Infodemiology and Infoveillance: Scoping Review

Background: Web-based sources are increasingly employed in the analysis, detection, and forecasting of diseases and epidemics, and in predicting human behavior toward several health topics. This use of the internet has come to be known as infodemiology, a concept introduced by Gunther Eysenbach. Infodemiology and infoveillance studies use web-based data and have become an integral part of health informatics research over the past decade. Objective: The aim of this paper is to provide a scoping review of the state-of-the-art in infodemiology along with the background and history of the concept, to identify sources and health categories and topics, to elaborate on the validity of the employed methods, and to discuss the gaps identified in current research. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to extract the publications that fall under the umbrella of infodemiology and infoveillance from the JMIR, PubMed, and Scopus databases. A total of 338 documents were extracted for assessment. Results: Of the 338 studies, the vast majority (n=282, 83.4%) were published with JMIR Publications. The Journal of Medical Internet Research features almost half of the publications (n=168, 49.7%), and JMIR Public Health and Surveillance has more than one-fifth of the examined studies (n=74, 21.9%). The interest in the subject has been increasing every year, with 2018 featuring more than one-fourth of the total publications (n=89, 26.3%), and the publications in 2017 and 2018 combined accounted for more than half (n=171, 50.6%) of the total number of publications in the last decade. The most popular source was Twitter with 45.0% (n=152), followed by Google with 24.6% (n=83), websites and platforms with 13.9% (n=47), blogs and forums with 10.1% (n=34), Facebook with 8.9% (n=30), and other search engines with 5.6% (n=19). As for the subjects examined, conditions and diseases with 17.2% (n=58) and epidemics and outbreaks with 15.7% (n=53) were the most popular categories identified in this review, followed by health care (n=39, 11.5%), drugs (n=40, 10.4%), and smoking and alcohol (n=29, 8.6%). Conclusions: The field of infodemiology is becoming increasingly popular, employing innovative methods and approaches for health assessment. The use of web-based sources, which provide us with information that would not be accessible otherwise and tackles the issues arising from the time-consuming traditional methods, shows that infodemiology plays an important role in health informatics research

Tracking COVID-19 in Europe: Infodemiology Approach

Background: Infodemiology (ie, information epidemiology) uses web-based data to inform public health and policy. Infodemiology metrics have been widely and successfully used to assess and forecast epidemics and outbreaks. Objective: In light of the recent coronavirus disease (COVID-19) pandemic that started in Wuhan, China in 2019, online search traffic data from Google are used to track the spread of the new coronavirus disease in Europe. Methods: Time series from Google Trends from January to March 2020 on the Topic (Virus) of “Coronavirus” were retrieved and correlated with official data on COVID-19 cases and deaths worldwide and in the European countries that have been affected the most: Italy (at national and regional level), Spain, France, Germany, and the United Kingdom. Results: Statistically significant correlations are observed between online interest and COVID-19 cases and deaths. Furthermore, a critical point, after which the Pearson correlation coefficient starts declining (even if it is still statistically significant) was identified, indicating that this method is most efficient in regions or countries that have not yet peaked in COVID-19 cases. Conclusions: In the past, infodemiology metrics in general and data from Google Trends in particular have been shown to be useful in tracking and forecasting outbreaks, epidemics, and pandemics as, for example, in the cases of the Middle East respiratory syndrome, Ebola, measles, and Zika. With the COVID-19 pandemic still in the beginning stages, it is essential to explore and combine new methods of disease surveillance to assist with the preparedness of health care systems at the regional level

