- Email: [email protected]
World Wide Web resources on zoonotic infections: a subjective overview
Transactions of the Royal Society of Tropical Medicine and Hygiene (2008) 102, 1181—1188
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/trst
REVIEW
World Wide Web resources on zoonotic infections: a subjective overview Georgios Pappas a,b, Konstantinos N. Fragoulis b, Matthew E. Falagas b,c,∗ a
Institute for Continuing Medical Education of Ioannina, Ioannina, Greece Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece c Department of Medicine, Tufts University School of Medicine, Boston, MA, USA b
Received 24 January 2008; received in revised form 1 April 2008; accepted 3 April 2008 Available online 2 June 2008
KEYWORDS Zoonoses; Zoonotic infections; Resources; World Wide Web; Internet; Medical education; Public health
Summary Zoonoses are a diverse group of infections whose significance is underestimated and understudied. The prevalence of zoonoses is higher in the developing world, where health professionals are often deprived of the rapid and free availability of related scientific information; however, continuous evolution of the World Wide Web (WWW) may offer such an option. This review sought to evaluate the content of available WWW resources on zoonoses. Two authors independently identified relevant websites. The selected websites were considered of merit upon consensus of all the authors. Only websites with freely available content were included. Websites on individual zoonoses were excluded. Through the numerous sites encountered on the WWW on zoonoses, there are certain ones that offer adequate information for the public and others that can serve as useful initiators for the non-specialist. Most sites approach zoonoses one-dimensionally, either as a public health, medical or veterinarian problem. The few sites that offer updates on zoonoses unfortunately focus on regional news. Ample information for the public and non-specialists on zoonoses can be traced on the WWW. However, what is missing is a site that will continuously update health professionals who deal with zoonoses in all their medical, veterinary and public health aspects. © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
1. Introduction Zoonotic infections account for a significant percentage of infection-related morbidity and mortality worldwide. Moreover, the majority of emerging and re-emerging infec-
∗
Corresponding author. E-mail address: [email protected] (M.E. Falagas).
tious threats belong to zoonoses (Feldmann et al., 2002). However, the importance of these infections is often underestimated for a variety of reasons. First, the diversity of the term zoonoses, which encompasses a wide variety of pathogens—–more than 175 infectious diseases are characterised as zoonoses and the list has been reproduced randomly and variably (Hub´ alek, 2002; Taylor et al., 2001). Second, zoonoses are often endemic in areas with lower socioeconomic and health-related status (Blancou et al., 2005; Pappas et al., 2006a) and thus fail to gain the scientific
0035-9203/$ — see front matter © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.trstmh.2008.04.006
1182
G. Pappas et al.
attention of the developed (scientific) world, at least until they also emerge in industrialised countries or until they become significant travel-related or pet animal-related factors of morbidity (Chomel et al., 2007). Third, the diverse background of these diseases often perplexes researchers who study them: most of these infections have not only a medical background, but also a veterinary and an ecological one (Pounds et al., 2006), and sometimes socioeconomic parameters also intervene; thus, studying them to their full extent demands a complex collaboration between various scientific specialties. In countries with poor health-related resources (including medical educational resources), zoonotic ecology imposes a significant burden on specialists and clinical practitioners. Information is often barely available and, for some entities, is scarce. Restrictions on literature availability may drastically affect a specialist’s ability to deal adequately with a disease. Evolution of the World Wide Web (WWW) promised to reverse the tide. The free electronic availability of information has rapidly transformed the ways medical practitioners get, distribute or discuss medical advances and data (Pappas and Falagas, 2007; Pappas et al., 2007) and certain indications show that we are only at the beginning of this information revolution. This review sought to summarise available WWW resources on zoonoses, focusing on free distribution of information related to more than one zoonotic infection. The authors further discuss individual website characteristics regarding the quality of information available and the scientific groups to which this information is targeted.
2. Materials and methods Data on available websites with information on zoonoses were collected as follows: two of the authors (one specialising in human zoonotic infections and one with marginal familiarity with the subject) independently performed an Internet search using general search engines such as Google and Yahoo and the keywords ‘zoonoses—zoonotic infections’. Of the endless list of websites retrieved (typing the word ‘zoonoses’ in Google retrieves 2 780 000 results), each author evaluated the first 1000 sites retrieved by the search engines and selected specific sites that were considered as
Table 1
helpful/interesting. Google offers subcategories of results with the tags ‘for health professionals’ and ‘for patients’, and these subcategories were also extensively investigated. References of retrieved websites were also evaluated for inclusion. Table 1 summarises the criteria used for assessment and the subcategories investigated. The websites that were selected by both authors were by default included. Websites selected by only one of the authors were further evaluated by the co-authors and included upon consensus of all authors. The rationale behind the method was that any individual, with or without a scientific interest, would use a similar approach in retrieving information on zoonoses and we chose to simulate this approach (Giustini, 2005).
