rapid Syndrome Validation Project (RSVP) ™ Users' Manual and Description."Google Scholar
  63. Zelicoff, A., Brillman, J., and Forslund, D. 2001. "The Rapid Syndrome Validation Project (R RSVP)," AMIA Symposium, pp. 771–775.Google Scholar
  64. Zeng, D., Chang, W., and Chen, H. 2004a. "A Comparative Study of Spatio-Temporal Hotspot Analysis Techniques in Security Informatics," 7th IEEE Transactions on Intelligent Transportation Systems, Washington, DC, pp. 106–111.Google Scholar
  65. Zeng, D., Chen, H., Tseng, C., Chang, W., Eidson, M., Gotham, I., and Lynch, C. 2005a. "Bioportal: A Case Study in Infectious Disease Informatics." JCDL, Denver, CA, USA, p. 418.Google Scholar
  66. Zhang, G., O'Connell, E., Leguen, F., Bustamante, M., Rodriguez, D., and Borroto-Ponce, R. 2007. "Use of Epidemiological Knowledge to Create Syndromic Surveillance Reports," Advances in Disease Surveillance (4), p. 211.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Hsinchun Chen
    • 1
  • Daniel Zeng
    • 2
    • 3
  • Ping Yan
    • 2
  1. 1.Department of Management Information SystemsEller College of Management University of ArizonaTucsonUSA
  2. 2.Department of Management Information SystemsEller College of Management University of ArizonaTucsonUSA
  3. 3.Chinese Academy of SciencesBeijingChina

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