Forewarned is forearmed in virus outbreaks

Got your mosquito repellent handy? First SARS, now West Nile. With all these viruses going around, a lot of Canadians are concerned about their health.

Not only do new diseases pose a threat, but so do resistant strains of old diseases such as yellow fever, malaria and cholera — which have all

made a reappearance in the West.

This is where the Global Public Health Intelligence Network (GPHIN) comes in. Developed by Health Canada in conjunction with the World Health Organization, the network has been in use since 1998 and is used to track infectious diseases such as West Nile, Ebola and HIV.

GPHIN uses the same principles as Web-based search engines to “”crawl”” through more than 900 English and French newswires, Web sites and databases worldwide looking for local news about disease outbreaks. The system is currently undergoing a major overhaul to include coverage in Russian, Spanish, Arabic and Chinese — the six official languages of the United Nations.

According to Health Canada, GPHIN provides 60 to 70 per cent of the global intelligence on communicable diseases to the WHO.

So what happened with SARS? Why didn’t we know more sooner?

With GPHIN, relevant information goes into a database to which WHO, the U.S. Centers for Disease Control and Prevention and the U.S. Armed Forces Medical Intelligence Center subscribe.

East/West differences

“”This is an early warning system,”” says Abla Mawudeku, manager of GPHIN. “”It did give that initial warning (about SARS).”” She says GPHIN identified a mysterious illness in China as far back as late November.

“”We did not know it was SARS, but we knew something was going on. This information was shared with all public health officials who had access to GPHIN and they continued to monitor (the situation) until we found out more about this mysterious disease when there was an outbreak in Hong Kong.””

Ultimately it is up to the users — including WHO — what they do with this information. “”With WHO, they review all the information to determine which of these public health events reported are of an international health concern and determine whether further verification is needed,”” Mawudeku says.

On Feb. 10, ProMed, a medical Web site, reported on an epidemic in Guangzhou in China. The WHO was already aware of this, referring to the epidemic as Acute Respiratory Syndrome, and issued a series of reports starting Feb. 11.

The information was available, but different governments and health organizations chose to use this information differently.

This can be evidenced by the different reponses — and ultimately different experiences — of Vancouver and Toronto during the SARS crisis.

On Feb. 20, B.C.’s Centre for Disease Control sent four e-mails to health-care workers across the province warning them to be on alert for any patients with unusual flu-like symptoms. Because of this, the BCCDC says it was able to keep the outbreak under control within the province.

In Toronto, there was no such e-mail alert issued to health-care workers. By March, the Premier of Ontario declared SARS to be a provincial emergency.

Rob Merrifield, senior health critic for the Canadian Alliance, says Vancouver did a number of things right. It dealt with its initial case of SARS by isolating the patient immediately and acted more aggressively at the airport to screen passengers — and paid more attention to the initial alert than did Toronto

“”What we can learn from that is if we’re forewarned we’re forearmed,”” he says.

“”Unfortunately this is a government that does have a history of not dealing with crises very well — 9/11, Iraq and now SARS.””

But the situation extends beyond the Canadian government. The WHO knew about the epidemic in China long before the Chinese government would come forward and admit it, Merrifield says.

“”I think the WHO is going to be much more aggressive — if they have the technology available there now and they’re watching, they will start acting much more aggressively now because world health is at stake,”” he says.

“”There may be hundreds of thousands of viruses out there right now incubating in certain areas and the right situations will trigger those — it’s a matter of time. So we know that whatever measures we put in place will likely save lives in the future.””

Sam Marafioti, vice-chair of the Ontario eHealth Council, says hospitals in the province are not connected to GPHIN in any organized way.

However, a provincial agency called Smart Systems for Health is developing a private health information network connecting all health-care providers in the province — from family physicians to hospitals. So far 80 per cent of hospitals are now connected over the network, Marafioti says.

“”I think the SARS challenge has really reinforced the need for such an effort and the urgency of being able to have all of the health-care providers connect to one another.””

Public health info critical

Applications are being developed for the network, such as electronic patient records, immunization records and patient tracking. “”Public health information is obviously critically important now,”” he says.

The network will allow new provincial directives and protocols to be disseminated to health-care workers on how to deal with infectious diseases.

Marafioti says this access is “”phenomenally important coming out of SARS”” as is the capacity of the system to respond to the situation. For example, in the event of an outbreak, the system could locate critical care beds and track patients.

“”There’s no doubt in my mind that the network has great opportunities to have a lot of health information exchange,”” he says.

But, he adds, there needs to be a pan-Canadian understanding of global infectious diseases.

“”That’s where you would want the provincial data to be available to some pan-Canadian repositories so Health Canada officials have immediate information at their hands and can also equally disseminate information down to the front lines.””

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Jim Love, Chief Content Officer, IT World Canada

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Vawn Himmelsbach
Vawn Himmelsbach
Is a Toronto-based journalist and regular contributor to IT World Canada's publications.

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