Eurosurveillance, Volume 16, Issue 9, 03 March 2011 Perspectives Evaluation of syndromic surveillance in the Netherlands: its added value and recommendations for implementation C C van den Wijngaard1, W van Pelt1, N J Nagelkerke2, M Kretzschmar1, M P Koopmans1,3 1.       Rijksinstituut voor Volksgezondheid en Milieu (National Institute for Public Health and the Environment, RIVM), Bilthoven, the Netherlands 2.       United Arab Emirates University, Al-Ain, United Arab Emirates 3.       Erasmus Medical Center, Rotterdam, the Netherlands Citation style for this article: van den Wijngaard CC, van Pelt W, Nagelkerke NJ, Kretzschmar M, Koopmans MP. Evaluation of syndromic surveillance in the Netherlands: its added value and recommendations for implementation. Euro Surveill. 2011;16(9):pii=19806. Available online: Date of submission: 05 July 2010 In the last decade, syndromic surveillance has increasingly been used worldwide for detecting increases or outbreaks of infectious diseases that might be missed by surveillance based on laboratory diagnoses and notifications by clinicians alone. There is, however, an ongoing debate about the feasibility of syndromic surveillance and its potential added value. Here we present our perspective on syndromic surveillance, based on the results of a retrospective analysis of syndromic data from six Dutch healthcare registries, covering 1999–2009 or part of this period. These registries had been designed for other purposes, but were evaluated for their potential use in signalling infectious disease dynamics and outbreaks. Our results show that syndromic surveillance clearly has added value in revealing the blind spots of traditional surveillance, in particular by detecting unusual, local outbreaks independently of diagnoses of specific pathogens, and by monitoring disease burden and virulence shifts of common pathogens. Therefore we recommend the use of syndromic surveillance for these applications.