USIS Washington File - March 20, 2008

Atlanta -- In an era of pandemics like HIV/AIDS and emerging diseases like highly pathogenic avian influenza and multidrug-resistant tuberculosis, disease surveillance is critical to early detection and response.

Until the early 1990s, such surveillance -- systematic data collection and analysis -- consisted largely of manual recordkeeping and official reporting of disease outbreaks to the World Health Organization (WHO) by member-state ministries of health.

Today, a growing number of informal Internet-based organizations contribute to emerging infectious disease surveillance by receiving information from subscribers or collecting it online from electronic media, discussion groups and other Web sites 24 hours a day, and sending alerts out by e-mail.

According to a statement on the WHO Web site, more than 60 percent of its initial outbreak reports now come from unofficial, informal sources.

Even Google.org, the philanthropic arm of the company behind the world's most popular search engine, has launched a Predict and Prevent Initiative, led by epidemiologist Dr. Larry Brilliant, to "use information and technology," a Google press release said, "to empower communities to predict and prevent emerging threats before they become local, regional or global crises." DIGITAL DETECTION The Program for Monitoring Emerging Diseases (ProMED)-mail, part of the International Society for Infectious Diseases, began as an experimental system in 1993 and is the oldest of the global electronic reporting systems for emerging infectious diseases and toxins.

Subscription is free and open to all sources; ProMED is approaching 45,000 subscribers worldwide and reports in seven languages. All reports are screened by a panel of expert moderators before the reports are posted.

Writing in Global Infectious Disease Surveillance and Detection: Assessing the Challenges, Finding Solutions, a 2007 workshop summary, Dr. Stephen Morse of Columbia University said ProMED was among the first to report the 1995 Ebola outbreak in Kikwit, Democratic Republic of the Congo; the 1999 West Nile virus outbreak in New York State; and the 2003 severe acute respiratory syndrome outbreak in China.

"What lessons have we learned?" asked ProMED's Dr. Marjorie Pollack during a presentation at the 2008 International Conference on Emerging Infectious Diseases (ICEID), held March 16-19 in Atlanta. "We live in a global village. No single institution has the complete capacity to address all needs and cover all bases with respect to disease surveillance." ProMED, Morse said, has encouraged the development of more digital detection networks, including Canada's Global Public Health Information Network and WHO's Global Outbreak Alert and Response Network (See "Updated Rules Offer New Framework for Health Security.") Other networks include the European Commission's Medical Intelligence System (MedISys), a real-time news alert system on medical topics that reviews more than 20,000 articles daily from 800 Web sources and categorizes articles in 25 languages; and HealthMap, a free automated network that gathers information on infectious outbreaks from news wires, RSS feeds, ProMED mailing lists and WHO alerts. The network then organizes and displays the information in real time as graphic maps.

HealthMap, a product of the Harvard-MIT Division of Health Sciences and Technology, was created by Clark Freifeld, a research software developer at the Children's Hospital Informatics Program, and John Brownstein, an assistant professor of pediatrics at Harvard Medical School.

Project Argus is a U.S. government global biological event-detection and tracking system that provides early warning alerts, according to Dr. James Wilson in Advances in Disease Surveillance 2007. Multilingual analysts cover global sources in 34 languages. Argus manages up to 3,300 biological event case files and, during the 2007 flu season, issued nearly 3,000 event reports across 128 countries and in 27 languages.

EARLY WARNING The Google.org Predict and Prevent Initiative will focus on emerging infectious diseases, which are on the rise because of climate change, urbanization, growing international travel and trade and closer contact between people and animals.

Most of the world's emerging diseases are zoonoses -- animal diseases that spread to people (See "Emerging Infectious Diseases Focus of International Meeting.") The effort supports two related pathways from prediction to prevention, Brilliant said during a presentation at ICEID 2008. The first is vulnerability mapping -- establishing which populations have minimal or no access to health care and may live with and depend on animals for their livelihood -- and identifying "hot spots" where diseases are most likely to arise.

The second path involves creating systems for better detection of threats by using innovative methods to find threats quickly wherever they occur, confirming outbreaks and identifying their cause, and alerting key involved parties, from villagers to global health authorities.

"Technology and access to multiple sources of information has brought us closer to this possibility," Brilliant added, "and that is what Google.org wants to help support. We want to join the researchers and public health heroes here in this room and throughout the world to push the boundaries of what is knowable about where, what, how and when the next pandemic, the next emerging communicable disease, will arise." More information about ProMED and HealthMap is available on the organizations' Web sites.