J Am Med Inform Assoc 11:141-150 doi:10.1197/jamia.M1356
  • The Practice of Informatics
  • Review Paper

Implementing Syndromic Surveillance: A Practical Guide Informed by the Early Experience

  1. Kenneth D Mandl,
  2. J Marc Overhage,
  3. Michael M Wagner,
  4. William B Lober,
  5. Paola Sebastiani,
  6. Farzad Mostashari,
  7. Julie A Pavlin,
  8. Per H Gesteland,
  9. Tracee Treadwell,
  10. Eileen Koski,
  11. Lori Hutwagner,
  12. David L Buckeridge,
  13. Raymond D Aller,
  14. Shaun Grannis
  1. Affiliations of the authors: Children's Hospital Informatics Program, Division of Emergency Medicine, Center for Biopreparedness at Children's Hospital Boston, Children's Hospital Boston, Harvard Medical School, Boston, MA (KDM); Indiana University School of Medicine, Regenstrief Institute, Indianapolis, IN (JMO, SG); The Real-time Outbreak and Disease Laboratory, Center for Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA (MMW); Department of Medical Education and Biomedical Informatics, School of Medicine, University of Washington, Seattle, WA (WBL); Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA (PS); Division of Epidemiology, New York City Department of Public Health, New York, NY (FM); Walter Reed Army Institute of Research, Silver Spring, MD (JAP); University of Utah and Intermountain Health Care, Salt Lake City, UT (PHG); Bioterrorism Preparedness and Response Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA (TT, LH); Quest Diagnostics Incorporated, Teterboro, NJ (EK); Palo Alto Veterans Health Care System, Palo Alto, CA, and Stanford Medical Informatics, Stanford University, Stanford, CA (DLB); Acute Communicable Diseases Unit, Los Angeles County Public Health, Los Angeles, CA (RDA)
  1. Correspondence and reprints: Kenneth D. Mandl, MD, MPH, Division of Emergency Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115; e-mail: kenneth_mandl{at}
  • Received 5 March 2003
  • Accepted 28 September 2003


Syndromic surveillance refers to methods relying on detection of individual and population health indicators that are discernible before confirmed diagnoses are made. In particular, prior to the laboratory confirmation of an infectious disease, ill persons may exhibit behavioral patterns, symptoms, signs, or laboratory findings that can be tracked through a variety of data sources. Syndromic surveillance systems are being developed locally, regionally, and nationally. The efforts have been largely directed at facilitating the early detection of a covert bioterrorist attack, but the technology may also be useful for general public health, clinical medicine, quality improvement, patient safety, and research. This report, authored by developers and methodologists involved in the design and deployment of the first wave of syndromic surveillance systems, is intended to serve as a guide for informaticians, public health managers, and practitioners who are currently planning deployment of such systems in their regions.


  • Work on the manuscript was supported in part by funding from the National Library of Medicine (grants R01LM07677-01, 2 T15 LM07117-06, GO8 LM06625-01, and T15 LM/DE07059; contract N01-LM-9-3536; and training grants 2 T15 LM07117-06, 01-T15/LM-7124), the Agency for Healthcare Research and Quality (contracts 290-00-0020 and 290-00-0009), the Defense Advanced Projects Research Agency (contract F30602-01-2-0550), the Centers for Disease Control and Prevention (cooperative agreement number U90/CCU318753-01), the Alfred P. Sloan Foundation (Grant 2002-12-1), and the Canadian Institutes of Health Research. The authors gratefully acknowledge the contributions of Drs. Daniel Pollock, John Loonsk, and Michael D. Jones from the Centers for Disease Control and Prevention and Michael K. Martin from the Connecticut Hospital Association. The authors would like to thank Dasha Cohen of the American Medical Informatics Association for facilitating the meeting of the authors.

    The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the United States government or the agencies listed above.

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