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Public health surveillance data is critical as it provides actionable information to guide public health response. Thirty interviews were conducted across North Carolina from May to September, 2009 with local public health department staff to describe the use of routine syndromic surveillance data during a local outbreak and compared this to usage during a large, statewide outbreak, during which the state disseminated syndromic data. The study examined the use of the syndromic surveillance system (NC DETECT) and the reportable communicable disease system (NC EDSS) during the 2009 novel influenza A (H1N1) pandemic and during another respondent-selected infectious disease outbreak. A larger percent of local health department (LHD) staff reported using information from NC DETECT (52%) during the 2009 H1N1 pandemic than during another infectious disease outbreak (20%) (P value = 0.01). North Carolina local public health staff used information from syndromic surveillance data more when the state health department disseminated summary syndromic surveillance reports than when this summary information was not provided. State aggregation and dissemination of timely and disease-relevant syndromic surveillance data may facilitate greater usage of such information at the local health department level.       Key words: Public health surveillance, public health practice, outbreaks, influenza A virus (H1N1) subtype.

Routine dissemination of summary syndromic surveillance data leads to greater usage at local health departments in North Carolina