John Brownstein and colleagues discuss HealthMap, an automated real-time system that monitors and disseminates online information about emerging infectious diseases.

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Surveillance Sans Frontières: Internet-based emerging infectious disease intelligence and the HealthMap project.

The increasing number of emerging infectious disease events that have spread internationally, such as severe acute respiratory syndrome (SARS) and the 2009 pandemic A/H1N1, highlight the need for improvements in global outbreak surveillance. It is expected that the proliferation of Internet-based reports has resulted in greater communication and improved surveillance and reporting frameworks, especially with the revision of the World Health Organization's (WHO) International Health Regulations (IHR 2005), which went into force in 2007. However, there has been no global quantitative assessment of whether and how outbreak detection and communication processes have actually changed over time. In this study, we analyzed the entire WHO public record of Disease Outbreak News reports from 1996 to 2009 to characterize spatial-temporal trends in the timeliness of outbreak discovery and public communication about the outbreak relative to the estimated outbreak start date. Cox proportional hazards regression analyses show that overall, the timeliness of outbreak discovery improved by 7.3% [hazard ratio (HR) = 1.073, 95% CI (1.038; 1.110)] per year, and public communication improved by 6.2% [HR = 1.062, 95% CI (1.028; 1.096)] per year. However, the degree of improvement varied by geographic region; the only WHO region with statistically significant (α = 0.05) improvement in outbreak discovery was the Western Pacific region [HR = 1.102 per year, 95% CI (1.008; 1.205)], whereas the Eastern Mediterranean [HR = 1.201 per year, 95% CI (1.066; 1.353)] and Western Pacific regions [HR = 1.119 per year, 95% CI (1.025; 1.221)] showed improvement in public communication. These findings provide quantitative historical assessment of timeliness in infectious disease detection and public reporting of outbreaks.

https://www.pnas.org/content/pnas/107/50/21701.full.pdf

Global capacity for emerging infectious disease detection

Free or low-cost sources of unstructured information, such as Internet news and online discussion sites, provide detailed local and near real-time data on disease outbreaks, even in countries that lack traditional public health surveillance. To improve public health surveillance and, ultimately, interventions, we examined 3 primary systems that process event-based outbreak information: Global Public Health Intelligence Network, HealthMap, and EpiSPIDER. Despite similarities among them, these systems are highly complementary because they monitor different data types, rely on varying levels of automation and human analysis, and distribute distinct information. Future development should focus on linking these systems more closely to public health practitioners in the field and establishing collaborative networks for alert verification and dissemination. Such development would further establish event-based monitoring as an invaluable public health resource that provides critical context and an alternative to traditional indicator-based outbreak reporting.

Use of unstructured event-based reports for global infectious disease surveillance.

The recent SARS epidemic has renewed widespread concerns about the global transmission of infectious diseases. In this commentary, we explore novel approaches to global infectious disease surveillance through a focus on an important Canadian contribution to the area--the Global Public Health Intelligence Network (GPHIN). GPHIN is a cutting-edge initiative that draws on the capacity of the Internet and newly available 24/7 global news coverage of health events to create a unique form of early warning outbreak detection. This commentary outlines the operation and development of GPHIN and compares it to ProMED-mail, another Internet-based approach to global health surveillance. We argue that GPHIN has created an important shift in the relationship of public health and news information. By exiting the pyramid of official reporting, GPHIN has created a new monitoring technique that has disrupted national boundaries of outbreak notification, while creating new possibilities for global outbreak response. By incorporating news within the emerging apparatus of global infectious disease surveillance, GPHIN has effectively responded to the global media's challenge to official country reporting of outbreak and enhanced the effectiveness and credibility of international public health.

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The Global Public Health Intelligence Network and Early Warning Outbreak Detection: A Canadian Contribution to Global Public Health

Today, everything is affected by the digital revolution – the impact of new technology on improving the health and well-being of individuals, communities, and populations is unprecedented. Recent technological achievements have revolutionized clinical practice, from prevention through diagnosis, monitoring to disease management, and enabled unprecedented public interest and engagement in self-management and well-being. Digital health is defined as the “use of information and communications technologies to improve human health, healthcare services, and wellness for individuals and across populations.”

Dozens of digital health projects have been conducted in Europe alone (1) and with the growth of mobile technology for improving health and well-being (mHealth). There is an unprecedented opportunity to transform the healthcare sector and empower citizens in taking charge of their own health (2).

However, the successful development, integration and implementation of new technology and methods require a radical shift from traditional and single-disciplinary academic and clinical approaches. In order to truly embrace these opportunities and transform healthcare and improve well-being, we need a new approach to science and health research. Only when investigated together, aimed at solving real-world problems, will health and technology be in a position to create results with significant impact on the delivery of clinical and social care and improve the well-being of individuals and populations.

First, recent technological advances enabled by the creation of real-time big data streams, social media, and infectious disease modeling are the focus of public health computer science, aiming to strengthen disease surveillance, early-warning, preparedness, and response through integration of traditional surveillance systems with new big data sources. Second, advances in reliability and accuracy of medical devices and personalized technology, together with booming wearable and tracking technology (MedTech), have rapidly become established as the mainstream enhancing opportunities for personalized care, improving self-management, and bringing the desirable outcome: behavior change. Third, with over 4.55 billion people worldwide using a mobile phone in 2014, mHealth apps and interventions empower users in the developed world and are accelerating unprecedented access to best evidence and healthcare service in the low and middle income settings. Fourth, more than a decade ago, Sir Muir Gray forecasted that “knowledge is the best enemy of disease – the application of what we know already will have a bigger impact on health and disease than any drug or technology likely to be introduced in the next decade” (3). Better use of technology for capturing, understanding, and disseminating knowledge is paramount for fulfilling this vision. The recent research achievements in web science, data mining and analytics, medical ontologies, and recommender systems provide further opportunities for better evidence dissemination, medical advice, and development of personalized persuasive intelligent systems. Fifth, serious games for health- and game-based learning have crossed the rubicon from entertainment technology to education and health interventions, and are getting firmly established as health educational and intervention tools. Finally, in light of the speed of data sharing technologies and the absence of a legal framework, we must engage in policy debates safeguarding individual privacy, regulation usage of data for commercial purposes, while enabling transparent data sharing for research.

However, these challenges are only achievable through truly multi-disciplinary research collaborations.

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Ron St. John

Papers

The Global Public Health Intelligence Network