Importance of Internet surveillance in public health emergency control and prevention: evidence from a digital epidemiologic study during avian influenza A H7N9 outbreaks.
BACKGROUND
Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media.


OBJECTIVE
This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks.


METHODS
Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword "H7N9" from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine.


RESULTS
Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (P<.001). So were the median daily posted and forwarded number and daily BAI in each province/city except Anhui province. We retrieved a total of 32 confirmed rumors spread across 19 provinces/cities in China. In all, 84% (27/32) of rumors were disseminated and transmitted by social media.


CONCLUSIONS
The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to prevent and control the epidemic, including preparation of personnel, technology, and other resources; information release; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks.
Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
Hua
H
Gu
Bin
B
Chen
Honghong
H
Zhu
Tao
T
Jiang
Xinyi
X
Wang
Lei
L
Chen
Zhenggang
Z
Jiang
Dawei
D
Zheng
Jianmin
J
Jiang
D000818:Animals; D001717:Birds; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000302:isolation & purification*; D005585:Influenza in Birds / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control / Q000821:virology; D020407:Internet; D011159:Population Surveillance; D015980:Public Health Practice
Internet; disease outbreak; influenza A virus, H7N9 subtype; surveillance