BioSense would sniff out bioterror

ATLANTA — In an effort to detect bioterrorism attacks at an early stage, Centers for Disease Control and Prevention officials are studying ways to access and analyze prediagnostic health data for indications of a disease outbreak.

BioSense is a new proposal being discussed with CDC's parent agency, the Department of Health and Human Services. By examining syndromic data from several national sources, public health officials may be able to detect a trend, allowing for a more rapid response.

"It's all about trying to move as far upstream as possible in public health reporting," said Jim Seligman, CDC's chief information officer. "It doesn't replace [public health reporting]; it augments."

BioSense would draw on several national data sources, such as requested lab tests, over-the-counter drug sales and managed care hot lines that patients call with questions or concerns. The system would also pull clinical data from the departments of Defense and Veterans Affairs. Much of this data is already collected on a regular basis and could be relayed to public health officials for analysis, Seligman said.

For example, he said, increases in the purchase of antidiarrheal medications or certain lab tests ordered by physicians may signal an outbreak.

An early detection system could speed response times, but CDC needs to focus its information technology efforts on dealing with subsequent actions, said John Loonsk, CDC's associate director for informatics. Once an outbreak is discovered, systems must be in place to manage the response by tracking the side effects of vaccines, disseminating disease alerts and information, and handling possible cases of the disease, he said.

"We can't neglect that other stuff," Loonsk said. "There's no ambiguity about those needs. It was evidenced with" the October 2001 anthrax attacks.

Brian Keaton, a member of the board of directors for the American College of Emergency Physicians, said syndromic surveillance can serve as a vital sign of a community, but might not be effective in identifying a specific outbreak. Many bioterrorism diseases present symptoms similar to the flu, but the surveillance will show a general increase.

"In terms of that first case of anthrax or that first case of smallpox, syndromic surveillance is probably not the tool to pick that up," Keaton said. "That syndrome would fall into the background noise."

The early detection concept has attracted public attention lately as the newest way to expand public health officials' ability to tackle an outbreak, Loonsk said. Much of this attention stems from the public's assumption that strong post-detection systems are already exist.

"There's a feeling that there's a robust response system that's already in place," Loonsk said. "In fact, we have a lot of work to do."