Aggregation of online media reports for global infectious disease intelligence Clark Freifeld Research Software Developer Harvard Medical School Children’s Hospital Informatics Program Harvard-MIT Division of Health Sciences and Technology

Early reporting of SARS Nov 2002 Mar 2003 Progression of outbreak Electronic Surveillance Cases of atypical pneumonia Foshan Nov 16th Infected Chinese Doctor Hong Kong hotel Feb 21st 305 Cases of acute resp Guangdong Province Feb 11th Pharma report Guangdong Province November 27 Media reports Guangdong Province Feb 10 Astute physician on ProMED Feb 10 Initial WHO Report Feb 25 Official WHO Report March 10

Traditional Surveillance Lack of infrastructure Low level training Gaps in coverage Poor information flow Internet-based Surveillance Abundant cheap/free resource Detailed local information Near real-time reporting Less susceptible to political pressure

Traditional Surveillance

Lack of infrastructure

Low level training

Gaps in coverage

Poor information flow

Internet-based Surveillance

Abundant cheap/free resource

Detailed local information

Near real-time reporting

Less susceptible to political pressure

Source of outbreak news verified by WHO Adapted from Heymann 2001

Limitations of Web-based surveillance Abundance of resources but none comprehensive Information is unstructured -- free text Each has geographic, expertise, population gaps Lack of integration between tools and information sources No synthesized view of the current state of global health Brownstein et al. Institute of Medicine. 2007.

Abundance of resources but none comprehensive

Information is unstructured -- free text

Each has geographic, expertise, population gaps

Lack of integration between tools and information sources

No synthesized view of the current state of global health

www.healthmap.org

HealthMap Objectives Automated, real-time, multi-stream Supplement existing clinical and public health systems Free and open resource Serve the public as well as professionals

Automated, real-time, multi-stream

Supplement existing clinical and public health systems

Free and open resource

Serve the public as well as professionals

HealthMap Article Processing EXTRACTION 8 Feeds;>10,000 sites Every hour; 24/7 TEXT MINING 1500 disease patterns 4000 location patterns BAYES FILTERING >5 million phrases 90-94% accuracy DUPLICATE ID Text Matching Similarity Score

Emerging Disease Surveillance Current Lyme disease (Brownstein et. al. Env Health Perspectives) 2020 2050 2080 West Nile virus (Brownstein et. al. Emerging Infectious Diseases)

Implementation Background Came about as a combination of new software tools and existing epidemiology challenges Linux, Apache, MySQL, PHP All free, open source tools, widely available Prototype early Start simple, think big

Came about as a combination of new software tools and existing epidemiology challenges

Linux, Apache, MySQL, PHP

All free, open source tools, widely available

Prototype early

Start simple, think big

Evolving Systems and Datasets - Challenges Until now, focus has been knowledge management Methods for analyzing news are currently under-developed Unknown data characteristics: geographic, population, availability Little assessment – sensitivity, specificity, signal:noise, timeliness  Evaluating statistical characteristics of data is a first step

Until now, focus has been knowledge management

Methods for analyzing news are currently under-developed

Unknown data characteristics: geographic, population, availability

Little assessment – sensitivity, specificity, signal:noise, timeliness

Data Quality News Sources Local National International Specificity Reliability Timeliness

News Sources

Local

National

International

Data Quality News Sources Local National International Timeliness Specificity Reliability

News Sources

Local

National

International

Data Quality News Sources Local National International Mailing lists (ProMED) Multi-national surveillance (Eurosurveillance) Validated official global alerts (WHO) Timeliness Specificity Reliability

News Sources

Local

National

International

Mailing lists (ProMED)

Multi-national surveillance (Eurosurveillance)

Validated official global alerts (WHO)

Data Quality Clickstream/Keyword Searching Blogs/Chatrooms News Sources Local National International Mailing lists (ProMED) Multi-national surveillance (Eurosurveillance) Validated official global alerts (WHO) Timeliness Specificity Reliability

