There has been a proliferation of surveillance systems for various diseases over the past 50 years, with many more geared towards EIDs in the past decade [16]. In North America, EID systems, many of these so-called “syndromic surveillance” systems, have increased in number since WNV first appeared on the continent in 1999 and fears of bioterrorism increased after the terrorist attacks of September 11, 2001 [16]. Syndromic surveillance loosely refers to collection of “new” data types that are not diagnostic of a disease, but that might indicate early stage of an outbreak, such as prescriptions filled and school/work absenteeism [17]. There are published recommendations for evaluating various types surveillance systems available (including syndromic surveillance systems) [14, 15, 17], but minimal attention has been placed on whether or not EID surveillance requires a different set of criteria for design and evaluation