ABSTRACT
Increasing concern about the threat of bioterrorism has stimulated efforts to improve infectious disease surveillance and develop greater capacity for early detection and control of outbreaks. Traditional surveillance systems are limited due to their lack of sensitivity and slow reporting mechanisms. In order to redress those limitations, substantial resources have been invested in the development of sophisticated electronic reporting systems, based on non-specific syndromic signs and symptoms. While syndromic surveillance systems have been tested on naturally occurring diseases, whilst their efficacy and usefulness for the early detection of bioterrorism outbreaks remain questionable. Based on the fundamentals of the natural history of the diseases and on simulated outbreaks, syndromic-type surveillance is unlikely to detect outbreaks caused by bioterrorism category A agents, prior to clinical and laboratory diagnoses of the early cases. Early detection of such outbreaks will depend on alert physicians, particularly in the emergency rooms, and training should be a priority in the allocation of resources. Nevertheless, syndromic surveillance systems can play an essential role in providing data for decision making in the outbreak. This should be the prime motivation for developing and deploying such systems.
