Multifaceted syndromic surveillance in a public health department using the early aberration reporting system

Local health departments concerned with early detection of potential terrorist threats are beginning to explore novel approaches to syndromic surveillance. Using the Early Aberration Reporting System (EARS) developed by the Centers for Disease Control and Prevention, a metropolitan health department in Tennessee and five community partners have agreed to exchange data in order to implement a multifaceted syndromic surveillance system for early detection of a biological attack. This article describes how we used EARS as the foundation for implementing a surveillance system that encompasses a rich variety of data sources. We address technical requirements for operating EARS, recommend staffing and training prerequisites, describe the involvement of our data partners, and provide details related to data transfer and analysis, review, and response protocol. Other health departments may find this information useful as a general model for implementing EARS-based syndromic surveillance systems in their own jurisdictions.