County works at detecting outbreaks sooner

Jace Radke

Wednesday, Nov. 20, 2002 | 9:53 a.m.

Quick identification of outbreaks of deadly pathogens could be the key to containing bioterrorism, but local health districts are just beginning to develop precise early warning systems.

The Clark County Health District is looking at new ways to collect medical data to develop a symptom surveillance system, said Dr. Rose Bell, the county's managing epidemiologist.

"There's a lot of reinventing the wheel going on out there," Bell said Tuesday at BioSecurity 2002, a bioterrorism conference running through Thursday at the MGM Grand. "We're working toward having a combination of surveillance data and astute physicians in order to identify infectious diseases right away."

Clark County recently partnered with one area hospital to have basic patient diagnosis data electronically transferred every day, and the county also receives absentee records from schools. Health District officials are also considering collecting data from emergency medical responders, Bell said.

The idea is to pool the data and determine a baseline of symptoms for comparison, so that when a spike occurs in a given symptom category officials will know that something is happening and will investigate further.

Dr. Farzad Mostashari, an assistant commissioner at the New York City Department of Health, manages a medical surveillance system that collects data from numerous sources ranging from emergency rooms to subway worker absentee records.

"We're looking for something we hope isn't there," said Mostashari, who was the lead investigator of West Nile Virus and anthrax in New York City. "These systems are our insurance policy, and if every alarm turns out to be false we use the experience to test our system for the big one."

Data is transmitted daily to the New York system, but health district officials can increase the frequency of the information updates to every 12 hours if they notice a suspicious trend.

A system that could provide a model for local health districts is one operated by the Defense Department. The Electronic Surveillance System for Early Notification of Community-based Epidemics, or ESSENCE, constantly pulls diagnostic data from military hospitals and shunts it to a website for military use.

Lt. Col. Julie Pavlin, chief of field studies for the Walter Reed Army Institute of Research, said the real-time approach is the only way to be as prepared as possible.

"We've worked with some of the local agencies in the Washington, D.C., area to bring local information into the net," Pavlin said. "All of the local entities have different ideas and ways to do things, so a national system may not work."

The closest thing to a national early warning system is the Centers for Disease Control's influenza-like illness surveillance system, Bell said.

"The CDC data is based on what physicians and hospitals give them, and we hope to use that along with what we can get locally," Bell said. "We are concentrating on categorizing the information we get so that we can pick out what is the most meaningful, and we're not just spinning our wheels."

Computer software to help categorize data is still in the early stages, so the effectiveness of emergency room patient information in identifying infectious diseases could improve, Mostashari said.

Representatives from health districts across the country are attending this week's conference to learn ways to detect biological attacks quickly and efficiently.

"We're looking to shift to a more active monitoring system to enhance what we already do," said M. Ward Hinds, health officer for the Snohomish County Health District north of Seattle. "A few weeks ago we detected West Nile Virus in our county for the first time."

While experiments continue with symptom surveillance, physicians and nurses will provide the best way of detecting pathogen outbreaks, said Nevada State Epidemiologist Dr. Randall Todd.

"The first anthrax case in New York was diagnosed by an astute doctor, who got the ball rolling," Todd said. "Without a doubt, when it comes to detecting these outbreaks there has been a paradigm shift since Sept. 11, and it picked up momentum with the anthrax incidents.

"We're making inroads into the health care community in gathering information, but these kinds of passive monitoring cannot replace what doctors can provide."

The State Health Division has used federal grant money over the last year to help educate Nevada's doctors about diseases that could be used in biological attacks, such as West Nile Virus, anthrax and smallpox.

"There aren't many doctors around anymore that have even seen a case of smallpox, so education is a big part of the equation," Todd said."There was a tendency that when doctors hear hoof-beats they diagnose horses instead of something exotic like a zebra.

"I think we've come full circle now. Doctors are now considering that it's possible that they could have a zebra on their hands."