title: The use of syndromic surveillance for decision-making during the H1N1 pandemic: a qualitative study.
abstract: BACKGROUND
  Although an increasing number of studies are documenting uses of syndromic surveillance by front line public health, few detail the value added from linking syndromic data to public health decision-making. This study seeks to understand how syndromic data informed specific public health actions during the 2009 H1N1 pandemic.
  
  
  METHODS
  Semi-structured telephone interviews were conducted with participants from Ontario's public health departments, the provincial ministry of health and federal public health agency to gather information about syndromic surveillance systems used and the role of syndromic data in informing specific public health actions taken during the pandemic. Responses were compared with how the same decisions were made by non-syndromic surveillance users.
  
  
  RESULTS
  Findings from 56 interviews (82% response) show that syndromic data were most used for monitoring virus activity, measuring impact on the health care system and informing the opening of influenza assessment centres in several jurisdictions, and supporting communications and messaging, rather than its intended purpose of early outbreak detection. Syndromic data had limited impact on decisions that involved the operation of immunization clinics, school closures, sending information letters home with school children or providing recommendations to health care providers. Both syndromic surveillance users and non-users reported that guidance from the provincial ministry of health, communications with stakeholders and vaccine availability were driving factors in these public health decisions.
  
  
  CONCLUSIONS
  Syndromic surveillance had limited use in decision-making during the 2009 H1N1 pandemic in Ontario. This study provides insights into the reasons why this occurred. Despite this, syndromic data were valued for providing situational awareness and confidence to support public communications and recommendations. Developing an understanding of how syndromic data are utilized during public health events provides valuable evidence to support future investments in public health surveillance.
authors.affiliation: Public Health Ontario, Toronto, ON, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Chu
authors.forename: Rachel
authors.initials: R
authors.lastname: Savage
authors.forename: Don
authors.initials: D
authors.lastname: Willison
authors.forename: Natasha S
authors.initials: NS
authors.lastname: Crowcroft
authors.forename: Laura C
authors.initials: LC
authors.lastname: Rosella
authors.forename: Doug
authors.initials: D
authors.lastname: Sider
authors.forename: Jason
authors.initials: J
authors.lastname: Garay
authors.forename: Ian
authors.initials: I
authors.lastname: Gemmill
authors.forename: Anne-Luise
authors.initials: AL
authors.lastname: Winter
authors.forename: Richard F
authors.initials: RF
authors.lastname: Davies
authors.forename: Ian
authors.initials: I
authors.lastname: Johnson
mesh_terms: D000288:Administrative Personnel / Q000523:psychology; D003199:Computer Systems; D003625:Data Collection; D003657:Decision Making; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology*; D007407:Interviews as Topic; D009864:Ontario / Q000453:epidemiology; D058873:Pandemics; D011634:Public Health / Q000592:standards*; D036301:Qualitative Research; D018570:Risk Assessment; D018571:Sentinel Surveillance