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RSVP system deployed along U.S.-Mexican border proves value, detects two disease outbreaks

DOE/Sandia National Laboratories : 22 December, 2006  (Technical Article)
RSVP was conceived by Sandia Senior Scientist Alan Zelicoff, a physician/physicist working in the National Nuclear Security Administration lab
Zelicoff is also a member of the team led by Sandia Vice President/Principal Scientist Gerold Yonas that is developing the Bi-National Lab concept. The idea was conceived by Yonas after a trip to Juarez, Mexico, during which he was struck by the grinding poverty and absence of technology development on both sides of the border.

Since then, U.S. and Mexican officials have met at various levels with Yonas and other members of the BNSL team in substantive discussions about ways to jointly develop the concept and exploit U.S. and Mexican technology as a means of realizing sustainable economic development and lessening tensions where international borders separate areas of need from areas of plenty.

Sen. Jeff Bingaman, D-N.M., an early supporter of the Bi-National Lab concept, got a firsthand look at the RSVP system Feb. 19 during a visit to Memorial Medical Center, the largest comprehensive medical-care campus in Las Cruces. It was demonstrated by Dr. Catherine Torres, a pediatrician and commissioner on the U.S.-Mexico Border Health Commission, who entered an actual case she was handling, a child with influenza-like symptoms.

Sandian Vipin Gupta, on assignment in the Las Cruces-El Paso, Texas area as part of the BNSL initiative, was present for the demonstration and pointed out to Bingaman that it is the same system he had seen only a couple of weeks before when he and Sen. Pete Domenici, R-N.M., hosted a briefing for Sen. Harry Reid, D-Nev., on counterterrorism technology being developed by Sandia and Los Alamos National Lab. Reid, majority whip in the Senate and chairman of the Energy and Water Development Appropriations Committee, said in a news conference following his tour at the lab that he had been impressed with Zelicoff’s briefing on RSVP’s potential.

Gupta said 33 members of the Memorial Medical Center staff, including physicians, nurse-practitioners, and nurses, now have RSVP log-in privileges. He said each case takes a minimum of 30-40 seconds to enter. The right combination of symptoms automatically notifies the New Mexico Department of Health by pager, fax, and e-mail, and public health officers can then call and talk to the care provider right away.

Torres said the system is a valuable aid in her practice. “Before, we never really knew what the rest of the state was doing,” she said. “The reporting system was slow and more difficult. Now, we can just push a button and get information.”

RSVP’s simplicity is key to its use, Zelicoff said recently after evaluating the numbers that show its growing popularity after the code was rewritten late last year.

“The good news is that Version 2.0 works very well,” he said. “Hospitals and clinicians like it. We keep stats on when they look at it, and it’s more or less while they’re drinking their morning coffee. They look and get a sort of ‘lay of the land.’

“It creates sort of an ‘index of suspicion’, the aches and pains could be flu, or something else,” he said. “Docs never had that data before. We gather it once a week and put it on the RSVP webpage and, finally, we have people in public health updating.

“We really are trying to capture their experience,” Zelicoff said, “because public health has the official role of declaring an epidemic. The system alerted physicians in Las Cruces to a sudden increase in flu and RSV, even before they began to see patients in their offices. By Saturday afternoon, stats were up on the Web, and they began to see patients in their offices Monday morning.

“In practical terms, they probably avoid lots of unnecessary tests, and probably lots of unnecessary drugs,” he added. “We are going to try to evaluate these and other parameters as part of the implementation in all clinics.”

Torres agreed, pointing out that there are medicines to prevent RSV in “preemies”, who might be at particularly high risk from pulmonary complications, and detecting the presence of the disease because of high numbers of symptoms delivered on RSVP makes treatment more likely to succeed.

She said she hopes the system will eventually be functioning in at least 150 sites strung out along both sides of the border, and Zelicoff was in Brownsville, Texas, at that moment setting up three stations in public health facilities for beta-testing prior to putting them on-line as part of the system.

RSVP also got a favorable nod from Dr. Bert Garrett, program director for the Southern New Mexico Family Practice Residency Program. “Having RSVP in areas along the border would allow for immediate input and useful information to be disseminated to a broader group of providers,” he said. “We predict that when the usefulness and potential of this program are generally understood, it will find widespread acceptance and application in the medical community.”

Bingaman, who watched the RSVP system operate in Las Cruces just a couple of days before joining Homeland Security Director Tom Ridge and NNSA Administrator Gen. John Gordon for briefings and demonstrations of counterterrorism technology at Sandia and Los Alamos, pointed out its utility in the current environment of the country’s war on terrorism.

“The Rapid Syndrome Validation Project could play a vital role in maintaining the public health, whether (health problems were) caused by Mother Nature or terrorists using biological agents,” he said. “This system could help quickly track illness outbreaks before they become a major threat. I’m pleased this system is now being deployed in communities along the border and I also hope this technology can be put to use across the public health system.”
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