Syndromic Surveillance

Unlike bombings, bioterrorism can be invisible, unapparent until people become ill, spreading silently as infected people interact with others. The sooner public health officials know about a bioterrorist attack, the more effective their response can be. In this article, the authors discuss the feasibility of using syndromic surveillance as an early warning system of bioterrorism. Syndromic surveillance involves the statistical analyses of data on individuals seeking care in emergency rooms or other health care settings for early symptoms of bioterrorist agents. The authors discuss results of a simple simulation they conducted using data from the emergency department at the George Washington University Hospital in Washington, D.C., to simulate a bioterrorist attack and examined how four different detection algorithms performed. They then discuss how performance can be improved and the challenges of integrating syndromic surveillance into public health systems. The authors conclude that the benefits of syndromic surveillance have not yet been established, and they caution city and state health departments about investing in costly syndromic surveillance systems until more research is done to improve their sensitivity. They add, however, that the potential of syndromic surveillance might be greater for monitoring naturally occurring diseases (such as the start of the flu season, sexually transmitted diseases, etc.) than for bioterrorism, and that this potential may make it worth the effort.