3. Zoonotic infections on the WWW The researcher with marginal interest in zoonotic infections retrieved 52 websites considered as potentially interesting, whilst the researcher specialising in human zoonotic infections retrieved 24 such websites. The 22 websites common for both researchers were considered as eligible for further evaluation, as well as 2 websites each selected by one researcher only, considered as eligible after consensus with the third researcher. Table 2 summarises the selected website resources on zoonotic infections in general, their background and their individual characteristics. It goes without saying that the list is by no means objective: the methods of retrieving these websites were at first subjective, but applying to practical experience as already discussed. A brief overview of Table 2 shows that information is derived from international organisations, academic institutions, national and regional health protection agencies, or websites offering general medical information. One would expect that the websites of large national or international organisations related to zoonoses would offer all information relevant to medical, veterinary and public health aspects of zoonotic infections, as well as sufficient introductory information for the public. However, the majority of the websites offer information that may address the public’s needs but serve only as a brief summary for healthcare practitioners, or vice versa. Another easily observed aspect is that the vast majority of websites
Criteria used for assessment of World Wide Web sites on zoonoses
Criteria • Freely available content • Objectivity of the data (presented by health authorities or specialists in aspects of zoonoses) • Regularly updated sites (evaluated through the ‘last updated’ date on the website, or for change of contents in two different time periods with a 1-month interval in case of recent update date) • Focus on zoonoses as a general concept or a large number of individual zoonoses (sites on isolated zoonoses were excluded) • Information relevant to a global audience (sites with information of regional importance on specific individual zoonoses were excluded) • Subcategories evaluated • Orientation of information to health professionals or the public • Orientation of information to medical, veterinary or public health aspects of zoonoses
Selected open-access World Wide Web (WWW) resources on zoonoses
Website title
Title of web page presenting information
Website URL
Information target
Comments
US Centers for Disease Control and Prevention (CDC)
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) Zoonoses
http://www.cdc.gov/nczved/
Health professionals (medical, veterinary, public health) and public
Recently launched, too early to judge?
http://www.who.int/topics/zoonoses/en/
Health professionals (medical, veterinary, public health) and public
Introductory remarks on the WHO/MZCP
http://www.mzcp-zoonoses.gr
Health professionals (veterinary, public health) and public
Disease information meets neither the public’s nor the professional’s demands Promoting programmes for the prevention, surveillance and control of zoonoses and related food-borne diseases
Detection, surveillance and control of zoonoses and other relevant diseases
http://www.veterinary-publichealth.de/home e/aufgaben/zoonosen/liste zoonosen e.htm
Health professionals (medical, veterinary, public health) and public
The most complete list of zoonoses available on the WWW, along with brief details and links
Zoonoses/Animal Health
http://www.paho.org/english/ad/dpc/vp/zoonosis.htm
Health professionals (medical, veterinary, public health)
Links to sites containing important information
http://www.oie.int/eng/en index.htm
Health professionals (veterinary, public health)
Professionally oriented, veterinary-oriented, news section, useful for epidemiology of animal disease, extensively informative
WHO
Mediterranean Zoonoses Control Programme (MZCP) of the WHO WHO Collaborating Centre for Research and Training in Veterinary Public Health (Hannover, Germany) The Pan American Health Organization (PAHO) The World Organisation for Animal Health (OIE)
Zoonoses on the world wide web
Table 2
1183
1184
Table 2 (Continued ) Website title
Title of web page presenting information
Website URL
Information target
Comments
http://www.medvetnet.org/cms
Health professionals (veterinary) and public
Zoonoses: Diseases
http://www.defra.gov.uk/animalh/diseases/zoonoses/common.htm
Health professionals (veterinary, public health) and public
Excellent network for veterinarians, ample scientific information with the relevant orientation The most comprehensive disease information for the public
Zoonoses (infections acquired from animals) Gastrointestinal & Zoonoses
http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/ Health professionals Page/1191942145653?p=1191942145653 (veterinary, public health) and public
Shares public information with Defra
http://www.hps.scot.nhs.uk/giz/
Health professionals (veterinary, public health) and public
Human Food/Waterborne Disease Surveillance—– Zoonoses
http://www.fsai.ie/surveillance/human foodborne/zoonoses.asp
Health professionals (veterinary, public health)
Information for scientists and public, surveillance reports, news of regional interest A concise introduction to zoonoses and regional reports
http://www.food.dtu.dk/Default.aspx?ID=8573
Health professionals (veterinary, public health)
MED-VET-NET
Department for Environment, Food and Rural Affairs (Defra), UK Health Protection Agency (HPA), UK Health Protection Scotland
