First Alert

| GCN STAFFFoot-and-mouth disease. West Nile virus. Legionnaires' disease. Words that put public health officials on the alert.But what do health agencies and hospitals do if they cannot identify a syndrome or they suspect a wide-scale outbreak of disease?The United States does not have a nationwide comprehensive network to share medical data that can alert state and local public health and emergency management agencies to possible outbreaks of disease or a release of biological and chemical weapons.In 1999, it took doctors and public health officials in New York several months to identify symptoms found in several locations around the state as resulting from the West Nile virus, which causes a sometimes deadly inflammation of the spinal cord and brain. The virus had not previously been seen in the United States.And the recent spread across Europe of foot-and-mouth disease, a severe, highly contagious viral infection of hoofed animals, has public health officials in the United States worried that the disease could eventually affect America's livestock.During the past year, public health departments, emergency management agencies and hospitals around the nation have been piloting an early warning medical surveillance system for infectious disease outbreaks and biological warfare attacks.Components of the Lightweight Epidemiology Advanced Detection and Emergency Response System, or LEADERS, were first tested in the United States in Seattle when the Pacific Northwest city hosted the World Trade Organization Summit in 1999. It was deployed last summer in Los Angeles and Philadelphia during the Democratic and Republican national conventions. LEADERS technology was most recently used in Washington during January's presidential inauguration.LEADERS resulted from the collaboration of the Defense Department and Ernst and Young Technologies of Chantilly, Va.; Idaho Technologies Inc. of Salt Lake City; Oracle Corp.; ScenPro Inc. of Richardson, Texas; and SRA International Inc. of Fairfax, Va.The surveillance system is a Web application subscription service hosted by EYT, the application service provider for the project. Oracle developed the database technology and ScenPro developed the system's mapping function.The Pentagon directed LEADERS' original technology development.Public health officials, emergency management agencies, hospitals, physicians and military personnel can access LEADERS over secure phone lines or satellite connections using a Web browser to determine if there is a potential health risk in a community.Brig. Gen. Klaus O. Schafer, Air Force assistant surgeon general for medical readiness, science and technology, said when he was a command surgeon he looked for a fast way to track illnesses electronically.'We send over 28,000 military personnel to the Persian Gulf every year, with new groups rotating every 90 days, and we needed some way to track what they were being exposed to,' Schafer said.Schafer helped secure a $7.7 million federal grant to establish the LEADERS program. He said the military first used LEADERS components in the Persian Gulf in December 1999 when several soldiers developed food poisoning.The military used Idaho Technologies' Ruggedized Advanced Pathogen Identification Device (RAPID) system to test DNA to identify the specific type of bacteria or agent that caused the illness. RAPID is a portable electronic molecular biology reference laboratory that is used to identify biological agents. The system identifies most agents within 15 minutes. RAPID sends information via e-mail, over phone lines or through a wireless connection back to the Oracle database that stores medical records.Todd Ritter, Idaho Technologies' business development director, said the United Kingdom recently sought help from the LEADERS program in its fight against foot-and-mouth disease.Idaho Technologies joined the U.S. Agriculture Department last month on Plum Island, a quarantined island off the coast of New York where foot-and-mouth viruses are kept, to develop a RAPID test for the disease.Ritter said military and health care officials use RAPID to identify everything from possible biological warfare agents to flu syndromes. RAPID is used in Idaho and Yellowstone National Park to track buffalo viruses. The military also uses it to identify mosquitoes in Japan that carry a strain of encephalitis.LEADERS uses MedView and ViewPort mapping software from ScenPro. The mapping applications let health officials view a defined geographical area and monitor reported syndromes.Hospitals enter symptom and abnormalities data into Web collection forms to determine if a particular syndrome needs to be tracked. The system then analyzes the medical data to spot trends.If the system finds an unusual trend it posts a warning on the alert screen. Health officials then analyze alert details. Doctors can transmit the information to the federal Centers for Disease Control and Prevention in Atlanta to determine if there is a public health emergency.The system also includes a critical-care tracking function that tells public health officials the available number of hospital beds in case of a wide-scale emergency.Sherry Adams, emergency health and medical services executive director for the city of Washington, said there are still a lot of questions about electronic medical surveillance.'There is a big concern about privacy, especially with hospitals,' she said. 'Hospitals are private institutions, but we need them to be part of the network to share information. We are still early in the process with sending medical surveillance information over the Web. And there really isn't a long track record yet.'