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Clinician Syndromic Surveillance Consequent to Participation in the National Bioterrorism Syndromic Surveillance Demonstration Project (NBSSDP) --- Central Texas, 2003

Janet L. Pichette,1 E. Sherwood,1,2 A. Valadez,1 J. Jackson,2 N. Neighbors,3 J. Schultz1
Austin/Travis County Health and Human Services Department, Austin, Texas; 2Williamson County and Cities Health District, Georgetown, Texas; 3Hays County Health Department, San Marcos, Texas

Corresponding author: Janet L. Pichette, Austin/Travis County Health and Human Services Department, 15 Waller, Austin, TX 78702. Telephone: 512-972-5486; Fax: 512-972-5772; E-mail:

Disclosure of relationship: The contributors of this report have disclosed that they have no financial interest, relationship, affiliation, or other association with any organization that might represent a conflict of interest. In addition, this report does not contain any discussion of unlabeled use of commercial products or products for investigational use.


Introduction: The implementation of automated syndromic surveillance of physician office visits in three counties in central Texas resulted in the addition of active clinician-based syndromic surveillance and a structured approach to reactive surveillance. Historically, mandated notifiable disease reporting has been passive in these counties. Compliance was inconsistent and triggered by final laboratory confirmation as opposed to first clinical suspicion.

During January--March 2003, three physician groups in these counties agreed to participate in the National Bioterrorism Syndromic Surveillance Demonstration Project (NBSSDP). During project implementation, three local health departments (LHDs) and the physician groups recognized limitations of mandated disease reporting and automated syndromic surveillance. The LDHs and infection-control practitioners (ICPs) applied the concept of syndromic surveillance to clinician-initiated reporting.

Objective: This abstract describes how active clinician-based reporting and reactive syndromic surveillance enhanced automated syndromic surveillance.

Methods: Active syndromic surveillance for specified concerns to public health (CPH) was initiated to include reporting of patients with signs or symptoms consistent with exposure to biologic or chemical agents, previously healthy persons with acute onset of a severe undiagnosed illness, or any condition warranted by ICP. All ICPs agreed to report immediately and to respond to a weekly e-mail verifying that they were "alive, well, and onthe-job."

LHD staff and ICPs also formed the Surveillance Emergency Response Group, providing a structured approach to reactive surveillance. Positive signals from surveillance triggers a request for ICPs to identify all inpatients with illnesses or symptoms compatible with an implicated agent. When a severe cryptic illness is reported, this procedure is also used to validate the absence of similar cases.

Results: During a 6-month period, three severe cryptic illnesses in previously healthy patients were reported. A reactive surveillance drill, which simulated a biologic release of Yersinia pestis, was conducted to test the ICP response in identifying and reporting patients in their facility with possible plague or pneumonia- like symptoms. For the 11 hospitals reporting, the average response time in identifying and reporting patients was 36.4 minutes (range: 14--88 minutes).

Conclusion: The implementation of NBSSDP facilitated improvements needed in clinician- based syndromic surveillance. By applying NBSSDP's approach, ICPs could quickly survey their hospitals and identify patients meeting a specified syndrome. Reporting CPH places minimal burden on ICPs and might contribute to the early detection of disease outbreaks. Reactive surveillance can provide timely information in response to positive surveillance signals.

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Date last reviewed: 8/5/2005


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