Food Safety Authority of Ireland
Danish Zoonoses Centre
Zoonoses
http://www.healthysa.sa.gov.au/zoonoses.asp
Health professionals (public health) and public
County of Los Angeles, Department of Public Health
Zoonoses Manual
http://www.lapublichealth.org/vet/guides/vetzooman.htm Zoonoses
Health professionals (veterinary, public health) and public
G. Pappas et al.
Government of South Australia, Department of Health
Typical website with regional surveillance data and information for professionals Links to other sites with information on zoonoses matters, however link selection does not always lead to the expected results An extensive text on the significance of zoonoses, with various regional epidemiology data
Zoonotic Disease Program
http://www.odh.ohio.gov/odhprograms/idc/zoodis/zoomain1.aspx
Public
Texas Department of State Health Services
Zoonotic Health Topics
http://www.dshs.state.tx.us/idcu/health/zoonosis/default.asp
Health professionals (medical, public health) and public
Washington State Department of Health
Zoonotic Disease Program
http://www.doh.wa.gov/ehp/ts/ZOO.HTM
Health professionals (medical, public health) and public
University of California, Santa Barbara
Zoonotic Diseases
http://research.ucsb.edu/connect/pro/disease.html
Health professionals (medical)
Oregon State University
Zoonoses
http://oregonstate.edu/occupationalhealth/educational/species/
Public
University of South Carolina, Department of Pathology, Microbiology, and Immunology
Zoonoses
http://pathmicro.med.sc.edu/ghaffar/zoonoses.htm
Health professionals (medical, public health)
Average factsheets for the public on certain zoonoses; more information on selected diseases such as vector-borne and rabies Excellent coverage of most aspects of zoonoses, including advice for the public and health professionals on almost everything Excellent, public-oriented, but interventional, website on zoonoses; an example of public health policy on the subject Similar to a pocket book companion for the non-specialist health professional, small vignettes for numerous zoonoses. One of the few sites to explain the origin of the word ‘zoonosis’ An interesting site for owners of household animals and pets A few clinical data and a lot of interesting clinical images for some diseases
Zoonoses on the world wide web
Ohio Department of Health
1185
1186
Table 2 (Continued ) Website title
Title of web page presenting information
Website URL
Information target
Comments
University of Wisconsin— Madison, School of Veterinary Medicine eMedicine
Zoonotic Diseases Tutorial
http://svmweb.vetmed.wisc.edu/pbs/zoonoses/
Health professionals (medical, veterinary)
Like an extended version of the above, for the non-specialist health professional
Articles on zoonoses
http://www.emedicine.com/cgi-bin/foxweb.exe/ searchengine@/em/searchengine?boolean=and&book= all&maxhits=40&HiddenURL=&query=ZOONOSES
Health professionals (medical)
Zoonoses.org
http://lifesavescience.org/Zoonoses/index.htm
Public
Infectious Animal and Zoonotic Disease Surveillance
http://www.fas.org/ahead/index.html
Health professionals (veterinary, public health)
The link returns results for a few zoonoses, but individual disease names can be used to trace the relevant, highly educative and reasonably updated information for clinicians ‘Zoonotic Epidemiological Research and Education for everyone to understand!’: focuses on a few social issues of a few zoonoses Focuses on surveillance with an eye on agroterrorism issues
LifeSave Biological Research & Education Consortium on Human (and Animal) Health, Utah, USA, Int’l Federation of American Scientists
G. Pappas et al.
Zoonoses on the world wide web arise from US-based academic institutions or agencies, and only a few are of European origin, an observation that has been reproduced when evaluating WWW resources on other health-related issues (Pappas and Falagas, 2007; Pappas et al., 2007). The website of the recently developed National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED), a US Centers for Disease Control and Prevention (CDC) branch, is one of the more widely known such organisations, linking also to FoodNet and PulseNet, two networks focusing on food-borne infections, the majority of which are zoonotic. The homepage spotlights certain interesting news related to the subject, but information on specific diseases is mainly based on CDC factsheets. However, since NCZVED is a new organisation, one has to see how its website will evolve. The website of the WHO on zoonoses includes minimal information on a few of the individual diseases, with some links to related WHO documents (where one may or may not find adequate information), informs on initiatives related to zoonoses and relevant outbreaks, and links to other WHO-related initiatives. One of these, the Mediterranean Zoonosis Control Programme (MZCP), has a website with very useful information on different zoonoses, which may be particularly interesting to veterinarians and public health practitioners (there is even more information with an orientation for the public in the Greek language—–MZCP is based in Athens). The organisation’s bulletin offers regional news on the subject and its activities, but the news section of the website is not updated. MZCP manages to keep a firm balance between information for the public (typically by well prepared brochures on individual diseases) and information for certain subcategories of health professionals (veterinarians and public health specialists). Another WHO-related institution, the WHO Collaborating Centre for Research and Training in Veterinary Public Health, based in Hannover, Germany, offers a website that has the most comprehensive list of zoonoses available on the WWW, along with brief information and links to further information on individual diseases. Yet another WHO-related organisation is the Pan American Health Organization (PAHO), which has the most extensively updated website on practically all aspects of zoonotic infections, such as surveillance, outbreaks, incidence reports and selected useful publications. However, its utility is marginalised by the fact that it is strongly focused on the American continent, itself home to a wide variety of zoonoses. A more veterinarian-oriented approach is present in the rich website of the World Organization for Animal Health (OIE, from the French initials). It has a news feed that is often updated, extensive information, mainly for the professional on individual diseases, and data on the animal prevalence of zoonoses worldwide (and a few selected anthropozoonoses). MED-VET-NET is ‘a newly-established Network of Excellence for the Integrated Research on the Prevention and Control of Zoonoses by integrating veterinary, medical and food science research’ that encompasses scientists from numerous European countries and offers excellent, if somewhat veterinarian-oriented, scientific information on current and future zoonoses research. A similar veterinarian-oriented approach is used in the relative website of the UK-based Defra (Department for
