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DISEASE SURVEILLANCE, ENHANCEMENT -
USA
*************************************** A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> Date: 27 Jan 2003 From: ProMED-mail <[EMAIL PROTECTED]> Source: NY Times 27 Jan 2003 [edited] <http://www.nytimes.com/2003/01/27/national/27DISE.html?pagewanted=all&posit ion=top> Health Data Monitored for Bioterror Warning - ----------------------- To secure early warning of a bioterror attack, the government is building a computerized network that will collect and analyze health data of people in 8 major cities, administration officials say. The Centers for Disease Control and Prevention [CDC] is to lead the multimillion-dollar surveillance effort, which officials expect to become the cornerstone of a national network to spot disease outbreaks by tracking data like doctor reports, emergency room visits, and sales of flu medicine. "Our goal is to have a model that any city could pick up and apply," a senior administration official said of the plan. Officials would not disclose the program's cost or which cities will be involved. But experts say Washington, DC is likely to be one of the 8. {It shouldn't be hard to guess most of the others: New York City, Los Angeles, for starters? - Mod.JW] Such surveillance is now possible because of an explosion in commercial medical databases that health authorities, with permission and under strict legal agreements, are starting to mine. In ambition and potential usefulness, the health network goes far beyond the environmental surveillance system, disclosed by the administration last week, that will sniff the air for dangerous germs. The emerging health monitoring network, officials and experts say, will provide information that could save lives if terrorists strike with deadly germs like smallpox or anthrax. In detecting attacks, a head start of even a day or 2 can greatly lower death rates by letting doctors treat rapidly and prevent an isolated outbreak from becoming an epidemic. A senior official said President Bush was expected to refer to these new bioterrorism defenses in his State of the Union address [on 28 Jan 2003]. Experts say the prospect of war with Iraq, and the chance that Baghdad might retaliate with germ weapons, are accelerating the effort to expand and integrate scores of rudimentary disease surveillance systems being developed by cities, states, and the federal government. But public health experts argue that even if the United States never suffers another bioterror attack like the anthrax strikes of late 2001, the emerging network can still help doctors better track, treat and prevent natural disease outbreaks. "We want as much protection as we can afford," said Dr. Daniel M. Sosin, director of public health surveillance at CDC, Atlanta. Dr. Sosin is helping to expand the nation's health surveillance to incorporate the new systems. Dr. Thomas R. Frieden, the health commissioner of New York City, which has one of the nation's most highly developed rapid surveillance systems, said the emerging network could help authorities gauge the dimensions of germ attacks and reassure the public. He pointed to a case in November 2002 in which a New Mexico man visiting New York was found to have bubonic plague, a deadly contagious disease. "We were concerned this was bioterrorism," Dr. Frieden said. "But we didn't see any signals. We didn't see any alarms. That added to our confidence to rule out bioterrorism." [The patient contracted plague in an endemic area of New Mexico -- see ref. below. - Mod.JW] Experts say most of the new systems, military and civilian, are still experimental. A critical challenge is finding needles in the haystacks of data about common ailments like respiratory infections, which can rise and fall with great suddenness in winter. Dr. Marcelle Layton, New York City's assistant health commissioner for communicable diseases, said another challenge was ensuring that there are enough public health officials to respond to alarms that the new environmental and medical surveillance systems might sound. "The best system will be useless if it's only a fire alarm with no firefighters to put out the flames," Dr. Layton said. Nonetheless, expectations run high. "We think this will be important," said Dr. Alan P. Zelicoff, a physician at the Sandia National Laboratories who helped develop a widely used surveillance method, the Rapid Syndrome Validation Project, which is now used in California, New Mexico, Texas, Singapore, and Australia. "We need to get disease reporting from the 19th to the 21st century." For decades, disease surveillance has valued accuracy over speed. Nurses, doctors and public health officers gather raw data, often using paper forms sent by mail. In the background, federal, state, and private laboratories use advanced technologies to determine the causes of disease and confirm diagnoses. But the process tends to take days or even weeks. Moreover, the system is narrow, revealing little about the nation's overall health. While the federal disease control agency [CDC] has more than 100 surveillance systems, most are designed to track a single organism or condition, like heart disease or flu virus. In addition, most are independent of one another. The system has serious gaps. While laboratories usually comply with federal rules to report certain illnesses to health authorities, physicians often do not. Syndromic surveillance - -------------------- The military and the national weapons laboratories, increasingly worried about germ attacks, tried a new approach in the late 1990's. To learn of impending trouble quickly, they