Web Watch: Infectious Diseases

Clicking on the Web...Anthrax, Severe Acute Respiratory Syndrome (SARS), Monkeypox—the list of infectious diseases in the news seems to grow longer every month. Library patrons, concerned about their health, most want to know, "Do I have it?" or "How do you get it?" or "Should I travel there?" The three web sites reviewed below are the best informational gateways about infectious diseases, without the hype that sometimes goes with news reporting. Alternate sites feature specific diseases and sites produced by nongovernmental organizations that often put a more personal face on the fight against disease. Many sites force users to wade through an alphabet soup of acronyms in order to locate information, but all the following sites have compiled authoritative information in easy-to-access formats.

MEDLINEplus is a consumer health information site with a very different objective than the MEDLINE periodical database. Provided by the U.S. National Library of Medicine and the National Institutes of Health (NIH), it is well organized, easy to use, and extremely informative. Since its debut in October 1998, MEDLINEplus has continued to grow and improve, and the latest update allows the easy print and email of articles.

Seven main headings are Health Topics, Drug Information, Medical Encyclopedia, Dictionary, News, Directories, and Other Resources, including libraries and national and international health organizations. For a specific disease, patrons may want to use the search engine to gather information from all of the seven topic areas. For research into infectious diseases in general, begin with a search in the Health Topics and choose the subject Infectious Diseases (General). This page has current information running down the center, including latest news stories, new reports from NIH, clinical trials, diagnosis/symptons, prevention/screening/research, and more. Three infectious diseases were prominently displayed: Lyme Disease, SARS, and West Nile Virus. The SARS topic includes news from a variety of sources, including United Press International, Centers for Disease Control (CDC), and Reuters Health.

On the left of the first page are also links to organizations, statistics, a link to a MEDLINE search on infectious diseases, as well as links to specific MEDLINEplus topics of interest (antibiotics, traveler's health). Links to state health departments are pending; North Carolina is the only state currently represented. The Statistics section links to CDC's Office of Media Relations, where information is organized in a table showing, for example, Monkeypox incidence by states. Links to Clinical Trials are given if applicable. To search a particular disease, the Medical Encyclopedia link offers definitions, causes, symptoms, signs and tests, prognosis, and advice on calling your healthcare provider. Links to other databases are carefully chosen according to standards that include quality, authority, accuracy, current content, educational purpose, free and without registration, and accessibility.

The Bottom Line: An attractive, consumer-oriented gateway that brings the many federal government medical resources, as well as information from leading associations and foundations, together in one place. Content is in English or Spanish and ranges from easy to read to the 11 million articles in MEDLINE intended for health professionals.

The World Health Organization (WHO), the health section of the United Nations headquartered in Geneva, was officially formed in 1948 with the goal of "the attainment by all peoples of the highest possible level of health." The web site reflects WHO's role in centralizing much of the world's health work, plus some of the politics involved. Several features are always listed, typically one addresses an infectious disease ("SARS: breaking the chains of transmission.")

There are five categories to navigate: Countries, Health Topics, Publications, Research Tools and WHO sites. Unless a patron is looking for particular country information, it is best to start at either Health Topics or WHO sites. For documents and databases, Publications and Research Tools are first stops. The search engine, powered by Google, is also very effective. Highlights and useful links are listed in a right-hand column.

The 192 member states and associate members are listed in alphabetical order, and each country page contains a wealth of statistical information, including news of disease outbreaks. The six regions are not represented here, but regional information can be seen, though not hyperlinked, on departmental pages, such as CSR—Communicable Disease Surveillance & Response. CSR collects statistical data and formulates it into easy-to-read maps, tables, and databases. For SARS, a table of current probable cases was cumulative from November 1, 2002 to present, showing the number of cases, number of new cases since last update, number of deaths, number recovered, date last probable case reported, and date for which cumulative number of cases is current. The result is a comprehensible table that provides information succinctly.

Maps are invaluable in understanding worldwide disease. The online Global Atlas of Infectious Diseases is useful, but the link on the CSR and other pages is outdated. Use the main header Research Tools to find updated links. CSR's Global Outbreak Alert and Response Network, begun in 2000, is still developing. Planned response to the threat of biological terrorism is called Preparation for Deliberate Epidemics; it contains a number of useful documents.

