Responding to the Patient Surge Following a Terrorist Attack

Patient confidentiality concerns may also limit the development of syndromic surveillance systems. Any automated reporting system will require confidentiality safeguards, such as the use of aggregated information (12). However, even with aggregated data, sorting by characteristics such as race, age, and zip code could still lead to identification of individuals. Therefore, surveillance systems will need standards restricting the display of aggregated data when numbers of events or population sizes are small (14). On the other hand, public health authorities may still need to be able to re-identify individuals to follow-up on cases (11). 

Given continued questions of timeliness, accuracy, confidentiality, and given the administrative hurdles facing development of complete, integrated syndromic surveillance systems, it is unlikely that automated syndromic surveillance systems will replace traditional clinician and laboratory initiated reporting systems within the next few years. Studies of the performance of syndromic surveillance systems are difficult due to the low frequency of large outbreaks of most diseases (11). Even if syndromic surveillance systems eventually demonstrate some utility, it is likely that they will complement, rather than replace, traditional clinician, and laboratory reporting. 

For example, once the system identifies a spatial or temporal cluster of syndromic symptoms, public health officials will still need to work with clinicians and other healthcare providers to differentiate natural illness from terrorist-caused illness. The necessary detailed investigation will involve personal contact, either by phone or in person, with individual cases regarding their medical condition, any unusual illness manifestations or specific exposures (11). In addition, identification of cases will still require the appropriate laboratory and radiological studies on individuals with syndromic symptoms. 

Responding to the Patient Surge Following a Terrorist Attack 

Following the 2001 anthrax attacks, public health authorities advised over 10,000 persons to take postexposure prophylactic medications for up to 60 days (1,15). An additional 20,000 patients started prophylactic treatment until the epidemiologic 

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