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Research Questions

  1. What is the state of the science of syndromic surveillance systems?
  2. What are the stages of epidemics, and which strategies address which stage(s)?
  3. Where can the Army focus its efforts and investments to improve outbreak detection and prevention?

The U.S. Army has a long history of preventing, detecting, and treating infectious diseases. Like other organizations and agencies involved in public health, the Army is increasingly interested in syndromic surveillance strategies — those designed to identify outbreaks before clinical data are available. Researchers use various methods to identify surveillance strategies across the globe, investigate these strategies' benefits and limitations, and recommend actions to aid the Army in their efforts to detect emerging epidemics and pandemics.

Key Findings

  • Many systems and strategies can identify and track epidemics before clinical confirmation; however, these efforts are often siloed. Increased cooperation among universities, private industry, and the military could improve syndromic surveillance.
  • Although there are numerous systems and tools to help combatant command personnel track possible disease outbreaks, there appears to be uneven awareness among some medical personnel regarding what systems, tools, and information they should use for this purpose.
  • In contrast to the many strategies for surveillance at the outbreak phase, there are relatively few at the emergence and spread stages in which the Army could be uniquely poised to contribute.
  • The inability to sustain, maintain, and update surveillance resources can create barriers to scientific advancement.


  • The Army should track academic and private enterprise efforts to detect diseases during the outbreak phase of epidemic surveillance.
  • The Army should establish more routine training to aid general medical officers in identifying and obtaining credible data and analyzing and interpreting the data.
  • The Army should consider investing in surveillance that detects the possible emergence of an epidemic for use during the emergence phase of epidemic surveillance.
  • The Army should consider investing in surveillance efforts that detect the confirmed or potential geographic spread of an outbreak for use during the spread phase of epidemic surveillance.
  • The Army should leverage opportunities to engage in regional and international dialogues, where appropriate, to enhance coordination and information-sharing.
  • The Army should sustain, maintain, and update current disease surveillance efforts and encourage the same investment throughout the U.S. Department of Defense.

Research conducted by

The research described in this report was sponsored by the U.S. Army Office of the Surgeon General and conducted by the Personnel, Training, and Health Program within the RAND Arroyo Center.

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