Comparison of syndromic surveillance and a sentinel provider system in detecting an influenza outbreak--Denver,...

Syndromic surveillance systems can be useful in detecting naturally occurring illness.

Syndromic surveillance performance was assessed to identify an early and severe influenza A outbreak in Denver in 2003.

During October 1, 2003-January 31, 2004, syndromic surveillance signals generated for detecting clusters of influenza-like illness (ILI) were compared with ILI activity identified through a sentinel provider system and with reports of laboratory-confirmed influenza. The syndromic surveillance and sentinel provider systems identified ILI activity based on ambulatory-care visits to Kaiser Permanente Colorado. The syndromic surveillance system counted a visit as ILI if the provider recorded any in a list of 30 respiratory diagnoses plus fever. The sentinel provider system required the provider to select "influenza" or "ILI."

Laboratory-confirmed influenza cases, syndromic surveillance ILI episodes, and sentinel provider reports of patient visits for ILI all increased substantially during the week ending November 8, 2003. A greater absolute increase in syndromic surveillance episodes was observed than in sentinel provider reports, suggesting that sentinel clinicians failed to code certain cases of influenza. During the week ending December 6, when reports of laboratory-confirmed cases peaked, the number of sentinel provider reports exceeded the number of syndromic surveillance episodes, possibly because clinicians diagnosed influenza without documenting fever.

Syndromic surveillance performed as well as the sentinel provider system, particularly when clinicians were advised to be alert to influenza, suggesting that syndromic surveillance can be useful for detecting clusters of respiratory illness in various settings.