Epidemic Intelligence: Using the Internet & Text Messages to Fight Disease

In the field of ‘epidemic intelligence,’ public health experts often turn to formal and informal data sources to learn about disease events occurring around the world. Advances in technology have been largely responsible for spurring the ability to augment the type and nature of potential data sources.

For example, unstructured data gleaned from the Internet in near real-time can be of significant value in identifying cues or signals that may indicate a disease outbreak is occurring in somewhere  in the world. This information can then be used to help guide response activities among public health officials when appropriate. The massive amount of data contained on the Internet, along with easy to use search tools and computerized language translation software, help make this work possible.

Websites hosted all over the world allow data to be uploaded from virtually anywhere – for instance, in the middle of the Congo with a cellular or satellite phone – making the Internet a very useful tool for discovering novel outbreaks. Where CNN and the BBC are less likely to provide news coverage, the multitude of non–English websites can provide access to information in remote towns in faraway places.

Surveillance of media and other Internet-based sites has become such a rapid method to learn about incipient outbreaks among humans, animals, and even plants, that agencies such as the World Health Organization , the U.S. Centers for Disease Control and Prevention (CDC) , and the European Centre for Disease Prevention and Control  have specialized programs to do this work.

Even the Department of Defense has embraced these new tools to help partner nations fight disease. One such tool developed by the DoD is called the Suite for Automated Global Electronic bioSurveillance (SAGES). Launched in 2008, SAGES is a collection of freely-available software tools to use for disease surveillance in countries with limited resources. SAGES was developed jointly by the Armed Forces Health Surveillance Center (AFHSC)  and the Johns Hopkins Applied Physics Laboratory. It is based on an existing, well-known surveillance tool called ESSENCE, or Electronic Surveillance System for the Early Notification of Community-based Events. The SAGES suite contains a variety of data collection tools to capture disease data, including web forms, e-mail, digital logbooks, text messages (SMS) and interactive voice response technology.

Of particular interest are text messages that can be sent from points of care – such as clinics, hospitals or the field – directly to local and national offices of a country’s ministry of health. That data could provide information on an individual patient or a group of patients in a clinic, which health officials can then use to identify unusual spikes in disease activity and further investigate. One of the benefits of SAGES is that it operates with little overhead, few technical requirements, and without the need for prior knowledge of circulating diseases. These minimal technical requirements allow for the system to be used in urban centers as well as hard-to-reach rural settings. Data collection via SAGES is currently in use among AFHSC partners in Peru, Cambodia, and the Philippines; and 12 other countries are currently in various stages of SAGES implementation.

By design, such epidemic intelligence tools are far more sensitive than specific to make sure as many events as possible – whether they are naturally occurring or intentionally caused – are captured by the system. Despite their lack of specificity, internet and cellular technologies have made easy and fast access to disease indications and warnings about outbreaks, allowing experts to stop outbreaks sooner than ever possible due to rapid identification, investigation and verification.

For more information on SAGES, please email the authors at rohit.a.chitale@us.army.mil and jennifer.cockrill@us.army.mil