ObjectiveTo improve the performance of the England and Wales large scale multiple statistical surveillance system for infectious disease outbreaks with a view to reducing the number of false reports, while retaining good power to detect genuine outbreaks. IntroductionThere has been much interest in the use of statistical surveillance systems over the last decade, prompted by concerns over bio-terrorism, the emergence of new pathogens such as SARS and swine flu, and the persistent public health problems of infectious disease outbreaks. In the United Kingdom (UK), statistical surveillance methods have been in routine use at the Health Protection Agency (HPA) since the early 1990s and at Health Protection Scotland (HPS) since the early 2000s (1,2). These are based on a simple yet robust quasi-Poisson regression method (1). We revisit the algorithm with a view to improving its performance.

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