Every 15 minutes, every day, every tidbit of medical and health news from thousands of the world's newspapers streams by computer into a small room at the Canadian Centre for Emergency Preparedness and Response.
There, seven analysts sift the most relevant of the fresh articles in a ceaseless hunt for hints of a newly emerging disease epidemic or the subtle signs of a spreading bioterror attack.
The worldwide computer network that brings articles from 10,000 public news sources into the nerve center of the Global Public Health Intelligence Network (GPHIN) is ever alert, seeking suggestions of an outbreak of SARS or avian influenza in Asia, a sign of Ebola in Africa or anthrax in Florida, or an indication of excessive radiation anywhere. It looks for the barest hints of an illness no one has seen before. It looks for a known disease to pop up for the first time in a continent where it is unknown—much like the West Nile virus's appearance in North America.
Most of the reports are trashed by the computer out of hand, but a few stay on the system for human analysis. Once or twice a day, the computer spots something so ominous or so important, in the view of the automated program, that it e-mails an alert to the World Health Organization and other GPHIN users, Peter Uhthoff, M.D., said in an interview. He is chief of counterterrorism coordination and health information networks for the Public Health Agency of Canada. GPHIN is one of his networks.
The automatic alerts have usually involved infectious disease but have also focused on chemical spills and radionuclear accidents. As for bioterrorism, Dr. Uhthoff added, “our purpose is to give an advance notice, as early as possible, and get the information as soon as possible to our users. The sooner they know, the better. Whether it is bioterrorism or an accidental nuclear event, it makes little difference, because the initial stages of reaction are the same.”
GPHIN was inaugurated in 1998 to screen the English-language newspaper literature. Last November, GPHIN was relaunched as GPHIN II, and it now sifts reports in Arabic, French, Russian, Spanish, and both simplified and traditional Chinese. Each language has an analyst fluent in the language and familiar with public health issues.
The GPHIN II upgrade was funded with $560,000 Canadian by the Nuclear Threat Initiative, a Washington-based group founded by Sam Nunn, the former U.S. senator, and Ted Turner. It is dedicated to reducing the worldwide threat of nuclear, biological, and chemical weapons.
The articles that are not trashed immediately or that don't merit an automatic e-mail are the ones that need to be reviewed by a language analyst for public health implications. The analyst also edits the computer's translation to English, going back to the source language if necessary; each sees about 200 articles a day, Dr. Uhthoff said.
Articles that pass muster are retained after editing on the GPHIN system and passed on to the GPHIN subscribers, such as the WHO and the U.S. Centers for Disease Control and Prevention.
Some reports might be of local interest with national implications; the arrival of West Nile virus in New York City would have been such a story. Others could have global implications, such as a worsening or spread of the avian flu outbreak in Asia.
U.S. reports with immediate patient implications are relayed to primary care physicians in the standard way, by state public health authorities. Yet with its active surveillance, GPHIN II allows authorities to rapidly connect the dots of isolated incidents in an outbreak.
Mark Smolinski, M.D., senior program officer of biological programs at the Nuclear Threat Initiative, cited the hantavirus outbreak a few years ago in the southwestern United States as a regional but isolated pattern. “Doctors are going to benefit by better, earlier detection of epidemic disease throughout the world and subsequently getting [the information] to the physician much earlier than if we didn't have such a system in place,” he said.