Over the past five years, the very real threat posed by emerging infections and bioterrorism has challenged and revolutionized the practice of disease surveillance. Many cities and countries are constructing new disease surveillance systems. Even the basic concept of surveillance data has changed, expanding dramatically beyond notifiable disease reporting to include sales of medications, emergency department registration records, and absenteeism. New methods have been introduced into routine practice, including time series analysis, spatial scanning, natural language processing, and real-time data collection. These fundamental changes in practice may account for the appearance of a new word—Biosurveillance— that is being used to refer to both this expanded notion of disease surveillance as well as the scientific field itself. The extent of the changes in the science and practice of biosurveillance is reflected in the contents of this book, which bear little resemblance to the contents of recent texts in public health surveillance, epidemiology, or hospital infection control.

The Handbook of Biosurveillance offers a unified, multidis-ciplinary examination of the field of biosurveillance as both a practice and a scientific field of research. The Handbook reviews the state-of-the-art and covers all facets of the emerging discipline, offering practical advice for organizations developing or acquiring biosurveillance systems as well as an in-depth discussion of the theoretical underpinnings of biosurveillance for researchers. We believe that this book is the first attempt to present a comprehensive unified exposition and definition of the field of biosurveillance and its many components.

We wrote the Handbook to assist individuals who work in biosurveillance to cope with the rapid changes in the field. The book is directed at this audience, which includes epidemiologists, public health physicians, infection control practitioners, researchers, and the information technology staffs of organizations that conduct biosurveillance. The book is also directed to a broader audience that includes policy makers, teachers, microbiologists, and clinicians. The audience that we have in mind also includes fire and police chiefs—who in this modern age find themselves participating in preparedness efforts, developing "all-threat" capabilities, making purchase and acquisition decisions, and writing funding proposals that include technical approaches to biosurveillance—as well as researchers. We wanted to make this field accessible to the interested lay person who wishes to better understand how the flow of people across international borders should be handled to make us less vulnerable to the potential ravages of infectious disease outbreaks as well as acts of bioterrorism. The book assumes little prior knowledge and each chapter begins with basic material and builds to more advanced material.

The future progress of the field of biosurveillance will depend on interdisciplinary teams of researchers and practitioners. Physicians, statisticians, emergency responders, policy makers, IT experts, and computer scientists need to speak the same language and share the broad vision of the field. We intend for this book to help act as a starting point for such interdisciplinarity.

We present biosurveillance from a global perspective and draw upon examples of biosurveillance systems being developed in Australia, Asia, Europe, and North America. For a discussion of the myriad organizations involved in biosurveillance (Part II), however, we made a pragmatic decision to discuss how biosurveillance is organized in the U.S. because of our first-hand experience. We also made a pragmatic decision to limit the scope of the Handbook to biosurveillance for threats to human and animal health, omitting discussion of plant diseases and agricultural terrorism, at least in this edition.

For instructors who consider the Handbook for course use, we note that the material is inherently interdisciplinary and is best taught by two or more instructors. To cover the entire content of the book, the instructors should be familiar with the disciplines of public health, epidemiology, statistics, artificial intelligence, economics, decision theory, hospital infection control, and medical informatics. However, it is eminently possible to cover large portions of the book with a smaller instructional staff. It is possible to cover the material in an intensive one-semester course by assigning selected chapters for self-study; a less intensive course might span two semesters or omit selected chapters.

The Handbook could also be used as the basis of a focused or advanced course in public policy, artificial intelligence, biomedical engineering, or computer science. Depending on the focus, parts of the book could serve as a general background for more intensive exploration of the other materials. For example, a course for engineers or computer scientists might use Parts I, II, and IV as general background for a more intensive exploration of the materials in Parts III, V and VI.

We believe that the emerging field of biosurveillance is of vital importance to the welfare of society. From a research perspective, we believe it is an intellectually deep and exciting area, with many opportunities for contributions by creative individuals and forward-thinking organizations from many disciplines. We sincerely hope and intend that The Handbook of Biosurveillance will play a part in accelerating the progress and interdisciplinarity of the field. Please send suggestion and comments to [email protected].

Michael M. Wagner Pittsburgh, PA Andrew W. Moore Pittsburgh, PA Ron M. Aryel Kansas City, MO

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