At regional or municipal levels, there is a hodgepodge of new IT systems arrayed against the flu. New York City may have the most advanced syndromic surveillance system established to date. It was launched in its present form as a response to the 9/11 terrorist attacks, says Dr. Farzad Mostashari, assistant commissioner at the New York City Department of Health and Mental Hygiene. The unit that operates the system oversees a mix of off-the-shelf and custom-written applications that track a variety of statistics through the city, including the daily pharmacy sales, the number and type of ambulance dispatches, and emergency-room visits. The software includes a SQL Server database, a SAS data warehouse and other tools that enable the analysis and visualization of information.

Mostashari notes that these systems are still "in their infancy," best practices have yet to be determined, and there is no standardization around the software or data formatting. His system receives information mostly via secure FTP with ebXML tags and so far has worked very well. Mostashari believes that overall, the next step for public health IT is to get "closer to the bedside" by accessing electronic medical records right from a doctor's office.

Communications and other high-tech capabilities must also extend to first responders -- that is, the health care workers and emergency personnel who would be the first professionals to encounter avian flu face to face, he says.

International efforts

The U.S. isn't alone in tracking the flu virus: The Public Health Agency of Canada has established the Global Public Health Intelligence Network (GPHIN), which functions as a secure, Internet-based early-warning system, according to an agency spokeswoman. The Java-based software has a search engine that works around the clock to pick up news reports of any significance to public health. The data is automatically filtered for relevance, analyzed by GPHIN officials and made available via reports and other means to interested parties -- including WHO personnel.