Using the Internet to Identify Infectious-Disease Outbreaks
http://www.100md.com
《新英格兰医药杂志》
To the Editor: The Emerging Infections Network (EIN) is a health care provider–based, sentinel network that was established in 1996. Its central feature is an e-mail list (listserv) with 946 participants from all 50 states and 36 foreign countries. The majority of participants are infectious-disease consultants in academia or private practice; 16 percent work in the public health sector. Participants communicate by means of a closed electronic mail system and Web site.1 The purposes of EIN are to detect new infectious diseases or outbreaks, identify cases during investigations of outbreaks, acquire knowledge rapidly about newer infections, facilitate research, and foster communication and education.2 EIN has been used successfully for the last three of these purposes.3,4 However, until now there have been no reports describing EIN's usefulness in identifying or investigating outbreaks.
On March 24, 2004, an EIN member from New York City used the EIN listserv to request advice regarding the care of a patient who had a Mycobacterium abscessus surgical-wound infection after a "tummy tuck" performed in the Dominican Republic. This posting was seen by a colleague in Springfield, Massachusetts, who had recently diagnosed a similar infection in a patient who had also undergone abdominoplasty in the Dominican Republic. After it was determined that the patients had undergone surgery in the same clinic, a local investigation identified three more cases linked to that clinic. Within 24 hours of the initial contact between the two physicians, the New York City Department of Health and the Centers for Disease Control and Prevention (CDC) were informed of a possible outbreak. The CDC then posted a case definition on EIN and ProMed (another electronic listserv). As of October 4, 16 potential cases had been identified in Massachusetts, New York, Rhode Island, North Carolina, and Puerto Rico. Pulsed-field gel electrophoresis confirmed that the seven available isolates were indistinguishable. The results of this preliminary investigation were published in the June 18, 2004, issue of Morbidity and Mortality Weekly Report.5
EIN and other listservs have great potential to help identify infectious-disease outbreaks and assist in case identification. Although serendipity and the presence of an uncommon pathogen obviously contributed to the identification of this international outbreak, the use of the EIN listserv was the proximate cause of the discovery of the outbreak. By periodically accessing EIN and other e-mail lists, members throughout the world participate in the passive surveillance of infectious-disease outbreaks.
Eric V. Granowitz, M.D.
Baystate Medical Center
Springfield, MA 01199
eric.granowitz@bhs.org
Arjun Srinivasan, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
Neville D. Clynes, M.D.
New York Presbyterian Hospital
New York, NY 10032
References
Strausbaugh LJ, Liedtke LA. The Emerging Infections Network electronic mail conference and web page. Clin Infect Dis 2001;32:270-276.
The Emerging Infections Network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25:34-36.
Baddour LM. Long-term suppressive antimicrobial therapy for intravascular device-related infections. Am J Med Sci 2001;322:209-212.
Strausbaugh LJ, Jernigan DB, Liedtke LA. National shortages of antimicrobial agents: results of 2 surveys from the Infectious Diseases Society of America Emerging Infections Network. Clin Infect Dis 2001;33:1495-1501.
Nontuberculous mycobacterial infections after cosmetic surgery -- Santo Domingo, Dominican Republic, 2003-2004. MMWR Morb Mortal Wkly Rep 2004;53:509-509.
On March 24, 2004, an EIN member from New York City used the EIN listserv to request advice regarding the care of a patient who had a Mycobacterium abscessus surgical-wound infection after a "tummy tuck" performed in the Dominican Republic. This posting was seen by a colleague in Springfield, Massachusetts, who had recently diagnosed a similar infection in a patient who had also undergone abdominoplasty in the Dominican Republic. After it was determined that the patients had undergone surgery in the same clinic, a local investigation identified three more cases linked to that clinic. Within 24 hours of the initial contact between the two physicians, the New York City Department of Health and the Centers for Disease Control and Prevention (CDC) were informed of a possible outbreak. The CDC then posted a case definition on EIN and ProMed (another electronic listserv). As of October 4, 16 potential cases had been identified in Massachusetts, New York, Rhode Island, North Carolina, and Puerto Rico. Pulsed-field gel electrophoresis confirmed that the seven available isolates were indistinguishable. The results of this preliminary investigation were published in the June 18, 2004, issue of Morbidity and Mortality Weekly Report.5
EIN and other listservs have great potential to help identify infectious-disease outbreaks and assist in case identification. Although serendipity and the presence of an uncommon pathogen obviously contributed to the identification of this international outbreak, the use of the EIN listserv was the proximate cause of the discovery of the outbreak. By periodically accessing EIN and other e-mail lists, members throughout the world participate in the passive surveillance of infectious-disease outbreaks.
Eric V. Granowitz, M.D.
Baystate Medical Center
Springfield, MA 01199
eric.granowitz@bhs.org
Arjun Srinivasan, M.D.
Centers for Disease Control and Prevention
Atlanta, GA 30333
Neville D. Clynes, M.D.
New York Presbyterian Hospital
New York, NY 10032
References
Strausbaugh LJ, Liedtke LA. The Emerging Infections Network electronic mail conference and web page. Clin Infect Dis 2001;32:270-276.
The Emerging Infections Network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25:34-36.
Baddour LM. Long-term suppressive antimicrobial therapy for intravascular device-related infections. Am J Med Sci 2001;322:209-212.
Strausbaugh LJ, Jernigan DB, Liedtke LA. National shortages of antimicrobial agents: results of 2 surveys from the Infectious Diseases Society of America Emerging Infections Network. Clin Infect Dis 2001;33:1495-1501.
Nontuberculous mycobacterial infections after cosmetic surgery -- Santo Domingo, Dominican Republic, 2003-2004. MMWR Morb Mortal Wkly Rep 2004;53:509-509.