You've got ProMED-mail; system spreads outbreak news

Washington -- A subscription to ProMED-mail, short for the Program for Monitoring Emerging Diseases, provides a virtual front seat to a world of infections.

The service is probably not for the fainthearted. A recent sampling provided updates on the spread of Marburg hemorrhagic fever in Angola, Avian flu's human and animal toll in the Far East, yellow fever in Ecuador, unexplained deaths among pigs in India and charcoal rot in U.S. soybeans.

ProMED-mail is offered free by the International Society for Infectious Diseases, a nonprofit professional organization based in Boston.

Its reports from sources all over the world are screened by a panel of experts, posted on a Web site and sent via e-mail to about 30,000 subscribers.

Lawrence C. Madoff, MD, the editor of ProMED-mail and an associate professor of medicine at Harvard Medical School, spoke with AMNews.

Question: Is it accurate to call ProMED-mail an early warning system?

Answer: That's what we strive to be. We don't pretend to be the only source of this kind of information but we feel, as do many in the public health field, that multiple sources of information are valuable because they are complementary and serve as validation for one another.

Q: Weren't you out in front in reporting the 2003 SARS outbreak?

A: I think we were pretty much the first to publicly report on it, and we were proud of that. I happened to be the top monitor for the week the SARS report was received. I had no idea what it was we were seeing, but I had a sense that something important was going on.

Q: How do you screen submitted reports?

A: We try to balance the need to be rapid, which is key, with the need for accuracy and reliability. I would say that for every 50 reports we receive, maybe 10 are posted. Experts in infectious diseases, epidemiology, animal and plant diseases review articles in their areas of expertise. ProMED has a staff of about 20 experts who receive small honoraria. New items are posted daily.

Q: Who subscribes to your service?

A: While we do use the term subscribers, what we really have are participants in the network. ProMED is a two-way means of communications and we get a lot of our information from participants.

Our participants are practicing physicians, including those in academic medicine and public health. They can also be lay people, journalists and people in industries that are sensitive to public health threats. For instance we have subscribers in the cruise ship industry who follow norovirus outbreaks. They reside in 150 countries.

Q: What languages are available?

A: We are now available in English, Spanish and Portuguese, and many reports are translated into Japanese. We are also developing a Russian language program and are hoping to establish our Chinese language capability in the not-too-distant future.

Q: Why include animal and plant outbreaks along with human outbreaks?

A: This was an education to me. I'm an infectious diseases physician, and I learned how important veterinary diseases are from many standpoints: first and foremost because they are a huge source of emerging human diseases and secondly because of the importance of plants and animals as food. Veterinarians talk all the time about human and animal health being inseparable and I've become an advocate of that also.

Q: You don't include information on tuberculosis, HIV or vaccine-preventable diseases. Why is that?

A: Occasionally we do, but it was a conscious decision not to cover them because we can't do everything and others cover them well.

Q: How did ProMED get started?

A: It began a little over 10 years ago as a way for participants in a World Health Organization meeting to communicate. As people heard about these reports they wanted to be included. There were originally 40 subscribers, and it really mushroomed.