The Bottom Line: Though not a consumer-oriented site like MEDLINEplus, for worldwide epidemics and specific country information, WHO is a first choice. News and press releases are authoritative, and it is an excellent archival documentary source for speeches and resolutions. Available in English, Spanish, or French.

This site sounds like an online pharmacy, but the name stands for Program for Monitoring Emerging Diseases, a disease outbreak reporting system produced by the International Society for Infectious Diseases (ISID), a nonprofit professional organization. ISID was formed in 1986 by combining the International Congress on Infectious Diseases and the International Federation on Infectious and Parasitic Diseases and focuses on the "exchange of information, technology, and ideas among health professionals," although the site is accessible to the general public. Information is collected from a variety of sources, ranging from the media, the Internet, and ProMED-mail subscribers. Moderators evaluate each report to confirm the information before posting it.

What is the advantage of ProMED-mail over official sources like WHO? According to ProMED-mail, "WHO and other official sources are constrained in their reporting by the need for bureaucratic clearance. ProMED-mail… has no such constraints, and posts outbreak reports seven days a week." ProMED-mail is meant to complement official sources and provide early warning of outbreaks. It claims to have a network of more than 20,000 people in over 150 countries, "who place their computers and time at the network's disposal and report on outbreaks of which they have knowledge."

Current news is listed chronologically, with SARS, Monkeypox, and West Nile virus separated out by topic. Immediately in the center of the screen are the reports from that day (Eastern equine encephalitis, malaria), with a link to reports from the last 30 days.

Navigation headers are on the left side of the page. The Maps of Outbreaks section is under construction and only contains five sites, but they are all high quality. Click on Links to be taken to a wealth of resources subdivided into Global, Regional, National, Bioweapon, and Miscellaneous. These links are up-to-date, authoritative, and wide ranging, although not necessarily deep. Regional links represented only Europe and Pan America, and national links were for 15 countries. Available in Portuguese, Spanish, Chinese, and Japanese versions.

The Bottom Line: Not an official source like WHO or MEDLINEplus, ProMED-mail is an excellent site for extremely current news. Editorial comments by the moderators make for interesting reading.

Europa, the European Union Online
europa.eu.int/comm/health/ph_threats/com/comm_diseases_en.htm
U.S. Agency for International Development
www.usaid.gov/pop_health/id/index.html
U.S. Department of Defense Global Emerging Infections System
www.geis.ha.osd.mil
These three governmental sites are international in scope, with daily news updates. The Europa communicable disease site highlights SARS as a special topic, though the list of other diseases covered is two pages long. The Communicable Disease Network collects daily reports from all member states in its monitoring mission of surveillance and early warning. Particular attention is paid to bioterrorism. The site is published in the 11 languages of the European Union countries. The U.S. Agency for International Development has programs in 60 countries in four world regions; links and information are regional and then country specific. U.S. Department of Defense Global Emerging Infections System, established by President Clinton in 1966, has a mission to "strengthen the prevention of, surveillance of and response to infectious diseases that: (1) are a threat to military personnel and families; (2) reduce medical readiness; or (3) present a risk to U.S. national security.

Centers for Disease Control Travelers' Health
www.cdc.gov/travel/diseases.htm
An excellent site to learn about reemerging diseases. Typhoid, for example, is primarily a disease of the developing world, and travelers need accurate information about precautions and vaccinations. Frequently updated.

The Global Fund To Fight AIDS, Tuberculosis, and Malaria
www.globalfundatm.org/index.html
Medicins sans frontieres
www.msf.org
Program for Appropriate Technology in Health
www.path.org
Roll Back Malaria
rbm.who.int
The Global Fund To Fight AIDS, Tuberculosis, and Malaria provides excellent collections of links for each of these three diseases—a good resource for student research. Medicins sans frontieres brings you to the front lines of disease control. The site is continuously being updated with worldwide headlines. Program for Appropriate Technology in Health is a 20-year-old organization that focuses on the elimination of a number of communicable diseases and the health of women and children. Click on resources for PATH publications and reports and links to other web sites. WHO, UNICEF, UN Development Programme, and the World Bank have joined forces in a "global partnership" to Roll Back Malaria. Most of the 300 million cases occur in Africa, with more than a million deaths, mostly children under five.