Beating the bug

Effective information management is critical to track the spread of infectious disease, especially when saving time means saving lives. Quick response is the key to minimizing the impact of the next pandemic.

Paul Sockett remembers the construction of Canada’s “Sphinx.” In its time, the Spatial Public Health Information Exchange (Sphinx) was an enormous, ambitious IT project aimed at public health surveillance. Its construction was as massive an undertaking as any of the ancient monuments in the Egyptian deserts.

The Sphinx was an attempt to give health care professionals a means to rapidly share public health data, as well as provide the tools to manage that information, explains Sockett, director of the Foodborne, Waterborne and Zoonotic Infections Division at Canada’s Centre for Infectious Disease Prevention and Control.

A decade later, the legacy of the Sphinx can be found coast to coast in a sophisticated network of common databases, analytical tools and surveillance software, many of which are global in scope and tightly integrated with advanced communications technologies.

Canada’s Public Health Agency (PHAC) has resuscitated the concepts behind its short-lived Sphinx project to develop the Canadian Network for Public Health Intelligence (CNPHI), which includes the Canadian Integrated Outbreak Surveillance Centre (CIOSC) and a response and resource management centre.

The Canadian government has also built a Web crawler and media monitoring application, dubbed the Global Public Health Intelligence Network (GPHIN), that’s fluent in eight languages and reports to both the Public Health Agency of Canada (PHAC), the World Health Organization, the Canadian Food Inspection Agency, the UN Food and Agriculture Organization and the Office of International Epizoonotics.

The WHO describes GPHIN as one of the most important ways of gathering informal information related to outbreaks. More than 60 per cent of the initial outbreak reports come from unofficial informal sources, it says, including sources other than the electronic media, which require verification.

“Right now, the whole basis of our pandemic response will undoubtedly rely on our capacity to exchange information rapidly and efficiently,” says Arlene King, director-general of PHAC’s Pandemic Preparedness Secretariat.

CNPHI and GPHIN are two cornerstones of Canada’s pandemic response, says King, designed to enhance the detection, collation, analysis and dissemination of information on infectious and contagious diseases.

“Our whole early-warning system is dependent on IT. Detection of events globally is dependent on our ability to get that information, put it into an electronic medium and then disseminate it.”

Global consciousness

When Margaret Chan of China took office as director-general of the WHO earlier this year, she set out six priorities. These included building the capacity of health systems and developing better information and knowledge.

She also warned that bird flu remains a global threat, after another outbreak of the disease hit Vietnam in December. In four years, avian influenza has claimed 163 lives: 62 in Indonesia, 42 in Vietnam, 17 in Thailand, 14 in China and 11 in Egypt.

The potential of a full-blown pandemic is real, although measured. Chan, who obtained her medical degree from the University of Western Ontario in London, admits there is no way to accurately predict when the next pandemic might strike.

“But the WHO has a responsibility to alert the international community when it appears the world is moving closer to a pandemic,” Chan says in an interview published on the WHO’s Web site.

“The preparations that we make for a pandemic are not disease-specific,” she adds. “They will increase our capacity to respond to all future outbreaks, including SARS (severe acute respiratory syndrome).”

SARS claimed 44 lives in Toronto and 251 worldwide, mainly in China and Hong Kong, in a matter of months during the spring of 2003.

The Naylor Commission’s investigation concluded among its findings that Canada was struggling to achieve the full potential of effective surveillance afforded by new technologies.

“The problems have been not only the cost of implementing these, but also the very slow progress in gaining consensus across jurisdictions on the architecture and standards,” reported the Commission headed by David Naylor, Dean of Medicine at the University of Toronto.

The Commission also urged greater capacity and closer interplay of provincial, territorial and federal responses to disease outbreaks, the interaction between outbreak management and broader emergency responses, as well as the design of information systems to cope with different sets of privacy legislation.

Since then, the federal government allocated $100 million in 2004 for Canada Health Infoway Inc. to invest in extending the pan-Canadian surveillance system to reach more regional and local health authorities, as well as another $15 million in 2005 to strengthen the public health systems in Southeast Asia and China.

Adding depth to pan-Canada

Canada’s provinces and territories need a better set of tools to manage and share information, says Tim Beasley, director of Infoway’s health surveillance program.

The new network is not only an outbreak management system, but is also used for the day-to-day case management of communicable diseases and immunization tracking.

CNPHI and GPHIN are good for Canada-wide alerting, says Beasley. One of the things the new system will give frontline health workers is their own alerting tools to issue local, regional or provincial alerts, and these can flow both up and down the communication pyramids, he explains.

“When we invest in a project with the Minist

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