ehrlichiosis/anaplasmosis 2010 typhoid fever west nile disease 2000 giardiasis yellow fever 1990 coccidioidomycosis typhus fever strep pneumoniae 1980 group a strep 1970 chickenpox listeriosis salmonellosis 1960 smallpox shigellosis 1950 cryptosporidiosis 1940 scarlet fever e. coli 1930 chlamydia 1920 pertussis haemophilus inf 1910 lyme disease 1900 diphtheria aids toxic shock 1888 measles legionellosis varioloid syphilis gonorrhea tuberculosis pneum & infl cholera rubella tetanus meningitis psittacosis pneumonia hepatitis malaria poliomyelitis trichiniasis streptococcal sore throat influenza botulism dengue meningococcal disease leprosy rabies in animals pellagra brucellosis mumps rocky mountain encephalitis tularemia anthrax dysentery

22 PITTMED featurefeature

A d atabase th at helps scientists understand contagion | By Brett Murphy Graphics courtesy Project Tycho

The History of Disease, in Color

ycho Brahe got his nose lopped off over an argu- ment about a math problem. He once refused to get up from a dinner party to relieve himself becauseT he thought it rude, resulting in, probably, a burst bladder that killed him. Yet, his peculiar brand of determina- This graphic chronicles the tion helped give rise to the scientific revolution. The Danish history of weekly disease reporting in the United States nobleman was among the last great “naked-eye” observers of since 1888. Each concentric circle represents a decade. the cosmos. Before his death in 1601, Brahe passed along his Moving clockwise, more dis- life’s work—30 years of detailed observations of the night eases are reported and filed. Red represents death reports. sky—to his assistant, Johannes Kepler, urging him not to let Other colors represent differ- the fruit of his labors languish. ent categories of reports. For instance, hepatitis began as a They did not. Brahe’s careful observations became the basis single report type, then differ- ent case reports led to other for Kepler’s laws of planetary motion, which would, in turn, classifications of the disease. contribute to Isaac Newton’s law of universal gravitation.

SPRING 14 23 where the d ata come from

1 ye ar

Each week, city public health officials report “notifiable” disease occurrences to their respective states. Outbreaks for a given disease can be plotted on an epidemiological curve (purple arrow). Data from all U.S. states and territories—the number of reported cases per week—are compiled at the federal level. Project Tycho digitized these data into color-coded bar graphs for the past 125 years for easy access and analysis. ( Red signifies a high number of reported cases and blue signifies a low number.)

Four centuries later, the Pitt researchers And access to it is free, says Wilbert van lation has been fraught with redundan- hok, C m the m the . S . Panhuis, an MD/PhD professor of epide- ro who created Project Tycho, a digital database cies. Most projects are focused on specific f N that provides open access to U.S. disease sur- miology at Pitt’s Graduate School of Public questions; a researcher might toil for years . Jung,

veillance data, hope they have created a simi- Health and lead investigator for the proj- answering a question like, .Y What effects do rmission S lar foundation for discovery. The newly built ect. “Our vision was that not only us, but condom distribution programs have on the ith pe gious Diseases in the w stette, everybody should be able to use this public epidemiological archive chronicles reports of rate of HIV infection in the rural United d en f onta C 56 infectious diseases in every state before, data for analysis and models.” For instance, States? In search of answers, investigators re G during, and after vaccination licensure from anybody with enough interest and access to painstakingly build data sets that often are Burke. uis, J. . 1888 to recent times. the Internet—a scientist at a university or not shared. And it can be difficult to get S anh It took almost three years and more than pharmaceutical company, a journalist, an funding to create archives with no specific P . van . van

undergrad—can easily track where and when G

200 million keystrokes to create the Project research questions in mind. mmings, D. u Tycho archive. Many of those workers were the polio vaccine was implemented and its Happily, both the National Institutes C n, D.

efficacy in those cities. w University of Pittsburgh undergrads as well of Health and the Bill and Melinda Gates 2013; 369(22): 2152-2158. reprinte

M J Bro

as students from Digital Divide Data, a social “We hope there are epidemiological, dis- Foundation saw value in creating a massive . . all others: W. NE S , enterprise that provides jobs and education ease-curing Keplers today who will be able to digital archive and funded Project Tycho. y UPMC hn z

use these data to derive important laws and ro

to young people in Cambodia, Laos, and The Project Tycho team has also been . y o Kenya. These clerks standardized and orga- insights on how epidemics arrive, leave, and inventing new methods to process and ana- d . Za V

nized almost 90 million cases from weekly interact,” says coinvestigator Donald Burke lyze public health data. In a November 2013 e, al al societ e L ic . d

public health records (paper and PDFs) in the project’s promotional video. Burke is New England Journal of Medicine paper, them 1888 to present. ro an MD professor of medicine and of infec- f from all U.S. states and territories, including Project Tycho researchers (from Pitt’s pub- ng, B.Y E . tes H

more than 3,000 American cities. What they tious diseases (among other appointments) lic health, medicine, and information sci- ta S s,

d

and dean of Pitt Public Health. e

wrought: the largest centralized bank of digi- ences schools with collaborators from Johns ros C nit . graphics: this Doug page, Freeman/ A U tized disease surveillance data ever assembled. The field of public health data compi- Hopkins) revealed that vaccination programs massachusetts me

24 PITTMED pertussis measles

Project Tycho stacks weekly graphs (incidence rates per 100,000) into years and then decades for each state. Before vaccine licensure, epidemics would occur every year across the nation. With each disease shown here, you can see the drastic shift in reported cases before and after the time of licensure— see the red lines. (Smallpox innoculation predates the graph.) The Y axes show U.S. regions/states. The top panels display the weekly incidence rates for all states combined. smallpox Of note is the natural rubella history of pertussis (whoop- ing cough). After vaccine development, we see a dramatic drop-off; between the ’40s and ’70s, not more than 1 case was reported per 100,000 people nation- wide in weekly updates. But recently, because of failure to vaccinate as well as the decline in efficacy of the acellular pertussis vaccine, whooping cough epidemics have been on the upswing. The Project Tycho team estimates that from 1924 to 2010, 103 million cases of serious childhood diseases were prevented by vaccina- tion in the United States.

for polio, measles, mumps, rubella, hepati- nization of their children,” the Project Tycho collect data, let alone analyze them. What’s in tis A, diphtheria, and pertussis (whooping team reports, “which leads to local variations it for us?, the gatekeepers may wonder. cough) have prevented more than 100 million in vaccine coverage and increased risk of Well, perhaps the lives of millions. cases of serious childhood infectious diseases disease outbreaks.” Van Panhuis admits he Van Panhuis remains optimistic. He says since 1924. Still, some of these pathogens are hopes the project “will introduce new evi- understanding a disease’s narrative, locally reemerging. Pertussis vaccines, for example, dence into the debate about vaccination.” and globally, can help move the scientific have been available since the 1920s, but the The next big step for Project Tycho is to field forward in developing theories about worst whooping cough epidemic since 1959 go global. But, Van Panhuis says, techno- causation—and then, ways to control or occurred in 2012, with more than 48,000 logical, economic, and political barriers can prevent disease. n cases nationwide reported by December of hinder cooperation. For instance, developing that year. countries that rely on tourism might be wary Elaine Vitone contributed to this report. “Parents who question the risk-benefit bal- of releasing information about epidemics. To take a peek at Project Tycho, visit: ance of vaccination may refuse or delay immu- And they may not even have the means to www.tycho.pitt.edu

SPRING 14 25