BioEd Online

Germany is still recovering from one of the world's worst outbreaks of enterohaemorrhagic Escherichia coli, which as of 18 June had sickened more than 3,200 people and caused 39 deaths¹. The unusually deadly bacteria moved undetected through the food supply from livestock to agriculture to the dinner table, and the response to the outbreak was branded slow and inefficient by physicians and scientists (see 'Microbe outbreak panics Europe').

Now a group of health professionals assembled by the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, has called for biosurveillance efforts in the United States and worldwide to be streamlined to help recognize and respond to threats quickly.

"We are trying to create an international immune system, a system that has the capacity to recognize abnormalities," says Ian Lipkin, co-chair of the National Biosurveillance Advisory Subcommittee (NBAS) and director of the Center for Infection and Immunity at the Mailman School of Public Health at Columbia University, New York.

The NBAS report, Improving the Nation's Ability to Detect and Respond to 21st Century Urgent Health Threats, is the second by the group originally assembled by former President George W. Bush over fears about bioterrorism. The report is now under consideration by the White House and the US Department of Health and Human Services.

Unified approach

The report recommends that the various US federal agencies that monitor infectious disease combine their operations. Currently, disease outbreaks are monitored by the CDC, the US Department of Agriculture, the Food and Drug Administration, the defence department, the Department of Homeland Security and state-level health agencies. The NBAS report calls for more common language and more 'data liquidity' between the agencies to promote the sharing of information. This would also allow better analyses to help detect relevant patterns in health complaints.

The NBAS wants the hub of biosurveillance to move from the CDC to the White House. This would free up agency budgets to invest in a programme currently lacking in the United States and globally: surveillance of domestic animal, wildlife, plant, food, vector, disease and environmental sources, integrated with monitoring of human health.

"It is clear given the events of the recent past, like the E. coli outbreak, that we weren't prepared to deal with it," says Lipkin. "We don't have common terminology, we don't have boots on the ground, we don't have people who have the capacity to recognize these risks, analyse them and present them in a way policy-makers can appreciate."

Disparate data

It took weeks before bean sprouts were finally identified as the source of the German E. coli outbreak, and a second, isolated outbreak in France has shifted suspicion to sprouted seeds. Yet the German outbreak is instructive, according to David Fisman, an epidemiologist at the Dalla Lana School of Public Health at the University of Toronto, Canada. If there had been a centralized database tracking pathogen profiles in animals, food and the environment — information that already exists at some level within disparate agricultural, food and drug, and human health agencies — it wouldn't have taken so long to isolate the cause of the outbreak, says Fisman.

A good tracking system would include pathogen profiles in a global database, according to Jørgen Schlundt, director of food safety, zoonoses and foodborne diseases at the World Health Organization headquartered in Geneva, Switzerland. In the event of disease, physicians would do a database search to discover where else the pathogen is found in the environment to try to stop infections at the source.

"The way we've done it in the past, you wait until you find them [the pathogens] in the humans and then you go back and say 'okay, where did that come from?'," he says. "But if everything was working in a good way, you would find them in the animal production units and then you'd prevent them getting to humans."

Funding for the proposals in the NBAS report would have to be figured out in this era of budget cuts and austerity, but Lipkin is optimistic. "There's going to be concern about investing here, but we think that if you take a look at the investments being made by all these agencies and you consider what would happen if we had an organized approach to this, I'm not even certain it would cost more money."