1187 Environment, Food and Rural Affairs). Here, though, one can find the most concise disease information for the public available, shared with the (also UK-based) Health Protection Agency (HPA), an ‘independent body that protects the health and well-being of the population’. Merging the interests of the public and public health, and posing as an excellent example of state intervention on zoonoses in the community, is the Washington State Department of Health zoonotic disease program, with information for the public that invites them to act, and a bulletin with regional zoonoses news that manages to attract equally the public and the scientific interest. The Texas Department of State Health Services website on zoonoses is another excellent site that answers practically any possible question of the public and the non-specialist health professional, even dealing with subjects such as animals in a disaster, etc. The most concise and reasonably up-to-date information for medical professionals, on the other hand, can be traced for individual diseases through the invaluable electronic medical encyclopaedia that is eMedicine. One aspect of interest is that the majority of the selected websites have been developed by or are principally oriented to veterinarians: as already stated, control of zoonotic infections is a multidisciplinary task that should encompass medical, public health and veterinary practitioners, as well as regional or national governmental authorities. Such a multidisciplinary approach is rarely encountered on the WWW. An important aspect of zoonoses that has been underestimated both in general and in their WWW representation is that they comprise almost the entire list of potential biological weapons. All bar one of the Category A biological agents listed by the CDC are zoonoses, as are the majority of Category B agents (Pappas et al., 2006b). One may support the fact that a lot of information on zoonotic agents may be derived from websites focusing on biological threats, but that is an entirely different field, beyond the aims of our study: what is missing is an electronic database focusing on the concept of zoonoses as biological weapons (a concept that, given their epidemiology, raises interesting issues). How reliable is the information available on these websites? This is an eternal question regarding the WWW, but in this case it can be ameliorated by the fact that the websites listed are derived from authoritative institutions and organisations. An opposing example that has been included, however, is that of Zoonoses.org, which promises ‘Zoonotic Epidemiological Research and Education for everyone to understand!’ and is developed by an independent association and, at present at least, offers mixed information focusing on social aspects of certain zoonoses. What is questionable, however, regarding some of these websites is whether they are up to date. Indeed, some of the websites listed (and remember that these were the selected ones), appear to be no more than classical information randomly, if at all, updated. This may be suitable for the public’s needs, which do not necessarily deviate over time, but it may be inadequate for a health practitioner who is in need of constant updating. For a medical practitioner to be constantly updated on a variety of zoonoses, the choices are few and not included in the list: medical search engines such as PubMed and Scopus do not summarise under the keyword zoonoses individual diseases, and a kind of newsreel on zoonoses is missing from the WWW.
1188 Such a website, one that would recognise the multifactorial approach needed in zoonotic infections, would serve as a platform that joins health professionals with common interests and would further serve in lobbying for dissemination of medical information on zoonoses where it is most needed, i.e. in the developing world. In summary, a member of the public can answer many of their queries by consulting a website such as Defra’s or that of the Texas Department of State Health Services, and can become active through the Washington State Department of Health’s website; veterinarians and public health practitioners may extract new regional and international data related to their field by numerous websites such as MZCP, MED-NETVET, OIE or the Hannover WHO Collaborating Centre; medical practitioners, however, as well as professionals looking for a more generalised approach have limited options. Funding: None. Conflicts of interest: None declared. Ethical approval: Not required.
References Blancou, J., Chomel, B.B., Belotto, A., Meslin, F.X., 2005. Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance and control. Vet. Res. 36, 507—522.
G. Pappas et al. Chomel, B.B., Belotto, A., Meslin, F.X., 2007. Wildlife, exotic pets, and emerging zoonoses. Emerg. Infect. Dis. 13, 6—11. Feldmann, H., Czub, M., Jones, S., Dick, D., Garbutt, M., Grolla, A., Artsob, H., 2002. Emerging and re-emerging infectious diseases. Med. Microbiol. Immunol. 191, 63—74. Giustini, D., 2005. How Google is changing medicine. BMJ 331, 1487—1488. Hub´ alek, Z., 2002. Emerging human infectious diseases: anthroponoses, zoonoses, and sapronoses. Emerg. Infect. Dis. 9, 404. Pappas, G., Falagas, M.E., 2007. Free internal medicine case-based education through the World Wide Web: how, where, and with what? Mayo Clin. Proc. 82, 203—207. Pappas, G., Papadimitriou, P., Akritidis, N., Christou, L., Tsianos, E.V., 2006a. The new global map of human brucellosis. Lancet Infect. Dis. 6, 91—99. Pappas, G., Panagopoulou, P., Christou, L., Akritidis, N., 2006b. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect. Dis. Clin. North Am. 20, 395—421. Pappas, G., Papadimitriou, P., Falagas, M.E., 2007. World Wide Web hepatitis B virus resources. J. Clin. Virol. 38, 161—164. Pounds, J.A., Bustamante, M.R., Coloma, L.A., Consuegra, J.A., Fogden, M.P., Foster, P.N., La Marca, E., Masters, K.L., MerinoViteri, A., Puschendorf, R., Ron, S.R., S´ anchez-Azofeifa, G.A., Still, C.J., Young, B.E., 2006. Widespread amphibian extinctions from epidemic disease driven by global warming. Nature 439, 161—167. Taylor, L.H., Latham, S.M., Woolhouse, M.E., 2001. Risk factors for human disease emergence. Philos. Trans. R. Soc. Lond. B Biol. Sci. 356, 983—989.
