title: A survey of usage protocols of syndromic surveillance systems by state public health departments in the United States.
abstract: OBJECTIVE
  To broadly describe current syndromic surveillance systems in use throughout the United States and to provide basic descriptive information on responses to syndromic system signals.
  
  
  METHODS
  Cross-sectional survey (telephone and e-mail) of state epidemiologists in all 50 states and the District of Columbia.
  
  
  RESULTS
  Forty-one states participated in the survey for a response rate of 80 percent. Thirty-three states (80%) had at least one syndromic surveillance system in addition to BioSense operating within the state. Every state with an urban area at highest risk of a terrorist attack reported monitoring syndromic surveillance data, and a state's overall preparedness level was not related to the presence (or lack) of operational syndromic surveillance systems. The most common syndromic surveillance systems included BioSense (n = 20, 61%) and RODS (n = 13, 39%). Seventy-six percent of states with syndromic surveillance initiated investigations at the state level, 64 percent at the county level, and 45 percent at both the state and county levels.
  
  
  CONCLUSIONS
  The majority of states reported using syndromic surveillance systems, with greatest penetration in those at highest risk for a terrorist attack. Most states used multiple systems and had varied methods (central and local) of responding to alerts, indicating the need for detailed response protocols.
authors.affiliation: Department of Environmental Health Sciences, The Johns Hopkins School of Public Health, Wynnewood, PA 19096, USA.
authors.forename: Lori
authors.initials: L
authors.lastname: Uscher-Pines
authors.forename: Corey L
authors.initials: CL
authors.lastname: Farrell
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Cattani
authors.forename: Yu-Hsiang
authors.initials: YH
authors.lastname: Hsieh
authors.forename: Michael D
authors.initials: MD
authors.lastname: Moskal
authors.forename: Steven M
authors.initials: SM
authors.lastname: Babin
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
authors.forename: Richard E
authors.initials: RE
authors.lastname: Rothman
mesh_terms: D003430:Cross-Sectional Studies; D003625:Data Collection; D006801:Humans; D011159:Population Surveillance / Q000379:methods*; D011634:Public Health; D013219:State Government; D013577:Syndrome; D023481:Terrorism; D014481:United States