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Effective public health surveillance is essential for detecting and responding to emerging public health threats, including terrorism and emerging infectious diseases. New surveillance methods are being developed and tested to improve the timeliness and completeness of detection of disease outbreaks. One promising set of approaches is syndromic surveillance, in which information about health events that precede a firm clinical diagnosis is captured early and rapidly from existing, usually electronic, data sources, and analyzed frequently to detect signals that might indicate an outbreak requiring investigation.

To provide a forum for scientists and practitioners to report on progress in developing and evaluating syndromic surveillance systems, the New York City Department of Health and Mental Hygiene, the New York Academy of Medicine, and CDC convened the second annual National Syndromic Surveillance Conference in New York City during October 23--24, 2003. The conference, supported by the Alfred P. Sloan Foundation, was attended by more than 460 public health practitioners and researchers, who had the opportunity to hear 41 oral presentations and view 50 poster presentations.

The original papers and posters for this conference were chosen by a scientific program committee after a review of submitted abstracts. Senior researchers in the field were also invited to address key concerns in surveillance for early detection of outbreaks. All participants who presented papers or posters at either the conference or at a preconference workshop were invited to submit manuscripts based on their presentations for publication in this Morbidity and Mortality Weekly Report Supplement. Each manuscript was then reviewed by at least two peer reviewers and final publication decisions were made by an editorial committee. Many of the articles are considerably different from the material originally presented at the conference. Certain authors updated their findings, and others were asked to revise their papers into descriptions of syndromic surveillance systems. Other presenters chose to submit only abstracts. Papers are presented here in the following order: system descriptions, research methods, evaluation, and public health practice.

In addition to these reports, other resources on syndromic surveillance are available. The proceedings of the 2002 National Syndromic Surveillance Conference were published in the Journal of Urban Health (accessible at http://jurban.oup In May 2004, a revised Framework for Evaluating Public Health Surveillance Systems for Early Detection of Outbreaks was published (MMWR 2004;53[No. RR-5]). An annotated bibliography of published papers and other Internet-accessible materials has been developed and is maintained monthly on a CDC website ( An Internet-based forum ( was established for discussion of topics related to syndromic surveillance and was used to distribute answers to audience questions raised at the conference. A related forum ( gov) has been maintained for discussion of topics related to surveillance system evaluation. Finally, the website of the Annual Syndromic Surveillance Conferences (http://www. includes links to recent news and scientific articles about syndromic surveillance, oral and poster presentations and workshop materials from past conferences, and notices of upcoming conferences. The third National Syndromic Surveillance Conference is planned for November 3--4, 2004, in Boston, Massachusetts.

The editorial committee acknowledges the work of the scientific planning committee: Dennis Cochrane, Christine Hahn, Patrick Kelley, Martin Kulldorff, John Loonsk, David Madigan, Richard Platt, and Don Weiss. The committee is also grateful for the support and efforts of the following staff members in conducting this conference and developing this Supplement: Alan Fleischman, Irv Gertner, and Jessica Hartman, New York Academy of Medicine; Rick Heffernan, New York Department of Health and Mental Hygiene; and Alan Davis, Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC; Valerie Kokor, Division of International Health, Epidemiology Program Office; and Stephanie Malloy, Jeffrey Sokolow, and Malbea LaPete, MMWR, Epidemiology Program Office, CDC. Special thanks are given to JoEllen DeThomasis, Division of Applied Public Health Training and Division of Public Health Surveillance and Informatics, Epidemiology Program Office, CDC, who coordinated the preparation of these reports.

--- The Editorial Committee

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