A decade ago, the primary objective of syndromic surveillance was bioterrorism and outbreak early event detection (EED. Syndromic systems for EED focused on rapid, automated data collection, processing and statistical anomaly detection of indicators of potential bioterrorism or outbreak events. The paradigm presented a clear and testable surveillance objective: the early detection of outbreaks or events of public health concern. Limited success in practice and limited rigorous evaluation, however, led to the conclusion that syndromic surveillance could not reliably or accurately achieve EED objectives. At the federal level, the primary rationale for syndromic surveillance shifted away from bioterrorism EED, and towards allhazards biosurveillance and SA. The shift from EED to SA occurred without a clear evaluation of EED objectives, and without a clear definition of the scope or meaning of SA in practice. Since public health SA has not been clearly defined in terms of operational surveillance objectives, statistical or epidemiological methods, or measurable outcomes and metrics, the use of syndromic surveillance to achieve SA cannot be evaluated.
Objective
Review concept of situation awareness (SA) as it relates to public health surveillance, epidemiology and preparedness. Outline hierarchical levels and organizational criteria for SA. Initiate consensus building process aimed at developing a working definition and measurable outcomes and metrics for SA as they relate to syndromic surveillance practice and evaluation.