SIDEBAR - PROMED-MAIL

by John P. Woodall Ebola, hantaviruses, toxic Escherichia coli, flesh-eating bacteria, chicken flu. The world needs to know about outbreaks of these and other potentially virulent emerging diseases as soon as they appear, anywhere on the globe. Public health workers need to take steps to prevent epidemics from spreading, and the public needs to know how to protect itself. Imagine more than 10,000 computers, with an equal number of usersscientists, health officials, journalists, laypeoplein 150 countries across the globe, keeping watch for disease outbreaks round the clock. That is precisely what the world's firstand so far onlyglobal merging disease reporting network can do. Moreover, it can get the word out even before official reports appear. ProMED-mail was established as a nonprofit project of the Federation of American Scientists in 1994. In 1999, ProMED-mail became a program of the International Society for Infectious Diseases. The network receives e-mail reports from subscribers that are analyzed by disease experts and sent out over the Internet. All of the ProMED-mail messages are archived and searchable. When a British travel medicine outfit wanted confirmation of a meningitis outbreak in Moscow, its query was posted on the Internet by ProMED-mail. Confirmation of the epidemic came from the Moscow Laboratory for Meningococcal Infection and Bacterial Meningitis. When Ebola broke out in Gabon in October 1996, ProMED-mail posted the news as soon as it was released by the World Health Organization's (WHO) Regional Office for Aftrica four days before it was disseminated on WHO's own outbreak-reporting system. After a tourist visiting the Amazon died of yellow fever, ProMED-mail alerted travelers of the need for vaccination and sparked the vaccination of the at-risk resident population of Manaus, Brazil. In June 1996 an epidemiologist in Los Angeles wanted to confirm a story he had heard concerning an outbreak Escherichia coli O157:H7 in Japan. Within four days the doctor in charge of the Hiroshima Quarantine Station in Japan began to post a daily account of the spread of what became a major epidemic. When ProMED-mail received reports from both sides of the Atlantic Ocean of similar illnesses caused by a rare type of Salmonella, the network linked the unusual outbreaks. In doing so, the network demonstrated what would be a critical capability in the event of the use of biological weapons by terrorists. When the worst epidemic ever recorded of the rat-transmitted viral illness Lassa fever struck war-torn Sierra Leone in 1997, the only drug known to be effective against it (ribavirin) was found to be in critically low supply. This led ProMED-mail moderator and viral disease expert Charles H. Calisher to post a notice that warned the U.S. Navy of the peril in a timely fashion. Enough ribavirin was secured to protect a fleet evacuating expatriates from Sierra Leone following a violent coup d'tat.