available at www.sciencedirect.com
journal homepage: www.elsevierhealth.com/journals/trst
REVIEW
World Wide Web resources on zoonotic infections: a subjective overview Georgios Pappas a,b, Konstantinos N. Fragoulis b, Matthew E. Falagas b,c,∗ a
Institute for Continuing Medical Education of Ioannina, Ioannina, Greece Alfa Institute of Biomedical Sciences (AIBS), 9 Neapoleos Street, 151 23 Marousi, Athens, Greece c Department of Medicine, Tufts University School of Medicine, Boston, MA, USA b
Received 24 January 2008; received in revised form 1 April 2008; accepted 3 April 2008 Available online 2 June 2008
KEYWORDS Zoonoses; Zoonotic infections; Resources; World Wide Web; Internet; Medical education; Public health
Summary Zoonoses are a diverse group of infections whose significance is underestimated and understudied. The prevalence of zoonoses is higher in the developing world, where health professionals are often deprived of the rapid and free availability of related scientific information; however, continuous evolution of the World Wide Web (WWW) may offer such an option. This review sought to evaluate the content of available WWW resources on zoonoses. Two authors independently identified relevant websites. The selected websites were considered of merit upon consensus of all the authors. Only websites with freely available content were included. Websites on individual zoonoses were excluded. Through the numerous sites encountered on the WWW on zoonoses, there are certain ones that offer adequate information for the public and others that can serve as useful initiators for the non-specialist. Most sites approach zoonoses one-dimensionally, either as a public health, medical or veterinarian problem. The few sites that offer updates on zoonoses unfortunately focus on regional news. Ample information for the public and non-specialists on zoonoses can be traced on the WWW. However, what is missing is a site that will continuously update health professionals who deal with zoonoses in all their medical, veterinary and public health aspects. © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.
1. Introduction Zoonotic infections account for a significant percentage of infection-related morbidity and mortality worldwide. Moreover, the majority of emerging and re-emerging infec-
∗
Corresponding author. E-mail address: [email protected] (M.E. Falagas).
tious threats belong to zoonoses (Feldmann et al., 2002). However, the importance of these infections is often underestimated for a variety of reasons. First, the diversity of the term zoonoses, which encompasses a wide variety of pathogens—–more than 175 infectious diseases are characterised as zoonoses and the list has been reproduced randomly and variably (Hub´ alek, 2002; Taylor et al., 2001). Second, zoonoses are often endemic in areas with lower socioeconomic and health-related status (Blancou et al., 2005; Pappas et al., 2006a) and thus fail to gain the scientific
0035-9203/$ — see front matter © 2008 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.trstmh.2008.04.006
1182
G. Pappas et al.
attention of the developed (scientific) world, at least until they also emerge in industrialised countries or until they become significant travel-related or pet animal-related factors of morbidity (Chomel et al., 2007). Third, the diverse background of these diseases often perplexes researchers who study them: most of these infections have not only a medical background, but also a veterinary and an ecological one (Pounds et al., 2006), and sometimes socioeconomic parameters also intervene; thus, studying them to their full extent demands a complex collaboration between various scientific specialties. In countries with poor health-related resources (including medical educational resources), zoonotic ecology imposes a significant burden on specialists and clinical practitioners. Information is often barely available and, for some entities, is scarce. Restrictions on literature availability may drastically affect a specialist’s ability to deal adequately with a disease. Evolution of the World Wide Web (WWW) promised to reverse the tide. The free electronic availability of information has rapidly transformed the ways medical practitioners get, distribute or discuss medical advances and data (Pappas and Falagas, 2007; Pappas et al., 2007) and certain indications show that we are only at the beginning of this information revolution. This review sought to summarise available WWW resources on zoonoses, focusing on free distribution of information related to more than one zoonotic infection. The authors further discuss individual website characteristics regarding the quality of information available and the scientific groups to which this information is targeted.
2. Materials and methods Data on available websites with information on zoonoses were collected as follows: two of the authors (one specialising in human zoonotic infections and one with marginal familiarity with the subject) independently performed an Internet search using general search engines such as Google and Yahoo and the keywords ‘zoonoses—zoonotic infections’. Of the endless list of websites retrieved (typing the word ‘zoonoses’ in Google retrieves 2 780 000 results), each author evaluated the first 1000 sites retrieved by the search engines and selected specific sites that were considered as
Table 1
helpful/interesting. Google offers subcategories of results with the tags ‘for health professionals’ and ‘for patients’, and these subcategories were also extensively investigated. References of retrieved websites were also evaluated for inclusion. Table 1 summarises the criteria used for assessment and the subcategories investigated. The websites that were selected by both authors were by default included. Websites selected by only one of the authors were further evaluated by the co-authors and included upon consensus of all authors. The rationale behind the method was that any individual, with or without a scientific interest, would use a similar approach in retrieving information on zoonoses and we chose to simulate this approach (Giustini, 2005).
