Internet As Sentinel I Promedmail

ProMED is the Program for Monitoring Emerging Diseases. As described on its website, ProMED-mail is "an Internet-based reporting system dedicated to rapid global dissemination of information on outbreaks of infectious diseases and acute exposures to toxins that affect human health, including those in animals and in plants grown for food or animal feed.'' ProMED-mail is developed and maintained by the International Society for Infectious Diseases and the Harvard School of Public Health, and is available at http://www.promedmail.org.

ProMED-mail is an e-mail list. Briefly, an e-mail list is a computer program that can accept subscribers (to the list), accept e-mails from subscribers, allow an operator of the software to decide whether to post an e-mail to the list, and for the operator to assign a posting to a topical category (called a thread). The primary function of an e-mail list is to disseminate new postings by e-mail to subscribers in a selective manner, based on their indicated interest in specific threads and their preferences for receiving new information immediately or periodically. We discuss e-mail lists in detail in Section 3.

ProMED-mail is a moderated e-mail list, which means that list moderators screen the reports submitted to ProMED-mail before posting them to a thread (and adding them to the archives on the ProMED website). The postings in ProMEDmail originate from a number of sources including ProMEDmail subscribers and the moderators of the threads, who may add information from media, government, or other sources. ProMED-mail has been in existence for 12 years and has 30,000 subscribers in 150 countries. Its subscribers include public health physicians, epidemiologists, animal health experts, reporters, and many other professionals and lay people. A subscription to ProMED is free.

ProMED-mail demonstrated its value during the 2003 outbreak of SARS. On February 10, 2003, ProMED-mail disseminated a posting entitled "Pneumonia-China (Guandong): RFI'' asking for information on an outbreak of pneumonia in the Guandong province of China (ProMED-mail, 2003e). Figure 26.2 reproduces this and the second posting in what was subsequently renamed the "SARS thread'' on ProMED-mail.

On the following day (February 11), ProMED-mail disseminated a WHO Routine Communicable Disease Surveillance Report about an outbreak of acute respiratory syndrome with 300 cases and five deaths in Guangdong Province (World Health Organization, 2003), along with a related Associated Press article (ProMED-mail, 2003c). ProMED-mail disseminated additional information from a British Medical Journal article on February 21 (ProMED-mail, 2003d).

There were 15 additional postings between February 10 and March 14. On March 14, ProMED-mail disseminated five reports of outbreaks of deadly or severe respiratory illness in four countries in East Asia (Singapore, Taiwan, Vietnam, and China), many in hospitals, and all with no known etiology (ProMED-mail, 2003b). That same day, ProMED-mail disseminated a Government of Ontario Press Release about four cases of atypical pneumonia in Canada (Toronto and British Columbia), and the editor noted an unconfirmed report that the British Columbia case had a travel history to Hong Kong (ProMED-mail, 2003a). On March 15, 2003, ProMED-mail followed up with a formal WHO report of a new entity named SARS (ProMED-mail, 2003f).

This brief chronology illustrates the role of ProMED-mail in keeping the multinational infectious disease community abreast of information. No single country or group of researchers could have easily accessed the wide variety of information submitted to and distributed by ProMED-mail about SARS in February and March 2003. Readers interested in the rest of the SARS story may refer to Chapter 2 or they can search ProMED-mail with the keyword "SARS'' and read the story as it unfolded.

ProMED-mail is an example of a biosurveillance system in which computers are used for data collection, archiving, and selective dissemination of new information, but not for analysis. People (list moderators) analyze the data, deciding whether to post the information to the list, and if so, with what title and framing comments to add a submission to a thread.

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