title: Framework for the development of response protocols for public health syndromic surveillance systems: case studies of 8 US states.
abstract: OBJECTIVE
  To describe current syndromic surveillance system response protocols in health departments from 8 diverse states in the United States and to develop a framework for health departments to use as a guide in initial design and/or enhancement of response protocols.
  
  
  METHODS
  Case study design that incorporated in-depth interviews with health department staff, textual analysis of response plans, and a Delphi survey of syndromic surveillance response experts.
  
  
  RESULTS
  All 8 states and 30 of the 33 eligible health departments agreed to participate (91% response rate). Fewer than half (48%) of surveyed health departments had a written response protocol, and health departments reported conducting in-depth investigations on fewer than 15% of syndromic surveillance alerts. A convened panel of experts identified 32 essential elements for inclusion in public health protocols for response to syndromic surveillance system alerts.
  
  
  CONCLUSIONS
  Because of the lack of guidance, limited resources for development of response protocols, and few examples of syndromic surveillance detecting previously unknown events of public health significance, health departments have not prioritized the development and refinement of response protocols. Systems alone, however, are not effective without an organized public health response. The framework proposed here can guide health departments in creating protocols that will be standardized, tested, and relevant given their goals with such systems.
authors.affiliation: Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, USA. luscher@jhsph.edu
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.forename: Corey L
authors.initials: CL
authors.lastname: Farrell
authors.forename: Steven M
authors.initials: SM
authors.lastname: Babin
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cattani
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moskal
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
mesh_terms: D003697:Delphi Technique; D004189:Disaster Planning; D004196:Disease Outbreaks / Q000517:prevention & control; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D019982:Organizational Case Studies; D011159:Population Surveillance / Q000379:methods*; D015980:Public Health Practice / Q000592:standards*; D014481:United States / Q000453:epidemiology