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In March and early April, while much of the world was focusing on the threat of avian influenza originating in Asia, intelligence-gathering systems were also extracting evidence of an epidemic of acute respiratory infections in Mexico. Early informal reports from the Mexican press indicated that a "mysterious" influenza-like illness was occurring in the town of La Gloria in the state of Veracruz, where it was reported that up to 60% of the 3000 inhabitants had been infected and 2 had died since early March. The HealthMap system, for instance, collected and disseminated a local media report describing this event on April 1, 2009 (see map).1 This report was followed by another on April 2 describing the possible role of Granjas Carroll, a U.S.-owned pig farm, in the epidemic.2 On April 10, the Global Public Health Intelligence Network (GPHIN) reported acute respiratory illness in Veracruz to the World Health Organization (WHO). This alert was followed by immediate communication among the WHO's Global Outbreak Alert and Response Network, the Pan American Health Organization, and the Mexican Ministry of Health.3
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Epidemic-intelligence systems receive many reports of mysterious respiratory illness daily, and the decision to consider this event one of international significance requires interpretation of context — for example, of the level of background noise inherent in various data-mining systems. A fully moderated approach (in which each communication is reviewed by someone with expertise in the subject matter), such as that of the International Society for Infectious Diseases' Program for Monitoring Emerging Diseases (ProMED), though potentially less timely, provides critical, evidence-based risk assessment. An in-depth evaluation is required to determine whether any earlier intervention efforts might have controlled the outbreak at the source. Clearly, this event also highlights the swift response capability of the global public health community.
The emergence of H1N1 has been subsequently tracked through both automated and manual data entry and visualization with the use of full-spectrum Web-based communication strategies. Though traditional official and media communication channels remain in place, Web-based mapping, search-term surveillance, "microblogging," and online social networks have emerged as alternative forms of rapid dissemination of information. Understandably, some observers worry about their ability to inspire public concern beyond the necessary levels. Clearly, these tools must be used with restraint and appropriate evaluation.
Dr. Brownstein, Mr. Freifeld, and Dr. Madoff report receiving grant support from Google.org. No other potential conflict of interest relevant to this article was reported.
Source Information
Dr. Brownstein is a faculty member at the Children's Hospital Informatics Program, Children's Hospital Boston, and an assistant professor of pediatrics at Harvard Medical School, Boston. Mr. Freifeld is a research software developer at the Children's Hospital Informatics Program in Boston and a master's candidate in the New Media Medicine Group of the MIT Media Laboratory in Cambridge, MA. Dr. Brownstein and Mr. Freifeld are the cocreators of the HealthMap system. Dr. Madoff is a professor of medicine at the University of Massachusetts Medical School, Worcester, an infectious disease physician with the Massachusetts Department of Public Health, Boston, and editor of ProMED-mail, a program of the International Society for Infectious Diseases.
This article (10.1056/NEJMp0904012) was published at NEJM.org on May 7, 2009.
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