3. Zoonotic infections on the WWW The researcher with marginal interest in zoonotic infections retrieved 52 websites considered as potentially interesting, whilst the researcher specialising in human zoonotic infections retrieved 24 such websites. The 22 websites common for both researchers were considered as eligible for further evaluation, as well as 2 websites each selected by one researcher only, considered as eligible after consensus with the third researcher. Table 2 summarises the selected website resources on zoonotic infections in general, their background and their individual characteristics. It goes without saying that the list is by no means objective: the methods of retrieving these websites were at first subjective, but applying to practical experience as already discussed. A brief overview of Table 2 shows that information is derived from international organisations, academic institutions, national and regional health protection agencies, or websites offering general medical information. One would expect that the websites of large national or international organisations related to zoonoses would offer all information relevant to medical, veterinary and public health aspects of zoonotic infections, as well as sufficient introductory information for the public. However, the majority of the websites offer information that may address the public’s needs but serve only as a brief summary for healthcare practitioners, or vice versa. Another easily observed aspect is that the vast majority of websites
Criteria used for assessment of World Wide Web sites on zoonoses
Criteria • Freely available content • Objectivity of the data (presented by health authorities or specialists in aspects of zoonoses) • Regularly updated sites (evaluated through the ‘last updated’ date on the website, or for change of contents in two different time periods with a 1-month interval in case of recent update date) • Focus on zoonoses as a general concept or a large number of individual zoonoses (sites on isolated zoonoses were excluded) • Information relevant to a global audience (sites with information of regional importance on specific individual zoonoses were excluded) • Subcategories evaluated • Orientation of information to health professionals or the public • Orientation of information to medical, veterinary or public health aspects of zoonoses
Selected open-access World Wide Web (WWW) resources on zoonoses
Website title
Title of web page presenting information
Website URL
Information target
Comments
US Centers for Disease Control and Prevention (CDC)
National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED) Zoonoses
http://www.cdc.gov/nczved/
Health professionals (medical, veterinary, public health) and public
Recently launched, too early to judge?
http://www.who.int/topics/zoonoses/en/
Health professionals (medical, veterinary, public health) and public
Introductory remarks on the WHO/MZCP
http://www.mzcp-zoonoses.gr
Health professionals (veterinary, public health) and public
Disease information meets neither the public’s nor the professional’s demands Promoting programmes for the prevention, surveillance and control of zoonoses and related food-borne diseases
Detection, surveillance and control of zoonoses and other relevant diseases
http://www.veterinary-publichealth.de/home e/aufgaben/zoonosen/liste zoonosen e.htm
Health professionals (medical, veterinary, public health) and public
The most complete list of zoonoses available on the WWW, along with brief details and links
Zoonoses/Animal Health
http://www.paho.org/english/ad/dpc/vp/zoonosis.htm
Health professionals (medical, veterinary, public health)
Links to sites containing important information
http://www.oie.int/eng/en index.htm
Health professionals (veterinary, public health)
Professionally oriented, veterinary-oriented, news section, useful for epidemiology of animal disease, extensively informative
WHO
Mediterranean Zoonoses Control Programme (MZCP) of the WHO WHO Collaborating Centre for Research and Training in Veterinary Public Health (Hannover, Germany) The Pan American Health Organization (PAHO) The World Organisation for Animal Health (OIE)
Zoonoses on the world wide web
Table 2
1183
1184
Table 2 (Continued ) Website title
Title of web page presenting information
Website URL
Information target
Comments
http://www.medvetnet.org/cms
Health professionals (veterinary) and public
Zoonoses: Diseases
http://www.defra.gov.uk/animalh/diseases/zoonoses/common.htm
Health professionals (veterinary, public health) and public
Excellent network for veterinarians, ample scientific information with the relevant orientation The most comprehensive disease information for the public
Zoonoses (infections acquired from animals) Gastrointestinal & Zoonoses
http://www.hpa.org.uk/webw/HPAweb&Page&HPAwebAutoListName/ Health professionals Page/1191942145653?p=1191942145653 (veterinary, public health) and public
Shares public information with Defra
http://www.hps.scot.nhs.uk/giz/
Health professionals (veterinary, public health) and public
Human Food/Waterborne Disease Surveillance—– Zoonoses
http://www.fsai.ie/surveillance/human foodborne/zoonoses.asp
Health professionals (veterinary, public health)
Information for scientists and public, surveillance reports, news of regional interest A concise introduction to zoonoses and regional reports
http://www.food.dtu.dk/Default.aspx?ID=8573
Health professionals (veterinary, public health)
MED-VET-NET
Department for Environment, Food and Rural Affairs (Defra), UK Health Protection Agency (HPA), UK Health Protection Scotland
