In the summer of 2001, New Jersey (NJ) was in the process of developing surveillance activities for bioterrorism. On September 11, 2001, the United States suffered a major terrorist attack. Approximately a month later, anthrax-laced letters were processed through a NJ Postal Distribution Center (PDC). As a result of these events, the state instituted simplistic surveillance activities in emergency departments (EDs). Over time, this initial system has developed into a broader, more streamlined approach to surveillance that now includes syndromic data, e.g., Influenza-like illness (ILI), as well as the use of technology (automated surveys, real-time data connections and alert analysis), to achieve surveillance goals and provide daily information to public health partners in local health departments and DHSS response colleagues.