The threat of epidemics due to nonhuman strains of influenza A viruses is ever present (1). Surveillance is a critical aspect of pandemic preparedness for early case detection (2) . Identification of the index cases of a pandemic virus can trigger public health mitigation efforts (3) . To develop an appropriate surveillance process, it is important to understand the two possibilities of pandemic evolution. A new pandemic may begin with mild cases, during which surveillance should be concentrated on work/school absenteeism and in physician offices. The other possibility begins with severe cases, characterized by sCAP, respiratory failure and ICU admission. As the syndrome of pneumonia is not reportable to health agencies for public health surveillance, a year-round, hospital-based surveillance mechanism may be an important tool for early case detection in the event of an epidemic of sCAP. To fill these gaps, we developed a statewide, hospital-based surveillance network for sCAP surveillance in Kentucky.