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ProMED-mail became a program of the International Society for Infectious Diseases and has grown along with the internet, currently reaching more than 40,000 subscribers in at least 185 countries. It is now also available in several languages (Portuguese, Spanish, Russian, and French, to support regional efforts in South America, Africa, Russia and the former Soviet Union, and southeast Asia).39 Reports are available in real time by e-mail subscription at no charge, or on the web, where all the reports are also archived (www.promedmail.org). All reports are edited (moderated) by a group of scientists, including public health and infectious disease experts, who vet the reports for scientific plausibility and provide commentary. The context and comments from the moderators (who are subject matter experts) are a unique feature that many subscribers have noted as especially useful, emphasizing the value of contextualizing raw information. A system like ProMED-mail, in addition to outbreak reporting, provides the ability to aggregate and correlate reports, allowing people to recognize that what they are observing locally may be happening in other places as well. Probably the best known outbreak
first reported on ProMED-mail was the early report of SARS in China (February 10, 2003).39 ProMED-mail received an unusual compliment from Steven Johnson in his book The Ghost Map, about cholera
in Victorian London: The popular ProMED-mail e-mail list offers a daily update on all the known disease outbreaks flaring up around the world, which surely makes it the most terrifying news source known to man.40(p219) With the rapid growth of the internet and the web in the past decade, it is now possible to have reports contributed from much of the world. At the same time, although strides have been made toward the original goal of peri-urban
centers with clinical and diagnostic capacity for surveillance, there is still no fully functional global network of regional centers of the sort envisioned by D. A. Henderson or by the original 1996 ProMED proposal.6,38
Since ProMED-mail was started as an experimental system over a decade ago, it has helped to demonstrate the
power of networks and the feasibility of designing widely distributed low-cost reporting systems (‘‘distributed surveillance’’), and it has encouraged the development of other systems using additional technologies. These concepts help to begin building the heavily networked surveillance systems that will be needed to deal with public health threats in an increasingly globalized and unpredictable world. The original use of the internet (through e-mail and later the World Wide Web) in surveillance was to provide disease reports sent in to ProMED-mail by subscribers. The next major innovation harnessed the availability of news sources on the web, a result of the explosion in the web’s information content. Since the late 1990s, news sources from around the world, in both English and other languages, have become readily available on the web. Several start-up companies (such as Factiva, started in 1996) were formed as ‘‘aggregators,’’ to collect and index this new
flood of information. In 1998, the Cana diangovernment, in an initiative led by Rudi Nowak and Ron St. John a what is now the Public Heal h Agency of Canada, thought to utilize this strategy for collecting news reports on health events. The result was the Global Public Health Intelligence Network (GPHIN ).41,42 Major sources for GPHIN include Factiva and the Arab language Al Bawaba news service. In November 2004, the second phase of GPHIN, GPHIN II, was launched by the government of Canada and the Washington-based Nuclear Threat Initiative (NTI). Expanding on the original GPHIN, which offered reports in English only, GPHIN II has capacity in 7 languages: Arabic, English, French, Russian, Simplified and Traditional Chinese, and Spanish.41 It can provide documents in the language of the user’s choice, as well as translate articles from English to the other languages and vice versa, and there are plans to expand it further. GPHIN is available to governments, the WHO, and to others by subscription. The automated search algorithms use keywords relating to health events of public health importance to identify the reports of interest. From this subset of aggregated news stories, GPHIN analysts read the reports and identify those that appear of greatest relevance and post them, often after some additional editing, translation, or polishing. A new version, GPHIN III, was in development at the time of
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