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Misdiagnosed in Translation

Rohit A. Chitale, MPH, PhD (Infectious Disease Epidemiology) ’06

Rohit ChitaleIn the field of ‘epidemic intelligence,’ public health experts use formal and informal data sources to learn about disease events occurring globally. Technological advances have been largely responsible for augmenting the type and nature of potential data sources.

For example, unstructured data gleaned from the Internet, in near real-time, can be of significant value in the form of cues or signals that may indicate an outbreak is occurring someplace in the world. This information can then be used to guide response activities when appropriate.

The massive amount of data contained on the Internet along with easy to use search tools and machine-translators help make this work possible. Websites are hosted all over the world, and data can be uploaded from virtually anywhere (e.g., in the middle of Congo with a cellular or satellite phone), making the Internet a very useful tool to find out about novel outbreaks.

The multitude of non–English websites can provide access to information in faraway places in small towns, where CNN and BBC are unlikely to have easy or quick coverage. In fact, surveillance of media and other Internet-based sites has become such a rapid method to learn about incipient outbreaks among humans, animals, and even plants, that agencies such as the Centers for Disease Control and Prevention (CDC), the European CDC and the World Health Organization have specialized programs to do this work.

While Internet technology enables eager journalists around the world to provide much grist for public health experts, sometimes data from these reports cause a waste of resources, and unnecessary political attention. The reporting of smallpox cases is an example. It is well known that naturally occurring infections from smallpox virus ceased (smallpox was eradicated) circa 1980, but it is also known that stocks of live smallpox virus are likely held in some nations such as those of the former Soviet Union. Therefore, any media reports of a case of “smallpox” must be investigated.

Upon investigation, we often find that the word “smallpox” is reported due to a mistranslation of the words from Spanish such that the word “small” together with the word “pox”, or simply “pox” (all could be used to describe other pox diseases), translate to “viruela”, which is also used to indicate the real smallpox virus. Such mistranslations can happen with other languages as well, and one can imagine the unnecessary attention this might cause.

Despite such occurrences, these technologies have made facile and rapid access to indications and warnings about outbreaks around the world, allowing experts to swiftly identify, investigate and verify, and stop outbreaks sooner than ever possible.

Rohit Chitale is an infectious disease epidemiologist and head of Biosurveillance Coordination at the Armed Forces Health Surveillance Center of the Department of Defense. Previously, he worked in the Global Disease Detection Operations Center at the Centers for Disease Control and Prevention (CDC). He holds faculty appointments at the Johns Hopkins Bloomberg School of Public Health and the Rollins School of Public Health at Emory University.

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