Using Cell Phone Technology to Investigate a Deliberate Bacillus anthracis Release Scenario

Unusual biological events and outbreaks require rapid epidemiologic investigation and contact tracing procedures, allowing optimal handling of resources. Currently, these are resource intensive, time consuming, and extremely complex, requiring large teams of trained and prepared personnel. The goal of this study was to determine whether a technological alternative to the classic systems, based on the use of mobile phones and a unique algorithm, could perform a complete epidemiologic investigation in a setting of a bioterrorism scenario. The system was tested with 32 volunteers during a bioterrorism simulation drill, with quantitative assessment of key outcome measures: perform a complete analysis of the scenario, determine the fundamental biological attributes of the scenario, distinguish between related and unrelated cases, and identify possible exposed people among a known group of participants. The system fully achieved the objectives in just under 5 hours from the beginning of the simulation with only 3 false-positive "exposed" participants, while identifying all 11 true-positive "exposed" participants (overall accuracy of 85%). We find the system advantageous over currently used tools in a way that could be integrated in conjunction with current outbreak epidemiologic investigation tools and syndromic surveillance efforts to shorten the response time of national authorities in handling adverse biological events.