Article Text

Download PDFPDF
Review of syndromic surveillance: implications for waterborne disease detection
  1. Magdalena Berger1,
  2. Rita Shiau2,
  3. June M Weintraub1
  1. 1San Francisco Department of Public Health, Environmental Health Section, USA
  2. 2San Francisco Department of Public Health, Communicable Disease Control and Prevention Section
  1. Correspondence to:
 MsM Berger
 San Francisco Department of Public Health, Environmental Health Section, 1390 Market Street, Suite 910, San Francisco, CA 94102, USA; mberger{at}


Syndromic surveillance is the gathering of data for public health purposes before laboratory or clinically confirmed information is available. Interest in syndromic surveillance has increased because of concerns about bioterrorism. In addition to bioterrorism detection, syndromic surveillance may be suited to detecting waterborne disease outbreaks. Theoretical benefits of syndromic surveillance include potential timeliness, increased response capacity, ability to establish baseline disease burdens, and ability to delineate the geographical reach of an outbreak. This review summarises the evidence gathered from retrospective, prospective, and simulation studies to assess the efficacy of syndromic surveillance for waterborne disease detection. There is little evidence that syndromic surveillance mitigates the effects of disease outbreaks through earlier detection and response. Syndromic surveillance should not be implemented at the expense of traditional disease surveillance, and should not be relied upon as a principal outbreak detection tool. The utility of syndromic surveillance is dependent on alarm thresholds that can be evaluated in practice. Syndromic data sources such as over the counter drug sales for detection of waterborne outbreaks should be further evaluated.

  • syndromic surveillance
  • waterborne disease
  • surveillance

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Funding: none.

  • Competing interests: none.