New Application Aims to Detect Flu Outbreaks Faster

A new iPhone app tracks outbreaks in your area.

September 2, 2009, 3:57 PM

Sep. 2, 2009— -- In the latest use of the Internet and social media to counter the flu and infectious diseases, researchers from MIT and Harvard said Tuesday that iPhone users have a new means of monitoring the spread of swine flu and other disease outbreaks.

The new iPhone application, "Outbreaks Near Me," attempts to track the spread of flu outbreaks by monitoring social media and news reports online, using an existing resource called HealthMap, started in 2006. The app is a joint venture between MIT's Media Lab and Children's Hospital Boston.

"The idea is to try to put public health information in the hands of a greater number of people," said John Brownstein, who co-founded HealthMap and is an assistant professor in the hospital's informatics program. "This is a whole new realm of potential users of applications."

He said about 5,000 people downloaded the app on its first day.

A viewing of the app itself reveals it may not have entirely escaped some of the criticisms of past flu-tracking systems. It had an alert for the Washington, D.C., area, this morning, for instance, although a closer look revealed that the alert was triggered by an article about a hypothetical outbreak in schools in a local newspaper.

When looked at a flu-tracking tool from Google last year, researchers noted that for many tracking tools, false positives could be an issue.

"There's that potential that things are incorrect and we try to be as explicit about that as possible," Brownstein said. "It's an automated system and things fall through the cracks and we try to correct them as quickly as possible."

He added that some precautions are present.

"The idea is that they link to the original source, so it's not like we're seeing a spike of news reports without any context," Brownstein said.

"Outbreaks Near Me" represents the latest venture in outbreak tracking. In November, Google unveiled Google Flu Trends, a collaboration with the U.S. Centers for Disease Control and Prevention in Atlanta, designed to help people know about flu outbreaks even more quickly than existing surveillance methods.

Google said its system would be able to detect influenza outbreaks up to two weeks faster than the traditional systems in use.

"As with any communicable disease, early detection is key for health professionals to react quickly," said Jeremy Ginsberg, the lead engineer who developed the new site.

"With online search queries, what we see is millions of people who are interested in searching online for information about health. And with winter approaching, more people will be curious about flu, because we are entering the flu season."

A paper accompanying the launch of the site was accepted by the journal Nature, with the editor in chief, Philip Campbell, praising the "exceptional public health implications of this paper."

The journal is allowing the paper to be discussed with the public before it is published.

Researchers' Expectations Mixed

But while researchers in the field call the new system interesting and novel, they are not ready to get behind the new site yet.

"I think the way to tell, obviously, is to compare it with actual surveillance data, which they should be able to pick up locally," said Stephen Morse, an epidemiologist at Columbia University's Mailman School of Public Health. "Whether searching for the flu is meaningful or not can only be compared with another gold standard method."

Morse said the system is open to a few problems.

"I think the approach sounds like a reasonable one, but I can think of several reasons why people might want to search for information on the flu," he said.

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For example, Morse noted, as a flu researcher, he searches for flu information constantly, despite not being ill. More prevalent problems could accompany an increase in flu-related search terms because of a media report about the flu or, at this point, the threat of avian influenza.

An Imperfect Tool

Others have similar concerns.

"It's certainly intriguing and outside-of-the-box," said Dr. Lisa Jackson, an infectious disease specialist with the Group Health Center for Health Studies in Seattle. "The difficulty is that the term, flu, is not just used for influenza. A lot of people think of flu as a gastrointestinal issue."

She cited the rhinovirus, which causes stomach flu, along with the norovirus and rhinovirus, which cause the common cold -- which many mistake for flu -- as possible confounders of Google's new system.

"I think a big problem is that the term, flu, is used for lots of different things, so right away you have an issue with that," Jackson said. "I'm not sure how well [Google Flu Trends] will translate into helping us identify areas of influenza activity."

In response to concerns like this, Ginsberg said that in researching the new site, the data that is gathered from search engine queries is compared against past search trends and physician data. In the past, the trends in searching for flu have lined up well with actual outbreaks.

"What we have done is actually looked at four or five years of all of the data collected by the CDC's network of physicians. ... We compared that to the aggregated search queries on the flu over the past five years. We realized that the correlation tends to be very, very tight."

It remains unclear, however, how the information will be affected by the possibility of manipulation on the Internet by people hoping to alter results.

New Tool for Flu Surveillance Needed

Still, while they wait to see the results of the new system, researchers say that unconventional methods like this have had some success in the past.

Jackson cited an outbreak of diarrhea several years ago in Milwaukee that was caused by a faulty septic system. She noted that the outbreak was caught because pharmacists in the area noticed that the diarrhea drug Imodium and toilet paper were flying off the shelves.

Morse noted that another Web site with a similar concept to Google Flu Trends, called "Who is Sick?" asks sick individuals to describe their symptoms. They can then observe if others in their area have similar illnesses.

Morse also indicated that better surveillance is certainly needed for figuring out where outbreaks of flu occur.

"Determining when a flu outbreak begins is difficult because there's a tendency not to report it," he said.

"Flu is underreported. People don't tend to go to hospitals or physicians unless they think they are very sick. What you're seeing, usually, when you actually get reports of flu outbreak, is those who are sick enough."

Morse said novel methods that observe human behavior to make predictions about disease outbreaks greatly aid the fight against influenza.

"I think we need a lot of ideas like this," he said.

Dan Childs contributed to this report.

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