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From Implementation to Automation --- A Step-by-Step Approach to Developing Syndromic Surveillance Systems from a Public Health Perspective

Brian M. Lawson,1 E. Fitzhugh,1 S. Hall,1 L. Hutwagner,2 G. Seeman2
Knox County Health Department, Knoxville, Tennessee; 2National Center for Infectious Diseases, CDC

Corresponding author: Brian M. Lawson, Knox County Health Department, 140 Dameron Ave., Knoxville, TN 37917. Telephone: 865-215-5095; Fax: 865-584-4604; E-mail:


Introduction: Implementing new surveillance for biologic terrorism is becoming an essential function of local public health departments. Although syndromic surveillance systems can be implemented by multiple methods (including commercially available products), one model might be particularly well-suited to public health. CDC's Early Aberration Reporting System (EARS) is a syndromic surveillance system that uses aberration-detection models to identify deviations in current data when compared with a historic mean. The Knox County Tennessee Health Department (KCHD) is using a 7-day seamless surveillance system based on the EARS program that incorporates multiple data sources, automated data transfer via file transfer protocol (FTP), scheduled batch analysis, and remote access to surveillance data.

Objectives: KCHD developed a 10-step process for designing a syndromic surveillance system, from implementation to automation.

Methods: The steps are as follows:

  1. Contact CDC staff to discuss acquisition of EARS programs.
  2. Assess infrastructure to implement EARS.
  3. Engage stakeholders.
  4. Identify staff and assign specific tasks.
  5. Select syndromes or symptoms to monitor.
  6. Establish daily data exchange.
  7. Develop automation routines for data transfer via FTP and for importing data into SAS.
  8. Schedule EARS analysis programs as a batch job.
  9. Establish a review and response protocol.
  10. Develop plans for long-term collaboration and system expansion, including evaluation.

Results: By following these 10 steps, KCHD has made substantial progress toward implementing a multifaceted, seamless, 7-day syndromic surveillance system.

Conclusions: Public health departments can use these 10 steps as a framework for developing local syndromic surveillance systems.

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