Google Trends in Infodemiology and Infoveillance: Methodology Framework

Background: The use of Internet data is increasingly integrated in Health Informatics research and is becoming a useful tool in exploring human behavior. The most popular tool for examining online behavior is Google Trends, an open tool that provides information on what is trending and on the variations of the online interest in selected keywords and topics over time. Online search traffic data from Google have been shown to be useful in analyzing human behavior towards health topics and in predicting diseases’ occurrence and outbreaks. Objective: Despite the large number of Google Trends studies during the last decade, the literature on the subject lacks a specific methodology framework. This article aims at providing an overview of the tool and data, and at presenting the first methodology framework in using Google Trends in Infodemiology and Infoveillance, consisting of the main factors that need to be taken into account for a solid methodology base. Methods: We provide a step-by-step guide for the methodology that needs to be followed when researching with Google Trends; essential for robust results in this line of research. Results: At first, an overview of the tool and the data are presented, followed by the analysis of the key methodological points for ensuring the robustness of the results, i.e., selecting the appropriate keyword(s), region(s), period, and category. Conclusions: In the era of Big Data, the analysis of online queries is all the more integrated in health research. This article presents and analyzes the key points that need to be considered for a solid methodology basis when using Google Trends data, which is crucial for ensuring the value and validity of the results

Infoveillance of infectious diseases in USA: STDs, tuberculosis, and hepatitis

Big Data Analytics have become an integral part of Health Informatics over the past years, with the analysis of Internet data being all the more popular in health assessment in various topics. In this study, we first examine the geographical distribution of the online behavioral variations towards Chlamydia, Gonorrhea, Syphilis, Tuberculosis, and Hepatitis in the United States by year from 2004 to 2017. Next, we examine the correlations between Google Trends data and official health data from the ‘Centers for Disease Control and Prevention’ (CDC) on said diseases, followed by estimating linear regressions for the respective relationships. The results show that Infoveillance can assist with exploring public awareness and accurately measure the behavioral changes towards said diseases. The correlations between Google Trends data and CDC data on Chlamydia cases are statistically significant at a national level and in most of the states, while the forecasting exhibits good performing results in many states. For Hepatitis, significant correlations are observed for several US States, while forecasting also exhibits promising results. On the contrary, several factors can affect the applicability of this forecasting method, as in the cases of Gonorrhea, Syphilis, and Tuberculosis, where the correlations are statistically significant in fewer states. Thus this study highlights that the analysis of Google Trends data should be done with caution in order for the results to be robust. In addition, we suggest that the applicability of this method is not that trivial or universal, and that several factors need to be taken into account when using online data in this line of research. However, this study also supports previous findings suggesting that the analysis of real-time online data is important in health assessment, as it tackles the long procedure of data collection and analysis in traditional survey methods, and provides us with information that could not be accessible otherwise

The Internet and the Anti-Vaccine Movement: Tracking the 2017 EU Measles Outbreak

In the Internet Era of information overload, how does the individual filter and process available knowledge? In addressing this question, this paper examines the behavioral changes in the online interest in terms related to Measles and the Anti-Vaccine Movement from 2004 to 2017, in order to identify any relationships between the decrease in immunization percentages, the Anti-Vaccine Movement, and the increased reported Measles cases. The results show that statistically significant positive correlations exist between monthly Measles cases and Google queries in the respective translated terms in most EU28 countries from January 2011 to August 2017. Furthermore, a strong negative correlation (p< 0.01) exists between the online interest in the term ‘Anti Vaccine’ and the Worldwide immunization percentages from 2004 to 2016. The latter could be supportive of previous work suggesting that conspiracist ideation is related to the rejection of scientific propositions. As Measles require the highest immunization percentage out of the vaccine preventable diseases, the 2017 EU outbreak could be the first of several other diseases’ outbreaks or epidemics in the near future should the immunization percentages continue to decrease. Big Data Analytics in general and the analysis of Google queries in specific have been shown to be valuable in addressing health related topics up to this point. Therefore, analyzing the variations and patterns of available online information could assist health officials with the assessment of reported cases, as well as taking the required preventive actions

Forecasting AIDS prevalence in the United States using online search traffic data

