Infectious diseases in developing countries are common in populations displaced by natural disasters. (1) Outbreaks of diarrhoeal disease after the flooding in Bangladesh in 2004 and in Pakistan after the 2005 earthquake attest to this. (2,3) A functional infectious disease surveillance system in the disaster-hit area is crucial for reducing the risk of epidemics. (1) Such a system, however, is often either nonexistent or damaged by the disaster itself.
On 12 May 2008, an earthquake with a magnitude of 8.0 struck the north-western part of Sichuan province, China. More than 80 000 people were killed and 5 million more became homeless. One urgent issue after the earthquake was the detection of occurrences of epidemic-prone diseases so that quick action could be taken to prevent outbreaks. Before the earthquake, the local health-care agencies were required to report 38 types of infectious diseases, as mandated by the law on prevention and treatment of infectious diseases, through the Chinese information system for disease control and prevention (CISDCP) to a national database. (4) In Sichuan, this electronic disease surveillance system has been set up in all townships since 2004 using dial-up or broadband internet connections. The earthquake paralysed the system in those areas. While working to repair the landline-based reporting system, the Chinese Center for Disease Control and Prevention (China CDC) developed an emergency reporting system based on mobile phones. This paper describes that system and the lessons learned from the utilization of mobile phones for infectious disease surveillance after the catastrophic earthquake.
The mobile phone emergency reporting system was set up by China CDC and the local CDC offices in five steps: (i) selecting mobile phones and the network supplier; (ii) developing a reporting system to run on mobile phones; (iii) identifying places where the mobile phones would be needed; (iv) distributing the mobile phones and providing onsite training; and (v) applying quality control measures.
China CDC immediately secured a donation of light-powered mobile phones (A6000 model; GSM/GPRS duel bands) from Hi-Tech Wealth, a domestic mobile phone manufacturer. This model is recharged through a crystalline silicon solar panel embedded into the shell of the phone. China Mobile was selected as the network supplier because of its extensive coverage in the disaster zones.
China CDC developed a reporting system based on the short messaging system (known as SMS or text messaging) and covering the same 38 infectious diseases reported in CISDCP. An epidemiologist in the field can input 16 categories of information about a case, including the name of patient, age, diagnosis, time and location, into a form. Except for names of patients, all data are input as numerical codes, using the same codes for CISDCP. Information on each case is then sent as an encrypted text message to the national database. It takes approximately 2-3 minutes for a trained person to report a case. The reported data are analysed by China CDC and displayed on digital maps in real time.
The local CDC offices singled out health agencies in regions where the intensity of the earthquake was more than seven and the reports could not be transmitted via the normal route. The mobile phones were delivered to those agencies by staff from the local CDC offices and epidemiologists in those agencies were trained to use the reporting system.
A quality control system was in place to ensure the quality of data. When a doctor encountered a patient with an infectious disease in the field, he/she would fill out a paper form. The paper records in the township or relocation camp were collected and verified by an epidemiologist. The epidemiologist then sent the information through the mobile phone reporting system to the national database. The CDC offices at the county level would check the data received and ask for changes if the data were incomplete or errors were found. …