Challenges and Future Directions

We conclude this book by discussing key challenges facing syndromic surveillance research and summarizing future directions. Although syndromic surveillance has gained wide acceptance as a response to disease outbreaks and bioterrorism attacks, many research challenges remain. First, there are circumstances in which syndromic surveillance may not be effective or necessary. The potential benefit of syndromic surveillance as to the timeliness of detection could not be realized if there were hundreds or thousands of people infected simultaneously. In extreme cases, modern biological weapons could easily lead to mass infection via airborne or waterborne agents. In another scenario, syndromic surveillance could be rendered ineffective if the cases involved only a few people (e.g., the anthrax outbreak in 2001) and thus would not trigger any alarms and could go undetected (2005b). In this situation, one single positive diagnosis of a spore of anthrax could be sufficient to confirm the event.