Abstract
This study introduced high-fidelity simulations based on real-world outbreaks for evaluating the performance of syndromic surveillance system. Findings showed that ISSC system was capable to detect the 3 disease outbreaks tested at an early stage, but the practical performance was to a great extent affected by the type and magnitude of outbreak event, the selection of syndromic groups for monitoring, the detection algorithm introduced in the system, and the preferred false alarm rate in real-time surveillance.