Classical disease monitoring in local public health jurisdictions has been based on a list of “notifiable diseases”, more or less consistent from state-to-state. While laboratories’ compliance with this requirement is, in general, excellent, clinician reporting is extremely poor [1]. In most circumstances, laboratory reporting is inherently delayed (perhaps by weeks), and most leaders in infectious disease and bioterrorism believe that recognition of abnormal spatiotemporal patterns within hours is essential [2]. Syndromic surveillance systems based on analysis of statistical aberrations in diagnosis code, chief complaint, or analysis of other data streams have been proposed and tested, but have largely failed to meet criteria of timeliness, sensitivity and specificity [3]. In addition, the vast majority of syndromic surveillance systems do not include veterinary surveillance, which may be important given that the vast majority of diseases of human public health importance are zoonotic in origin. Thus, we have tested the hypothesis put forward by Henderson that “the astute clinician” can serve as the best early-warning indicator [4], with minimal demands on clinician time while simultaneously providing situational awareness to the broad community of health care providers and political decision makers who require such information.
Objective
It is widely agreed that "situational awareness" in disease surveillance is essential for intervening early in an infectious disease (or intoxination) outbreak. We report on 3.5 years of experience of a clinician-based system in a 25,000 square mile area of northwest Texas, a mixed urban, semi-rural and agricultural setting.