This system raised awareness of infectious diseases and provided good information for risk assessment. Before the earthquake, the pharmacy surveillance and the school surveillance (only in Miyagi prefecture), which are nationwide syndromic surveillance in Japan, were operating, and these played a complementary role for evacuation site surveillance and the official surveillance. Our experience showed that it would be too late to start to develop the system from the scratch after a disaster occurred. Thus, it is essential to make a plan on activation of the system in advance in case a severe disaster occurs and to prepare and stockpile the hardware that is necessary for an early activation of evacuation site surveillance. The necessary hardware, for example, includes battery and communication tool even if electronic power, internet and (mobile) phone network are shut down. This is the next challenge. 