In the last decade, the scope of public health (PH) surveillance has grown, and biosurveillance capacity has expanded in Duval County. In 2004, the Duval County Health Department (DCHD) implemented a standalone syndromic surveillance (SS) system, which required the manual classification and entry of emergency department (ED) chief complaints by hospital staff. At that time, this system, in conjunction with other external systems (e.g., CDC ILInet, FluStar and NRDM) were used to conduct surveillance for health events. Recommendations from a 2007 ISDS panel were used to strengthen surveillance within Duval County. Later that year, the Florida DOH moved to a statewide SS system and implemented ESSENCE, which has been expanded to include (1) ED record data from 176 hospitals (8 within Duval County); (2) reportable disease case records from Merlin; (3) Florida Poison Information Network consultations; and, (4) Florida Office of Vital Statistics death records (1) . ESSENCE has subsequently become a platform for rapid data analysis, mapping and visualization across several data sources (1) . As a result, ESSENCE has improved business processes within DCHD well beyond the initial scope of event detection. These improvements have included (1) expansion of the ability to create visualizations (e.g., epi-curves, charts and maps); (2) reduction in the time required to produce reports (e.g., newsletters and media responses); (3) reduction in staff training needs; and (4) augmentation of epidemiology processes (e.g., active case finding, emergency response and quality improvement [QI] ) and closing the PH surveillance loop.