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FIGURE A9-6 Timeline showing time differences between official WHO reports, selected informal reports, and various “outbreak milestones.”

FIGURE A9-6 Timeline showing time differences between official WHO reports, selected informal reports, and various “outbreak milestones.”

identify the right signals and make it possible to shorten the interval between outbreak and detection. Using this analysis, we can prospectively evaluate these findings using ProMED and HealthMap as we go forward.

Conclusions

The monitoring of informal sources of information or rumors is an important tool in public health. It is free of political constraints, it is transparent, and it allows for clinicians and other observers to have a role in reporting on emerging diseases.

Informal sources of information can complement and assist the traditional public health systems rather than attempt to replace them. Multiple systems are complementary and enhance the ability to detect outbreaks. Those using informal surveillance systems need to maintain a broad view and not focus on a particular disease, region, or type of disease. They need to keep their eyes on the horizon and need to work to improve the signal-to-noise ratio and to improve geographic coverage.

Acknowledgments

We are grateful to the following people and groups: ProMED and HealthMap participants, subscribers, and staff; Google.org; the Oracle Corporation; Harvard



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