The web survey identified 20/38 (53%) organizations which use at least one syndromic surveillance system; key informant interviews identified another 2 organizations, for a total of 22/38 (58%) syndromic surveillance 'users'. Mirroring routine surveillance, traditional surveillance systems, specifically laboratory and reportable disease data (iPHIS) and school absenteeism data were the most frequently used sources during the pandemic (Fig. 1) . Laboratory data were considered the most useful data source for monitoring the epidemiology (71% of organizations perceived it as 'essential') and informing decision making (76%), while emergency department screening data were considered the most useful syndromic surveillance source (52% and 70%). Syndromic data were found to support two specific public health actions taken during the pandemic: influenza assessment centers and communications, including recommendations to the public. Informants felt that syndromic data provided confidence to decide whether and when to open/close influenza assessment centers and when/what to communicate to the public. Nonsyndromic users utilized stakeholder consultations and traditional surveillance data to support these decisions. Syndromic surveillance did not appear to have a role in supporting decisions around immunization clinics, school closures or recommendations to health care professionals; rather vaccine availability and ministerial guidance acted as drivers for these decisions.