Food Safety Authority of Ireland
Danish Zoonoses Centre
Zoonoses
http://www.healthysa.sa.gov.au/zoonoses.asp
Health professionals (public health) and public
County of Los Angeles, Department of Public Health
Zoonoses Manual
http://www.lapublichealth.org/vet/guides/vetzooman.htm Zoonoses
Health professionals (veterinary, public health) and public
G. Pappas et al.
Government of South Australia, Department of Health
Typical website with regional surveillance data and information for professionals Links to other sites with information on zoonoses matters, however link selection does not always lead to the expected results An extensive text on the significance of zoonoses, with various regional epidemiology data
Zoonotic Disease Program
http://www.odh.ohio.gov/odhprograms/idc/zoodis/zoomain1.aspx
Public
Texas Department of State Health Services
Zoonotic Health Topics
http://www.dshs.state.tx.us/idcu/health/zoonosis/default.asp
Health professionals (medical, public health) and public
Washington State Department of Health
Zoonotic Disease Program
http://www.doh.wa.gov/ehp/ts/ZOO.HTM
Health professionals (medical, public health) and public
University of California, Santa Barbara
Zoonotic Diseases
http://research.ucsb.edu/connect/pro/disease.html
Health professionals (medical)
Oregon State University
Zoonoses
http://oregonstate.edu/occupationalhealth/educational/species/
Public
University of South Carolina, Department of Pathology, Microbiology, and Immunology
Zoonoses
http://pathmicro.med.sc.edu/ghaffar/zoonoses.htm
Health professionals (medical, public health)
Average factsheets for the public on certain zoonoses; more information on selected diseases such as vector-borne and rabies Excellent coverage of most aspects of zoonoses, including advice for the public and health professionals on almost everything Excellent, public-oriented, but interventional, website on zoonoses; an example of public health policy on the subject Similar to a pocket book companion for the non-specialist health professional, small vignettes for numerous zoonoses. One of the few sites to explain the origin of the word ‘zoonosis’ An interesting site for owners of household animals and pets A few clinical data and a lot of interesting clinical images for some diseases
Zoonoses on the world wide web
Ohio Department of Health
1185
1186
Table 2 (Continued ) Website title
Title of web page presenting information
Website URL
Information target
Comments
University of Wisconsin— Madison, School of Veterinary Medicine eMedicine
Zoonotic Diseases Tutorial
http://svmweb.vetmed.wisc.edu/pbs/zoonoses/
Health professionals (medical, veterinary)
Like an extended version of the above, for the non-specialist health professional
Articles on zoonoses
http://www.emedicine.com/cgi-bin/foxweb.exe/ searchengine@/em/searchengine?boolean=and&book= all&maxhits=40&HiddenURL=&query=ZOONOSES
Health professionals (medical)
Zoonoses.org
http://lifesavescience.org/Zoonoses/index.htm
Public
Infectious Animal and Zoonotic Disease Surveillance
http://www.fas.org/ahead/index.html
Health professionals (veterinary, public health)
The link returns results for a few zoonoses, but individual disease names can be used to trace the relevant, highly educative and reasonably updated information for clinicians ‘Zoonotic Epidemiological Research and Education for everyone to understand!’: focuses on a few social issues of a few zoonoses Focuses on surveillance with an eye on agroterrorism issues
LifeSave Biological Research & Education Consortium on Human (and Animal) Health, Utah, USA, Int’l Federation of American Scientists
G. Pappas et al.
Zoonoses on the world wide web arise from US-based academic institutions or agencies, and only a few are of European origin, an observation that has been reproduced when evaluating WWW resources on other health-related issues (Pappas and Falagas, 2007; Pappas et al., 2007). The website of the recently developed National Center for Zoonotic, Vector-Borne, and Enteric Diseases (NCZVED), a US Centers for Disease Control and Prevention (CDC) branch, is one of the more widely known such organisations, linking also to FoodNet and PulseNet, two networks focusing on food-borne infections, the majority of which are zoonotic. The homepage spotlights certain interesting news related to the subject, but information on specific diseases is mainly based on CDC factsheets. However, since NCZVED is a new organisation, one has to see how its website will evolve. The website of the WHO on zoonoses includes minimal information on a few of the individual diseases, with some links to related WHO documents (where one may or may not find adequate information), informs on initiatives related to zoonoses and relevant outbreaks, and links to other WHO-related initiatives. One of these, the Mediterranean Zoonosis Control Programme (MZCP), has a website with very useful information on different zoonoses, which may be particularly interesting to veterinarians and public health practitioners (there is even more information with an orientation for the public in the Greek language—–MZCP is based in Athens). The organisation’s bulletin offers regional news on the subject and its activities, but the news section of the website is not updated. MZCP manages to keep a firm balance between information for the public (typically by well prepared brochures on individual diseases) and information for certain subcategories of health professionals (veterinarians and public health specialists). Another WHO-related institution, the WHO Collaborating Centre for Research and Training in Veterinary Public Health, based in Hannover, Germany, offers a website that has the most comprehensive list of zoonoses available on the WWW, along with brief information and links to further information on individual diseases. Yet another WHO-related organisation is the Pan American Health Organization (PAHO), which has the most extensively updated website on practically all aspects of zoonotic infections, such as surveillance, outbreaks, incidence reports and selected useful publications. However, its utility is marginalised by the fact that it is strongly focused on the American continent, itself home to a wide variety of zoonoses. A more veterinarian-oriented approach is present in the rich website of the World Organization for Animal Health (OIE, from the French initials). It has a news feed that is often updated, extensive information, mainly for the professional on individual diseases, and data on the animal prevalence of zoonoses worldwide (and a few selected anthropozoonoses). MED-VET-NET is ‘a newly-established Network of Excellence for the Integrated Research on the Prevention and Control of Zoonoses by integrating veterinary, medical and food science research’ that encompasses scientists from numerous European countries and offers excellent, if somewhat veterinarian-oriented, scientific information on current and future zoonoses research. A similar veterinarian-oriented approach is used in the relative website of the UK-based Defra (Department for
