The National Syndromic Surveillance Program's (NSSP) instance of ESSENCE* in the BioSense Platform generates about 35,000 statistical alerts each week. Local ESSENCE instances can generate as many as 5,000 statistical alerts each week. While some states have well-coordinated processes for delegating data and statistical alerts to local public health jurisdictions for review, many do not have adequate resources. By design, statistical alerts should indicate potential clusters that warrant a syndromic surveillance practitioner's time and focus. However, practitioners frequently ignore statistical alerts altogether because of the overwhelming volume of data and alerts. In 2008, staff in the Virginia Department of Health experimented with rules that could be used to rank the statistical output generated in ESSENCE alert lists. Results were shared with Johns Hopkins University Applied Physics Lab (JHU/APL), the developer of ESSENCE, and were early inputs into what is now known as "myAlerts," an ESSENCE function that syndromic surveillance practitioners can use to customize alerting and sort through statistical noise. NSSP ESSENCE produces a shared alert list by syndrome, county, and age-group strata, which generates an unwieldy but rich data set that can be studied to learn more about the importance of these statistical alerts. Ultimately, guidance can be developed to help syndromic surveillance practitioners set up meaningful ESSENCE myAlerts effective in identifying clusters with public health importance.

Objective: Find practical ways to sort through statistical noise in syndromic data and make use of alerts most likely to have public health importance.