Rapid Syndrome Validation Project

Los Alamos National Laboratory is collaborating on a new tool that will provide public health officials with an early warning and response system for threats to public health.

The threat to public health from infectious diseases is increasing. New, evolving and emerging diseases have appeared in unexpected locations with increasing regularity as society becomes more mobile. Diseases such as HIV, dengue fever and hantavirus present unique and significant challenges to the public health infrastructure, both in recognizing their presence and dealing with their effects. The familiar flu virus takes a significant toll every year, causing thousands of deaths, mostly among the aged or the young.

The threat of bioterrorism also has increased. A rogue group could introduce virulent biological pathogens into a popula- tion with potentially catastrophic results, if we do not have the tools to detect and respond. Most flu epidemics are recognized only after they happen, and therefore, appropriate medical attention is often too late.

Physicians and public health officials realize that information systems to recognize and respond to public-health threats need to be better. Officials need tools to recognize an outbreak, make quick diagnoses, disseminate infor- mation throughout the health-care community and allocate the resources to deal with such threats.

A new project will put important new tools in health-care providers' and emergency planners' hands. The Rapid Syndrome Validation Project is a collaboration of several institutions including Los Alamos and Sandia national labora- tories, the University of New Mexico Emergency Medicine Department and the New Mexico Department of Health Office of Epidemiology.

Al Zelicoff, senior scientist in the Center for National Security and Arms Control at Sandia, conceived the project.

"Its primary objective is to provide early warning and response to emerging health threats," Zelicoff said.

RSVP is a computer-based system that operates at the nexus of public health and bioterrorism. Los Alamos scientist Dave Forslund provided the software package that resulted in a portable system that can run on any computer platform anywhere in the world that has access to a Web browser. The portability along with the low cost of running the program through a Web browser makes the technology ultimately available to anyone, anywhere.

Input computers can be set up with touch screens to make the data input faster, which would help emergency room personnel. Health-care providers enter a patient's symptoms on a highly secure, encrypted Internet transmission. After the new syndrome is entered, the output screen shows a map, organized by zip code, of all similar syndromes.

The project is being piloted on six syndromes: flu-like illness, fever with skin findings, fever and altered mental status, acute bloody diarrhea, hepatitis and acute respiratory distress.

Physician judgment determines the syndrome that best represents the patient's condition and is partially captured by the syndrome selections. The reporting system assists the physician with appropriate clinical and epidemiological data. If the syndrome matches a reportable disease, an alert will be provided to the physician and automatically sent to the Department of Health. The reportable-disease database provides the DOH with data on potential outbreaks and other public health risks.

RSVP may benefit another Los Alamos project called EpiSIMS, a disease-outbreak computer model primarily designed for tracking respiratory illnesses. EpiSIMS currently is being developed to model the spread of influenza through a population and is a derivative of the TRANSIMS model, which predicts the flow of traffic. By coupling the infectivity rates of an influenza virus with the flow of people and their contacts with each other, the goal is that EpiSIMS will develop into a powerful model for projecting the scope and impact of an influenza outbreak. EpiSIMS would be a tool to benefit public health planners and disaster response officials in responding to public health emergen- cies of either natural or man-made origin.