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Use of Syndromic Surveillance at Local Health Departments: Movement Toward More Effective Systems

Samoff, Erika PhD, MPH; Fangman, Mary T. MSPH; Hakenewerth, Anne PhD; Ising, Amy MSIS; Waller, Anna E. ScD

Journal of Public Health Management and Practice: July/August 2014 - Volume 20 - Issue 4 - p E25–E30
doi: 10.1097/PHH.0b013e3182a505ac
Original Articles

Context: Syndromic surveillance systems enhance public health practice in both large and small population settings. However, data from these systems are typically monitored by state and federal agencies and less frequently used by small public health agencies, such as local health departments (LHDs). Syndromic surveillance system modifications may facilitate use by LHDs.

Objective: To describe syndromic surveillance system modifications and survey LHD staff to assess subsequent changes in system use.

Design: Pre- and postintervention cross-sectional analysis.

Setting: North Carolina (NC) LHDs, 2009 and 2012.

Participants: LHD nursing and preparedness staff.

Main Outcome Measures: Use of syndromic surveillance data by LHDs for outbreak response, seasonal event response, program management, and stakeholder reports.

Results: In NC, syndromic surveillance system modifications made between 2009 and 2012 included implementation of LHD-specific data “dashboards” and increased distribution of LHD-specific surveillance information by the state public health agency. Users of LHD syndromic surveillance system increased from 99 in 2009 to 175 in 2012. Twenty-seven of 28 (96%) and 62 of 72 (86%) respondents completed the 2009 and 2012 surveys, respectively. Among respondents, 23% used syndromic surveillance data for outbreak response in 2009, compared with 25% in 2012. In 2009, 46% of respondents used these data for seasonal event response, compared with 57% in 2012. Syndromic surveillance data were used for program management by 25% of respondents in 2009 (compared with 30% in 2012) and for stakeholder reports by 23% of respondents in 2009 (compared with 33% in 2012).

Conclusions: Syndromic surveillance system changes supported modest increases in LHD use of syndromic surveillance information. Because use of syndromic surveillance information at smaller LHD is rare, these modest increases indicate effective modification of the NC syndromic surveillance system.

Supplemental Digital Content is Available in the Text.Syndromic surveillance systems enhance public health practice in both large and small population settings. This article discusses the use of syndromic surveillance at local health departments in the United States.

North Carolina Preparedness and Emergency Response Research Center (Drs Waller and Samoff, Ms Fangman), NC Institute for Public Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (Dr Samoff and Ms Fangman); and Carolina Center for Health Informatics, Department of Emergency Medicine, University of North Carolina Medical School (Drs Waller and Hakenewerth).

Correspondence: Erika Samoff, PhD, MPH, Durham County, Department of Public Health, 414 E. Main St, Durham, NC 27701 (

The authors thank Lana Deyneka and Heather Vaughn-Batten for their contributions to this project and acknowledge the thoughtful input of North Carolina local health department staff members. This research was carried out by the North Carolina Preparedness and Emergency Response Research Center, which is part of the UNC Center for Public Health Preparedness at the University of North Carolina at Chapel Hill's Gillings School of Global Public Health, and was supported by the Centers for Disease Control and Prevention (CDC) grant 1PO1 TP 000296. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. Additional information can be found at

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors have no conflicts of interest to declare.

© 2014 Lippincott Williams & Wilkins, Inc.