title: Biosurveillance in outbreak investigations.
abstract: Following the terrorist attacks of September 11 and the anthrax attacks in 2001, public health entities implemented automated surveillance systems based on disease syndromes for early detection of bioterror events and to increase timeliness of responses. Despite widespread adoption, syndromic surveillance systems' ability to provide early notification of outbreaks is unproven, and there is little documentation on their role in outbreak response. We hypothesized that biosurveillance is used in practice to augment classical outbreak investigations, and we used case studies conducted in 2007-08 to determine (1) which steps in outbreak investigations were best served by biosurveillance, and (2) which steps presented the greatest opportunities for improvement. The systems used in the case studies varied in how they functioned, and there were examples in which syndromic systems had identified outbreaks before other methods. Biosurveillance was used successfully for all steps of outbreak investigations. Key advantages of syndromic systems were sensitivity, timeliness, and flexibility and as a source of data for situational awareness. Limitations of biosurveillance were a lack of specificity, reliance on chief complaint data, and a lack of formal training for users. Linking syndromic data to triage notes and medical chart data would substantially increase the value of biosurveillance in the conduct of outbreak investigations and reduce the burden on health department staff.
authors: RTI International, Research Triangle Park, NC 27709-2194, USA. neely@rti.org
authors: S Cornelia
authors: SC
authors: Kaydos-Daniels
authors: Lucia
authors: L
authors: Rojas Smith
authors: Tonya R
authors: TR
authors: Farris
mesh_terms: D001331:Automation; D055877:Biosurveillance / Q000379:methods*; D023482:Bioterrorism; D002641:Chicago; D003141:Communicable Diseases / Q000175:diagnosis*; D004196:Disease Outbreaks; D042241:Early Diagnosis; D004636:Emergency Service, Hospital; D006801:Humans; D007407:Interviews as Topic; D009657:North Carolina; D058996:Quality Improvement; D013781:Texas