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2 2 This presentation will discuss: 1. Development of the GPHIN system 2. How the system works 3. Successes and challenges 4. Areas for Improvement 5. Future

3 3 Development of GPHIN Conceptualized and developed in 1998 by Health Canada in partnership with the World Health Organization (WHO). Objective: To develop an alert system by: Capitalizing upon the latest emerging information technologies (e.g. Internet, text-mining) Monitoring global media sources 24/7 Aggregating information for analysis on a near real-time basis Disseminating information for further analysis and action by user

4 4 Information Needs Known Health Risk Alerts Disease Outbreaks Contaminated Food, water, air Environmental Disaster- flood, hurricane Product Recalls Unknown Health Risk Discovery Syndromes Unexplained Morbidity and Mortality

5 5 Source of Initial Reporting of WHO Reported Events of Potential PH Concern 01 Jan 2001 to 31 Dec (n=439) Organization GPHIN MOH News Media NGO Other Org. Personal Com. UN Org. WHO WHO Country Off. WHO Regional Off. Verified Not Verified Source: WHO Number of Events

6 6 GPHIN Complements the Public Health Surveillance System Regional / International level Analysis and Feedback. Support Policy, target funding Central level Analyze, Investigate, Confirm, Plan, Fund, Respond, Feedback Intermediate level Analyze, Investigate, Report, Respond, Feedback WHO Ministry of Health Time (Weeks / Months) Peripheral level Detect, Treat, Report GPHIN Early Warning System

7 7 GPHIN s Modus Operandi Timeline: Hours Days Detection by GPHIN Dissemination by GPHIN Verification by users Information on Public Health Risks Intelligence on Public Health Risks

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9 GPHIN Multilingual System (Launched in 2004) An early-warning multilingual system for potential public health threats worldwide Arabic, Chinese (Simplified & Traditional), English, Farsi, French, Russian and Spanish 9 Monitors global media sources and provides relevant information in near real-time and on a 24/7 basis Web based password protected accessible anywhere in the world where there is internet access

10 10 GPHIN Taxonomy Human diseases Animal diseases Plant diseases Chemical incidents Radioactive exposures Unsafe products Natural Disasters

11 11 Two Critical Components of the GPHIN System» Automated Processes» Human Analysis

12 12 GPHIN Workflow Data Collection Advanced Analytics Multilingual Real Time Intelligence Rendering Multilingual Sources Duplicate elimination Metadata Insertion (taxonomy) Categorization En Fr Fa Es Ru Alerts? Publish Manual Analysis Alerts not yet automated Translation Ar Zhs 30 -Publish -Reject -Alert Pushed Item Relevancy Score Zht 0 Reject Query Output Rendered

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14 14 GPHIN Team GPHIN is comprised of a team of analysts driving a very innovative and unique technology. The Team Multi-lingual Multi-disciplinary Multi-cultural Synergy 24/7 Analytical coverage begun on December 9.

15 15 GPHIN Team Day team 7 Analysts 1 Surveillance Officer 1 IT Advisor Night team 6 Analysts Staggered shifts

16 DECISION INSTRUMENT FOR THE ASSESSMENT AND NOTIFICATION OF EVENTS THAT MAY CONSTITUTE A PUBLIC HEALTH EMERGENCY OF INTERNATIONAL CONCERN -Events detected by GPHIN - an ALERT under the International Health Regulation? To a specific region? A case of the following diseases is unusual or unexpected and may have serious public health impact, and thus shall be notified a,b : - smallpox - Poliomyelitis due to wild-type poliovirus - Human influenza caused by a new subtype - Severe acute respiratory syndrome (SARS). Yes Or Any event of potential international public health concern, including those of unknown causes or sources and those involving other events or diseases than those listed in the box on the left and the box on the right shall lead to utilization of the algorithm. Is the public health impact of the event serious? Or No An event involving the following diseases shall always lead to utilization of the algorithm, because they have demonstrated the ability to cause serious public health impact and to spread rapidly internationally b: - Cholera Pneumonic plague - Yellow fever - Viral haemorrhagic fevers (Ebola, Lassa, Marburg) - West Nile fever - Other diseases that are of special national or regional concern, e.g. dengue fever, Rift Valley fever, and meningococcal disease. Is the event unusual or unexpected? Is the event unusual or unexpected? Yes No Yes No Is there a significant risk of International event? Is there a significant risk of International event? Yes No Yes No Is there a significant risk of international travel or trade restriction? Yes No Not notified at this Stage. Reassess when More information Becomes available. GPHIN ALERT UNDER INTERNATIONAL HEALTH REGULATIONS Adapted from - Source: World Health Organization, Fifty-Eight World Assembly Agenda Item 13.1, Third Report of Committee A, 23 May 2005

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18 18 Criteria to Evaluate Effectiveness of GPHIN System Usefulness: how beneficial are the news reports to users? Timeliness: how quickly can the GPHIN system access news reports immediately after being published? Sensitivity/ : is the GPHIN system able to gather Specificity relevant news reports?

