Official versus unofficial outbreak reporting through the Internet.

Several countries, a number of regional bodies, and a handful of both commercial and not-for-profit outfits and international organizations operate sites on the World Wide Web on which disease outbreaks are reported. But there is only one publicly accessible e-mail service with no subscription cost that reaches health workers and the general public in countries, and remote regions within countries, that are on the far fringes of the Internet. That service is ProMED-mail, a project of the Federation of American Scientists operated by SatelLife, which is a not-for-profit organization that brings medical information to the developing world. ProMED-mail reaches more than 15000 e-mail subscribers in at least 140 countries by a combination of satellite, phone and ground radio links. It receives reports of outbreaks of emerging infectious human, animal and plant diseases from official sources, the media and subscribers, and disseminates them rapidly, without any of the constraints that often delay official reporting. All reports pass first through the hands of a panel of disease experts, to ensure as far as possible reliability and completeness. ProMED-mail has reported outbreaks more rapidly than official sources, and responded to calls for help from doctors battling epidemics, or confronted with baffling cases. It is proving that public participation in outbreak reporting complements official reporting systems in a highly practical way.