1187 Environment, Food and Rural Affairs). Here, though, one can find the most concise disease information for the public available, shared with the (also UK-based) Health Protection Agency (HPA), an ‘independent body that protects the health and well-being of the population’. Merging the interests of the public and public health, and posing as an excellent example of state intervention on zoonoses in the community, is the Washington State Department of Health zoonotic disease program, with information for the public that invites them to act, and a bulletin with regional zoonoses news that manages to attract equally the public and the scientific interest. The Texas Department of State Health Services website on zoonoses is another excellent site that answers practically any possible question of the public and the non-specialist health professional, even dealing with subjects such as animals in a disaster, etc. The most concise and reasonably up-to-date information for medical professionals, on the other hand, can be traced for individual diseases through the invaluable electronic medical encyclopaedia that is eMedicine. One aspect of interest is that the majority of the selected websites have been developed by or are principally oriented to veterinarians: as already stated, control of zoonotic infections is a multidisciplinary task that should encompass medical, public health and veterinary practitioners, as well as regional or national governmental authorities. Such a multidisciplinary approach is rarely encountered on the WWW. An important aspect of zoonoses that has been underestimated both in general and in their WWW representation is that they comprise almost the entire list of potential biological weapons. All bar one of the Category A biological agents listed by the CDC are zoonoses, as are the majority of Category B agents (Pappas et al., 2006b). One may support the fact that a lot of information on zoonotic agents may be derived from websites focusing on biological threats, but that is an entirely different field, beyond the aims of our study: what is missing is an electronic database focusing on the concept of zoonoses as biological weapons (a concept that, given their epidemiology, raises interesting issues). How reliable is the information available on these websites? This is an eternal question regarding the WWW, but in this case it can be ameliorated by the fact that the websites listed are derived from authoritative institutions and organisations. An opposing example that has been included, however, is that of Zoonoses.org, which promises ‘Zoonotic Epidemiological Research and Education for everyone to understand!’ and is developed by an independent association and, at present at least, offers mixed information focusing on social aspects of certain zoonoses. What is questionable, however, regarding some of these websites is whether they are up to date. Indeed, some of the websites listed (and remember that these were the selected ones), appear to be no more than classical information randomly, if at all, updated. This may be suitable for the public’s needs, which do not necessarily deviate over time, but it may be inadequate for a health practitioner who is in need of constant updating. For a medical practitioner to be constantly updated on a variety of zoonoses, the choices are few and not included in the list: medical search engines such as PubMed and Scopus do not summarise under the keyword zoonoses individual diseases, and a kind of newsreel on zoonoses is missing from the WWW.
1188 Such a website, one that would recognise the multifactorial approach needed in zoonotic infections, would serve as a platform that joins health professionals with common interests and would further serve in lobbying for dissemination of medical information on zoonoses where it is most needed, i.e. in the developing world. In summary, a member of the public can answer many of their queries by consulting a website such as Defra’s or that of the Texas Department of State Health Services, and can become active through the Washington State Department of Health’s website; veterinarians and public health practitioners may extract new regional and international data related to their field by numerous websites such as MZCP, MED-NETVET, OIE or the Hannover WHO Collaborating Centre; medical practitioners, however, as well as professionals looking for a more generalised approach have limited options. Funding: None. Conflicts of interest: None declared. Ethical approval: Not required.
References Blancou, J., Chomel, B.B., Belotto, A., Meslin, F.X., 2005. Emerging or re-emerging bacterial zoonoses: factors of emergence, surveillance and control. Vet. Res. 36, 507—522.
G. Pappas et al. Chomel, B.B., Belotto, A., Meslin, F.X., 2007. Wildlife, exotic pets, and emerging zoonoses. Emerg. Infect. Dis. 13, 6—11. Feldmann, H., Czub, M., Jones, S., Dick, D., Garbutt, M., Grolla, A., Artsob, H., 2002. Emerging and re-emerging infectious diseases. Med. Microbiol. Immunol. 191, 63—74. Giustini, D., 2005. How Google is changing medicine. BMJ 331, 1487—1488. Hub´ alek, Z., 2002. Emerging human infectious diseases: anthroponoses, zoonoses, and sapronoses. Emerg. Infect. Dis. 9, 404. Pappas, G., Falagas, M.E., 2007. Free internal medicine case-based education through the World Wide Web: how, where, and with what? Mayo Clin. Proc. 82, 203—207. Pappas, G., Papadimitriou, P., Akritidis, N., Christou, L., Tsianos, E.V., 2006a. The new global map of human brucellosis. Lancet Infect. Dis. 6, 91—99. Pappas, G., Panagopoulou, P., Christou, L., Akritidis, N., 2006b. Category B potential bioterrorism agents: bacteria, viruses, toxins, and foodborne and waterborne pathogens. Infect. Dis. Clin. North Am. 20, 395—421. Pappas, G., Papadimitriou, P., Falagas, M.E., 2007. World Wide Web hepatitis B virus resources. J. Clin. Virol. 38, 161—164. Pounds, J.A., Bustamante, M.R., Coloma, L.A., Consuegra, J.A., Fogden, M.P., Foster, P.N., La Marca, E., Masters, K.L., MerinoViteri, A., Puschendorf, R., Ron, S.R., S´ anchez-Azofeifa, G.A., Still, C.J., Young, B.E., 2006. Widespread amphibian extinctions from epidemic disease driven by global warming. Nature 439, 161—167. Taylor, L.H., Latham, S.M., Woolhouse, M.E., 2001. Risk factors for human disease emergence. Philos. Trans. R. Soc. Lond. B Biol. Sci. 356, 983—989.