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
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,
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."
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
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
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.
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.