decided to scrutinize populations for clues of diseases before they were officially diagnosed. Experts zeroed in on how clusters of such symptoms as fever, cough, headache, vomiting, rash, and diarrhea could suggest -- but not prove -- the presence of particular diseases, some of them lethal. The method was called syndromic surveillance. An early military system was the Electronic Surveillance System for Early Notification of Community-Based Epidemics, or Essence. It drew medical data from some 400 000 members of the military and their dependents who lived in the Washington area -- a major potential terrorist target, but hard for civilians to scan medically because of "the numerous city, county, and state jurisdictions," according to a Defense Department statement. After the 2001 terrorist attacks, the Pentagon's Defense Advanced Research Projects Agency [DARPA] put $12 million into an experimental program, Essence 2, which tracked millions of civilians in the Washington [DC] area for signs of bioterrorism. Joe Lombardo, a civilian who runs Essence 2, which is based at the Johns Hopkins Applied Physics Laboratory in Maryland, said it gathers electronic records from drugstore chains, hospitals, and physician groups. Mr. Lombardo said about a dozen people were developing the technology and collecting and analyzing the data. He said. "Our objective is to support public health. The information we receive has been sanitized by the provider to ensure that it is impossible to identify individuals." Privacy concerns - ------------- The emerging network has raised concerns that such surveillance may violate individual medical privacy rights, and computer surveillance itself has drawn criticism from the American Civil Liberties Union, members of Congress and others. But supporters of the emerging surveillance network insist it raises few privacy issues, saying that the data are purged of names and identifiers. People are not tracked as individuals, they say, but their symptoms are, and often their age, sex, and ZIP code as well. The system is needed, proponents say, because few cheap, reliable sensors exist for detecting deadly germs in such likely target areas as subways and shopping malls. Sensors are also prone to false positives, or incorrect germ identifications. A Pentagon planning document on the surveillance effort for fiscal 2002 and 2003 said the Defense Department was working to develop "enhanced automated privacy protection methods" that will "assure the anonymity of records accessed by the data monitoring software." Experts say that privacy can, in theory, be violated when connections are made between disparate databases -- for instance, between those of physician payment and disease diagnosis, or health and law enforcement. They also say the potential for personal identification increases as the surveillance becomes a 2-way street in which not only are problems detected but physicians are notified about potential problems involving individual patients. Administration officials say the new 8-city disease control network will deal with the privacy issue directly. "We have to satisfy the legal constraints, and also people's concerns," a senior official said. Other civilian surveillance systems are emerging quickly. In Boston, the Harvard Medical School faculty and the Massachusetts Department of Public Health are working closely with Harvard Pilgrim Health Care, a health maintenance organization. For more than a year, the team has studied data from 175 000 people in eastern Massachusetts, and it will soon cover as many as 20 million people coast to coast. In October 2002, CDC awarded the Harvard team $1.2 million to expand its pilot network nationally. The expansion will not monitor cities, but will concentrate on patients calling an after-hours medical advisory service. Health officials say civilian emphasis in the developing surveillance field will help ensure privacy and enhance routine disease monitoring. "It's the practical stuff that's most promising," Dr. Sosin of CDC said. "Whether this is going to detect terrorism is unclear. But as a safety net and for tracking an event once it's going on, it's very promising." [Byline: William J. Broad and Judith Miller] - -- ProMED-mail <[EMAIL PROTECTED]> [ProMED-mail has covered several of the initiatives falling under the heading of "syndromic surveillance" in 2002 under the thread "Disease surveillance, enhancement," and readers are referred to prior postings listed below for additional information and links. The above newswire article raises interesting points, not the least being the very astute comment on the part of Dr. Layton from New York City about the need to have adequate trained staffing/personnel to respond to the various alerts that are produced by the increased surveillance information/data generated. One hopes that a part of the funding that is being allocated for the implementation of these additional complementary syndromic surveillance systems will include increasing the disease investigation and control capabilities of the geographic areas that will have this additional information available. - Mod.MPP] [see also: 2002 - ---- Plague, bubonic - USA (New York City ex New Mexico) 20021106.5735 Disease surveillance: enhancement (03) 20021107.5740 Disease surveillance: enhancement (02) 20020708.4696 Disease surveillance: enhancement 20020128.3424 Bioterrorism: WHO guidance 20020126.3401 1998 - ---- International health regulations, revisions 19980124.0177] ...............................mpp/pg/jw ------------------------------ End of ProMED Digest V2003 #31 ****************************** Ain't Karma A Bitch! |