Clickstream/Keyword Searching

Blogs/Chatrooms

News Sources

Local

National

International

Mailing lists (ProMED)

Multi-national surveillance (Eurosurveillance)

Validated official global alerts (WHO)

Alert Volume by Source Google News: 3194 (22.8 per day) ProMED: 985 (7.0 per day) WHO: 45 (0.32 per day)

Google News: 3194 (22.8 per day)

ProMED: 985 (7.0 per day)

WHO: 45 (0.32 per day)

Multi-Stream Alarming: Heat Index Meta-alert composite score, based on Number of sources providing information at a particular location Recentness of alert Marker algorithm Exponentially weighted alerts Increase heat (redness) for more recent event and higher impact low high

Meta-alert composite score, based on

Number of sources providing information at a particular location

Recentness of alert

Marker algorithm

Exponentially weighted alerts

Increase heat (redness) for more recent event and higher impact

www.healthmap.org

Geographic Representation Alerts by country 1-USA: 4351 2-UK: 1018 3-Canada: 880 4-China:737

Alerts by country

1-USA: 4351

2-UK: 1018

3-Canada: 880

4-China:737

Multi-lingual Surveillance

Coverage Comparison: Argentina English News Bovine Anthrax Citrus Canker

English News

Bovine Anthrax

Citrus Canker

Coverage Comparison: Argentina Spanish News Trichinosis Bronchiolitis Rotavirus Influenza

Spanish News

Trichinosis

Bronchiolitis

Rotavirus

Influenza

Case Study: Legionnaire’s in Spain June 30th Google (ES) Alert Alert #1 July 2nd ProMED-mail Alert Alert #2 July 4th Google (EN) Alert Alert #3

Early Stats 150 alerts per day > 34,000 alerts so far Alerts in 201 countries 169 disease categories

150 alerts per day

> 34,000 alerts so far

Alerts in 201 countries

169 disease categories

Usage 500-600 visits per day 80,000 unique visitors since 9/06 launch Top visitors: dhs.gov cdc.gov state.fl.us reinhartfoodservice.com state.id.us

500-600 visits per day

80,000 unique visitors since 9/06 launch

Top visitors:

dhs.gov

cdc.gov

state.fl.us

reinhartfoodservice.com

state.id.us

Public Health Resource

Various implementations International Society for Infectious Disease Liberty Science Museum, NYC HHS Command Center

Tool for general population

Future Directions Improve existing filtering algorithms More sensitive, noisy sources More filters: number of cases, species affected More languages Other areas: Environmental health Chronic disease Violence, conflict zones Pharmaceuticals Your ideas

Improve existing filtering algorithms

More sensitive, noisy sources

More filters: number of cases, species affected

More languages

Other areas:

Environmental health

Chronic disease

Violence, conflict zones

Pharmaceuticals

Your ideas

Acknowledgments Children’s Hospital Informatics Program @ Harvard-MIT HST John Brownstein, PhD Ken Mandl, MD MPH Ben Reis, PhD Mikaela Keller, PhD Isaac Kohane, MD PhD Carlo Venis (Wabash) Roger Araujo (Peru NMRCD) David Blazes (Peru NMRCD) Aranka Anema (UBC) Larry Madoff (ProMED) Funding Google Foundation National Library of Medicine (NLM) Centers for Disease Control and Prevention Canadian Institutes of Health Research (CIHR)

Children’s Hospital Informatics Program

@ Harvard-MIT HST

John Brownstein, PhD

Ken Mandl, MD MPH

Ben Reis, PhD

Mikaela Keller, PhD

Isaac Kohane, MD PhD

Carlo Venis (Wabash)

Roger Araujo (Peru NMRCD)

David Blazes (Peru NMRCD)

Aranka Anema (UBC)

Larry Madoff (ProMED)

Funding

Google Foundation

National Library of Medicine (NLM)

Centers for Disease Control and Prevention

Canadian Institutes of Health Research (CIHR)

Contact [email_address] www.healthmap.org www.chip.org

[email_address]

www.healthmap.org

www.chip.org