Canadian and United States Cross-Border Collaboration for Syndromic Surveillance: Overview and Recommendations from an International Society for Disease Surveillance

The objectives of this consultation, supported by the International Society for Disease Surveillance (ISDS), were to develop expert, consensus-based recommendations to promote Canadian and U.S. collaboration in using syndromic surveillance (SS) to detect, assess, monitor, or respond to potential or actual public health threats. The consultation focused on the Great Lakes region of the Canadian-U.S. borderóa region where there is substantial flow of people and goods between the two nations, a potential for occurrence of public health emergencies that affect people in both countries. Despite prior advances achieved by participants in the Early Warning Infectious Disease Surveillance (EWIDS) program regarding cross-border collaboration in notifiable disease reporting and follow-up, the EWIDS deliberations had not substantially addressed the role and uses of syndromic surveillance as part of cross-border disease prevention and control efforts, particularly in the context of potential large-scale public health emergencies. Presentations addressed a mix of issues that define the context for cross- border collaboration, including updates on SS practice and development in jurisdictions in the region, shared methodological challenges, protocols for responding to SS alerts, health information privacy regulations, and policies concerning public health emergencies that may shape information sharing during a crisis. Potential legal barriers to information sharing centered on individual-level privacy concerns, as opposed to sharing of aggregate SS data or notices of statistical alerts based on SS data. The meeting provided an impetus and agenda for future, ongoing consideration of including syndromic surveillance as a key component within the broader context of the EWIDS process. Identified priorities included development of procedures to share information about SS alerts and alert response protocols within EWIDS, increased use of SS inputs in crossborder tabletop exercises for pandemic influenza, and further collaboration in development of mapping projects that use data inputs from both sides of the border. In addition, the participants recommended that annual ISDS conferences provide a forum to address challenges in cross-border collaboration in SS practice and research.