19 19 Criteria to Evaluate Effectiveness of GPHIN System Flexibility: how easy and quick is it to make modifications to the system? add modules? Stability: how much downtime occurs? Is there adequate staffing to manage system? Cost: is there financial stability?

20 20 Examples of Successes and Challenges

21 21 Usefulness Source of information for various types of organizations

22 22 GPHIN Users - National v v v v Public Health Agency of Canada (PHAC) Canadian Food Inspection Agency (CFIA) Department of Defence (DND) Royal Canadian Mounted Police (RCMP)

23 23 v v v v v GPHIN Users - International World Health Organization (WHO) UN Food and Agriculture Organization (FAO) World Organization for Animal Health (OIE) European Commission s Center for Disease Control (ECDC) North Atlantic Treaty Organization (NATO)

24 24 GPHIN Users International Cont d v Government Institutions (i.e. Ministries of Health, Military, Depts of Agriculture, Chemical Safety) Algeria, Australia, France, Italy, Germany, Netherlands, Switzerland, Wales, United States

25 25 Timeliness First account of a public health event could be in one of the eight languages GPHIN system retrieves news reports every 15 minutes News reports are automatically processed on a 24/7 basis and accessible to users immediately

26 GPHIN s Reporting Suggestive of the Early Detection of atypical pneumonia in China Time Line (days) Media Reports WHO initial WHO official

27 GPHIN s Early Reporting of the Presence of A/H5N1 Virus in Iran September 13, 2005: First media report of avian influenza in birds in Iran. October 6, 2005: Media report states that Minister of Agriculture notified Vice-President that chicken farms are contaminated with the lethal bird flu strain. February 14, 2006: Iran officials confirm the presence of A/H5N1 in swans Time Line (days) Initial report about the presence of avian influenza in birds in Iran - not confirmed by Iranian officials Media reports about the presence of avian influenza in birds in Iran - not confirmed by Iranian officials Media report about the presence of avian influenza in birds in Iran - confirmed by Iranian officials

28 28 Sensitivity & Specficity Filtering process has several steps» Search criteria» Relevancy scoring algorithm» GPHIN analysts review

29 29 Writing Style of Journalist Yellow Fever 18 November 2003 Tampa Tribune Yellow fever grips Oasis 24 February 2006 Kalgoorlie Miner An epidemic of penalties have thwarted many drives, resulting in a three-game losing streak and essentially leaving the Bucs' season on life support. AN OUTBREAK of yellow fever struck the Oasis last Friday when John Paul College held its annual swimming carnival.

30 30 Versatility & Flexibility

31 31 GPHIN's Versatility : Information for Action Detect potential public health threats Estimate magnitude of the public health threat Determine geographic distribution of public health threat Identify control and preventative measures considered and implemented Monitor concerns of the general public Observe situational politics

32 32 Stability» Robust system» GPHIN Analysts» IT expert team» Some financial support

33 33 Cost Annual budget approaching $3.5M» Operational expenses covered by Canadian government» Upgrades and enhancements to the system covered by subscription payments

34 34 Working Relationships WHO OIE FAO GPHIN FCPSA ECDC CFIA

35 35 Collaboration with other informal systems MedIsys GPHIN networks ProMED Other Systems / networks??

36 36 Areas for Improvement Analytical coverage on a 24/7 basis Information sources, i.e. webcrawling Languages, i.e. Portuguese User profiles Enhanced GIS (drill down mapping) Graphical rendering Financial stability

37 37 Future

38 38 TED Prize TED - Technology, Entertainment and Design Community of philanthropists, i.e. Google, EBay, Microsoft TED Prize make a wish that will make a difference in the world and TED community will try to fulfill wish Dr. Larry Brilliant, one of three recipients of the TED prize (February 2006) Dr. Brilliant s wish to enhance and expand the GPHIN system should become a non-governmental entity free access or lower subscription rates to anyone in the world

39 Thank You Merci

40 News Stories Retrieved by the GPHIN System 1 Jan to 30 June