It is important to mention, however, that informal sources have played a role in monitoring the progress of this outbreak and in keeping tabs on what is happening. To date, ProMED has posted more than 230 reports about it, many of them long, multipart reports, since April 2009.

How well do informal sources work in detecting and reporting public health events? How can we look at this, evaluate it, and improve it? One of the activities that ProMED has pursued in collaboration with HealthMap is to take the archive of ProMED data, which consists of more than 40,000 free text reports dating back to 1994, and put them into a structured database. This was done by extracting, in a mostly automated way, the information from reports based on disease occurrence, type of disease, location, numbers of cases, dates of onset, dates of detection, dates of lab confirmation, and so forth, and putting them into a structured database and combining these data with external informal sources (such as news media). For the first time ProMED was able to see clearly what it had been doing.

Each circle in Figure A9-5 represents a particular disease. Many of the diseases that ProMED reports on are undiagnosed or unidentified, but there are quite a few others that are; avian flu is again at the forefront.

Through this approach, diseases can be followed over time. An individual disease can be observed and in some ways a bit of the history of emerging infectious diseases over the past 15 years can be seen. The system provides the ability to look at ProMED reports, the numbers of ProMED reports over time, and to track disease occurrence. It also shows that it is important to look not just for what is expected, but for that which is not.

From the structured database, it is possible to visualize the locations of ProMED reports over the period. It was noted that reports tend to occur most frequently in the northern hemisphere, in the information-rich and media-rich regions of the world, the United States and Western Europe in particular. Thus, the Southern Hemisphere, South America, Africa, and Asia are much less well covered by ProMED, a problem that ProMED is aware of and striving to solve.

One of the ways in which ProMED is addressing this issue is through regional programs. One of its oldest and best-established programs is in Latin America, which Eduardo Gotuzzo helped form in collaboration with the Panamerican Infectious Disease Association (API). ProMED has established relationships with the Mekong Basin Disease Surveillance Group in the countries that border the Mekong River in Southeast Asia in collaboration with WHO and the Rockefeller Foundation. With funding provided by Google.org it has established two new networks, in East Africa and in Francophone Africa, particularly West Africa; and the Nuclear Threat Initiative (NTI) provided funding for a Russian-language system based in the former Soviet Union.