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The anthrax attacks of 2001 and recent outbreaks of severe acute respiratory syndrome (SARS) highlight the importance of surveillance systems in rapidly detecting and monitoring the course of an outbreak and minimizing illness and death. However, few surveillance systems have been specifically designed for collecting and analyzing data for the early detection of a bioterrorist event. Also, current evaluations of surveillance systems for detecting bioterrorism and emerging infections are insufficient to characterize their timeliness or sensitivity and specificity. As a result, clinical and public health decisions based on these systems may be compromised, concludes Dena M. Bravata, M.D., M.S., of the University of California, San Francisco-Stanford Evidence-based Practice Center (EPC). The EPC is supported by the Agency for Healthcare Research and Quality (contract 290-97-0013).
Dr. Bravata and her colleagues systematically and comprehensively reviewed 17,510 research article citations and 8,088 government and nongovernment Web sites on disease surveillance systems. They reviewed the available evidence on 115 systems that collect various surveillance reports, including 9 syndromic surveillance systems, 20 systems collecting bioterrorism detector data, 13 systems collecting influenza-related data, and 23 systems collecting laboratory and anti-microbial resistance data.
The researchers identified published descriptions of 29 systems designed specifically for bioterrorism surveillance—that is, the systems either monitor the incidence of bioterrorism-related syndromes or monitor environmental samples for bioterrorism agents. Only two syndromic surveillance systems and no environmental monitoring systems had been evaluated in peer-reviewed studies. Dr. Bravata and her colleagues conclude that existing evaluations of surveillance systems for detecting bioterrorism are insufficient to characterize the performance of these systems.
See "Systematic review: Surveillance systems for early detection of bioterrorism-related diseases," by Dr. Bravata, Kathryn M. McDonald, M.M., Wendy M. Smith, B.A., and others, in the June 2004 Annals of Internal Medicine 140, pp. 910-922.
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