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DoD Database Provides Global Tripwire for Bio-Terror

By Gerry J. Gilmore
American Forces Press Service

WASHINGTON, Dec. 17, 2002 – DoD personnel are on the watch for possible bio-terrorism, scanning computer databases featuring outpatient treatment information gathered from more than 300 military hospitals and medical clinics worldwide.

That effort, called the Electronic Surveillance System for Early Notification of Community-based Epidemics, or ESSENCE, is helping DoD to detect both naturally occurring outbreaks of disease -- and potential bio-terrorism attacks, noted Army Dr. (Col.) Patrick W. Kelley. He is an epidemiologist at the Walter Reed Army Institute of Research in Silver Spring, Md.

ESSENCE started up in 2000 as a pilot program to monitor the medical health of service members, family members and military retirees living in metropolitan Washington, Kelley explained.

After the Sept. 11, 2001, terror attacks on the United States, he said, ESSENCE was expanded to include outpatient information from 313 Army, Navy, Air Force and Coast Guard medical facilities around the world.

ESSENCE is on the front line of defense in the war against global terrorism, Kelley maintained. Its worldwide reach is important, he emphasized, because "infectious diseases have no borders and an attack on one country with a bio- terrorist agent could well be an attack on the globe."

To detect potential epidemics or bio-terror attacks, Kelley noted, graphs of fresh medical data provided by ESSENCE are overlaid and examined alongside older data.

"We not only have today's data, we also have historical data going back several years," he added. He explained that mathematical formulas are used to see whether a comparison is within or outside of the bounds of what would be expected. For example, a sharp spike in the number of people being treated for gastrointestinal disorders could indicate the beginnings of an epidemic.

Regarding bio-terrorism, Kelly noted that anthrax and smallpox are especially insidious diseases. They both can masquerade as the flu in the early stages after exposure.

If abnormal incidences of disease are observed, then an alert is provided to local public health officials, who investigate the situation and report back, Kelley noted.

"Our job is to call the alert and mobilize the response. We can identify the places that are the most out of the expected range so that we can prioritize our responses," he explained.

He noted that DoD also maintains a companion medical database program, ESSENCE II, in partnership with the Johns Hopkins Applied Physics Laboratory in Laurel, Md., and several other groups. ESSENCE II, Kelley noted, gathers outpatient medical information from stateside civilian hospitals, school absenteeism data and veterinary facilities.

Such civil-military cooperation is indicative of efforts to increase ESSENCE's reach, making the system more powerful and robust, he explained.

Ever since the terror of Sept. 11, military and civilian public health professionals have been ever mindful of the specter of bio-terrorism being unleashed upon the American population, Kelley noted.

"We will really be doing our job if we have systems that are sensitive enough to pick up problems very early," he said. "Everybody in the homeland security world believes that an important part of bio-defense is early detection and response."

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Walter Reed Army Institute of Research

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