Surveillance systems for early detection and mapping of the spread of morbidity caused by bioterrorism

The early clinical presentations of many infectious diseases, including those initiated by bioterrorism, tend to have non-specific features such as flu-like symptoms, skin rashes, encephalitis and acute flaccid paralysis. Standard public health infectious disease surveillance systems depend on reports of specifically diagnosed diseases and thus may be relatively insensitive to the early identification of outbreaks. During the past few years, efforts have been made to improve the sensitivity of traditional systems, partly through implementation of new technologies such as electronic reporting and use of geographical information systems. In the United States, intensive efforts are being made to develop new surveillance systems for the early detection and mapping of the spread of diseases caused by bioterrorism. The development of such systems is based on the concept that surveillance for non-specific syndromes will enable earlier detection of infectious disease outbreaks compared with traditional systems. In addition, surveillance for non-specific syndromes could enable monitoring of the spread the outbreak, even before a definitive diagnosis has been made. In this paper, we describe several examples of prototype syndrome surveillance systems developed in the United States. These include the telephone hot-line system maintained by the New York City public health department, two internet based systems, LEADERS and RSVP, and an electronic reporting system, ESSENCE, operating in military facilities in the Washington DC area.