Cover Image


View/Hide Left Panel

BOX A9-1



Date: 10 Feb 2003

From: Stephen O. Cunnion, MD, PhD, MPH

International Consultants in Health, Inc


This morning I received this email and then searched your archives and found nothing that pertained to it. Does anyone know anything about this problem?

“Have you heard of an epidemic in Guangzhou? An acquaintance of mine from a teacher’s chat room lives there and reports that the hospitals there have been closed and people are dying.”

SOURCE: ProMED (2003).

closed and people who were dying. Since there were H5N1 avian influenza cases in Hong Kong at around this time, there were many questions about whether this could have been avian influenza. All ProMED reports are moderated and the moderator comment questioned whether this outbreak in fact was due to flu. It was not clear at the time.

SARS traveled quickly. The first Canadian death occurred in March 2003, raising the issue of who needs to know what and when (Poutanen et al., 2003). One of the problems with the traditional public health system is that it often presumes to know who needs access to information. But the ethos of ProMED has always been for transparency—that we cannot predict who is going to need to know. Who would have guessed that doctors in an emergency room in Toronto were going to be seeing cases of SARS so quickly after this mysterious illness appeared in Asia?

Hierarchical Surveillance Systems Versus Informal-Source Surveillance Systems

If we look at how traditional public health works, we can see that there is a flow of information from the ground up (Figure A9-1). Laboratories, practitioners, and members of the general public report to local officials, who then report to regional officials, and they to national officials. These, in turn, report to world bodies, who will publicize or convey back information to others as they deem necessary and inform the people who need to be involved in response to an outbreak or who need to be aware of it.

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement