- The US Centers for Disease Control yesterday announced
plans for a national early warning system against bioterror attack, using
a system pioneered at Harvard that will look for signs of an anthrax, smallpox,
or other disease outbreak in the aches, pains, and sniffles of 20 million
patients.
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- The CDC is committing $1.2 million to a trial of the
computerized surveillance network, which will review thousands of diagnoses
daily for unusual patterns, such as a sudden increase in reports of flu-like
symptoms that could signal an anthrax attack.
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- Early detection is pivotal. If smallpox and anthrax infections
are caught in their first stages, patients can be treated much more effectively.
In the case of smallpox, the spread can be contained.
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- ''A system like this may give public health officials
a three-day lead time. And that lead time may result in the saving of a
great number of lives,'' said Dr. James Nordin, a clinical investigator
at HealthPartners Research Foundation in Minnesota, which is participating
in the experiment.
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- In addition, the system could provide early warnings
of less sinister disease outbreaks, such as the flu or food poisoning.
The lack of such surveillance in Milwaukee in 1993 resulted in hundreds
of thousands of people getting sick from a water-borne illness before authorities
recognized its scope.
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- The national system, expected to be operating within
a year, will mirror a network begun in Boston nearly a year ago, in the
midst of the anthrax scare.
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- Dr. Richard Platt, a Harvard infectious disease epidemiologist,
led the team that created that surveillance network, which had not been
scheduled to start until August 2002. But in the days following the Sept.
11 attacks, the decision was made to bring it on line as quickly as possible.
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- The anthrax attacks that began in early October of last
year, ultimately killing five people, underscored the need for a national
system for tracking bioterrorism. Since the attacks, public health officials
have been even more concerned about smallpox because, unlike anthrax, it
can be spread from person to person.
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- Since last fall, 14 Harvard Vanguard treatment centers
have reported data every day on 250,000 patients. So far, the system has
detected no suspicious patterns in the Boston area.
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- Now, Platt presides over the national coalition of researchers
designing a system capable of tracking medical trends in all 50 states.
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- ''It may be possible to get an earlier signal of a bioterrorism
event by looking at the pattern of symptoms like cough than you could get
by waiting until the first clearly recognizable bioterrorism infections
appear,'' Platt said.
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- In many cases, the symptoms the surveillance network
will track seem surprisingly routine - things like upper and lower respiratory
infections and small rashes accompanied by fever. But that's exactly the
point: to look for small signs of big problems.
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- The system will take information from health plans, clinics,
and a company that runs a telephone hotline staffed by registered nurses
who answer patient calls. It represents an unusual banding together of
disparate, frequently competing, arms of the US health care system.
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- But Platt knew that if doctors and other medical staff
were asked to complete more paperwork in a field already drowning in documents,
a tracking system was doomed to fail. Instead, the surveillance system
prepares computers to review standard medical reports. Those reports are
automatically measured against years of medical history for unusual patterns.
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- That way, the system will be able to determine, for instance,
if the number of respiratory cases on a Thursday in early October varies
dramatically from Thursdays in past Octobers. Then, the computer hunts
for geographic clusters of cases.
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- ''There's a big difference,'' Platt said, ''between having
five people who are sick in a ZIP code with 100 people than a ZIP code
with 10,000 people.''
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- When worrisome patterns emerge, public health authorities
will be alerted so that they can open an investigation to ascertain whether
a cluster of coughing is attributable to a winter virus or whether it's
evidence of a rogue bacterial agent circulating.
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- Smallpox is a leading example of how early intervention
can translate into effective treatment and a limited spread of disease.
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- Researchers know that if patients are inoculated soon
after being exposed to smallpox, that shot can stop symptoms from manifesting.
And centuries of experience with the disease show that it's vital to contain
it geographically - something best done before thousands of people are
exposed.
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- If the national trial proves successful, infectious disease
specialists predict that the network will be expanded to cover an even
broader spectrum of patients.
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- While the fear of bioterrorism is prompting creation
of the national system, its greatest value may prove to have nothing to
do with terrorists.
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- The need for such a network was demonstrated in 1993
when Milwaukee's water supply was fouled by a microbe called cryptosporidium
due to runoff from a cattle lot. More than 400,000 people became ill and
100 died, in part because it took days for disease trackers to realize
an epidemic was felling thousands.
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- ''These investments in the surveillance system are clearly
going to have multiple purposes in making the public health system stronger,''
said Dr. Steven L. Solomon, acting director of the division of health care
quality promotion at CDC.
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- http://www.boston.com/dailyglobe2/276/nation/US_plans_a_system_to_detect_bioattack+.shtml
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