May 27, 2004
By Stephen Smith, Globe Staff

Starting Tuesday, Boston’s public health agency will begin tracking every sniffle, cough, and stomachache that comes into the city’s emergency rooms, hoping that unusual patterns of routine symptoms would provide an early alert of acts of bioterrorism or major outbreaks of disease.

The hunt for unexpected clusters of illness is a cornerstone of the effort to detect episodes of biological or chemical poisoning, a concern that arose again yesterday as federal officials confirmed they have information that Al Qaeda is plotting a terrorist attack in the United States that could occur this summer.

The early warning system will also allow doctors and publichealth authorities to identify the arrival of less-sinister outbreaks of illness, ranging from epidemics of flu to stomach ailments spawned by rotten food.

The system has been in the works for months, but officials expedited the start of operations so that it would be collecting information by the time thousands of Democrats arrive for their national convention during the last week of July.

‘‘The Democratic National Convention was definitely an impetus,’’ said Dr. Anita Barry, director of communicable disease control at the Boston Public Health Commission. ‘‘We just want to be on the alert for anything that might happen at the convention, not that I have information that anything is going to happen.’’

For about two years, the health agency has been tracking how many patients turn up every day in the emergency departments of the city’s nine full-service hospitals, which see 1,300 to 1,400 patients a day. At best, that system has presented a blurry portrait of broad trends. The new network will offer a more tightly focused snapshot, determining whether patients have arrived complaining of respiratory ailments, rashes, gastrointestinal woes, or another symptom.

Early detection is pivotal: For example, if smallpox and anthrax infections are caught in their first stage, patients can be treated more effectively, and in the case of smallpox, its spread can be contained.

The city put together the alert network with part of a $2.3 million federal bioterrorism preparedness grant received through the state Department of Public Health.

About 100 other health departments across the nation - including those in New York, Chicago, and Miami - have some variation of such a syndromic surveillance system up and running, said Dr. Tracee Treadwell, chief for the Epidemiology, Surveillance and Response Branch at the US Centers for Disease Control and Prevention.

Those networks have proved crucial in identifying outbreaks of West Nile virus and respiratory and stomach ailments. The need for such early warnings was demonstrated dramatically in 1993, when a lack of surveillance in Milwaukee resulted in hundreds of thousands of people getting sick from a waterborne illness before authorities recognized its scope.

‘‘The sooner that we’re able to identify that something is occurring in a population, the quicker we can mount an effective public health response or intervention,’’ Treadwell said. ‘‘It may be due to Norwalk virus, a day-care center, bad mayonnaise in the potato salad - or it may be bioterrorism. This gives us the first early clue.’’

Initially, that’s all it is, a clue.

The first step in the Boston surveillance system begins as soon as a patient enters a hospital emergency room. Triage nurses or other health-care workers will gather information about a patient’s age, place of residence, and primary medical complaint. Those facts will be entered into a computer, and, once a day, all that data - stripped of information that would identify the patient - will be forwarded to the Boston Public Health Commission.

‘‘We’re told that we will automatically download the information to the Health Commission,’’ said Dr. Mark Pearlmutter, chief of emergency medicine at Caritas St. Elizabeth’s Medical Center in Brighton. ‘‘If we had this last December, I am sure we would have been able to identify an increase in flu much faster, and we might have reported it before the state even knew about it.’’

When the emergency room data arrive at the public health agency, computer software called EARS, Early Aberration Reporting System, will search for potentially worrisome trends by comparing reported symptoms to what is seen on a typical day in Boston. It will do that by grouping patients’ medical complaints into one of eight medical syndromes, including gastrointestinal, respiratory, and hemorrhagic illnesses.

‘‘No one is going to walk into the emergency room and say, ‘I have anthrax,’ ’’ said Olumide Adebo, manager of computer networks at the Boston Public Health Commission. ‘‘They’re going to walk into the emergency room and say, ‘I have respiratory problems.’ ’’

Then disease trackers can direct the software to look for clusters based on the home address of residents, by age, by gender, or by other parameters. The surveillance network, for instance, can track patients in 15 different Boston neighborhoods.

Identifying clusters and broad sets of symptoms tell public health authorities little. That’s where the hard work of epidemiology starts.

When a suspicious blip is discovered, disease investigators will then review detailed medical records at hospitals, cull death certificates, and contact poison control offices that might have received patient calls and school nurses who might have treated ailing students.

http://www.boston.com/news/nation/articles/2004/05/27/city_and_hospitals_to_watch_for_early_signs_of_bioterrorism/