Over the past decade and with the increasing use of the Internet, the assessment of health issues using online search traffic data has become an integral part of Health Informatics. Internet data in general and from Google Trends in particular have been shown to be valid and valuable in predictions, forecastings, and nowcastings; and in detecting, tracking, and monitoring diseases’ outbreaks and epidemics. Empirical relationships have been shown to exist between Google Trends’ data and official data in several health topics, with the science of infodemiology using the vast amount of information available online for the assessment of public health and policy matters. The aim of this study is to provide a method of forecasting AIDS prevalence in the US using online search traffic data from Google Trends on AIDS related terms. The results at first show that significant correlations between Google Trends’ data and official health data on AIDS prevalence (2004–2015) exist in several States, while the estimated forecasting models for AIDS prevalence show that official health data and Google Trends data on AIDS follow a logarithmic relationship. Overall, the results of this study support previous work on the subject suggesting that Google data are valid and valuable for the analysis and forecasting of human behavior towards health topics, and could further assist with Health Assessment in the US and in other countries and regions with valid available official health data

Predicting referendum results in the Big Data Era

In addressing the challenge of Big Data Analytics, what has been of notable significance is the analysis of online search traffic data in order to analyze and predict human behavior. Over the last decade, since the establishment of the most popular such tool, Google Trends, the use of online data has been proven valuable in various research fields, including -but not limited to- medicine, economics, politics, the environment, and behavior. In the field of politics, given the inability of poll agencies to always well approximate voting intentions and results over the past years, what is imperative is to find new methods of predicting elections and referendum outcomes. This paper aims at presenting a methodology of predicting referendum results using Google Trends; a method applied and verified in six separate occasions: the 2014 Scottish Referendum, the 2015 Greek Referendum, the 2016 UK Referendum, the 2016 Hungarian Referendum, the 2016 Italian Referendum, and the 2017 Turkish Referendum. Said referendums were of importance for the respective country and the EU as well, and received wide international attention. Google Trends has been empirically verified to be a tool that can accurately measure behavioral changes as it takes into account the users’ revealed and not the stated preferences. Thus we argue that, in the time of intelligence excess, Google Trends can well address the analysis of social changes that the internet brings

Evaluating Google Trends as a Tool for Integrating the ‘Smart Health’ Concept in the Smart Cities’ Governance in USA

AbstractThe aim of this paper is to introduce the methodology of using online search traffic data in order to integrate the public's online behavior in Smart Health; a concept that is currently rising concerning the health factor of Smart Cities. We use normalized data from Google Trends from January 2013 to December 2015 in the US, aiming at exploring the change in interest in various medical terms, and examine if Google Trends is a possible tool for evaluating health search queries by nowcasting the public's online interest. The results show that Google Trends’ data can be used for measuring the public's interest in health related terms, in order to assist with the evaluation of ‘Smart Health’

COVID-19 predictability in the United States using Google Trends time series

During the unprecedented situation that all countries around the globe are facing due to the Coronavirus disease 2019 (COVID-19) pandemic, which has also had severe socioeconomic consequences, it is imperative to explore novel approaches to monitoring and forecasting regional outbreaks as they happen or even before they do so. To that end, in this paper, the role of Google query data in the predictability of COVID-19 in the United States at both national and state level is presented. As a preliminary investigation, Pearson and Kendall rank correlations are examined to explore the relationship between Google Trends data and COVID-19 data on cases and deaths. Next, a COVID-19 predictability analysis is performed, with the employed model being a quantile regression that is bias corrected via bootstrap simulation, i.e., a robust regression analysis that is the appropriate statistical approach to taking against the presence of outliers in the sample while also mitigating small sample estimation bias. The results indicate that there are statistically significant correlations between Google Trends and COVID-19 data, while the estimated models exhibit strong COVID-19 predictability. In line with previous work that has suggested that online real-time data are valuable in the monitoring and forecasting of epidemics and outbreaks, it is evident that such infodemiology approaches can assist public health policy makers in addressing the most crucial issues: flattening the curve, allocating health resources, and increasing the effectiveness and preparedness of their respective health care systems

Exploring the role of non-pharmaceutical interventions (NPIs) in flattening the Greek COVID-19 epidemic curve

Due to the COVID-19 pandemic originating in China in December 2019, apart from the grave concerns on the exponentially increasing casualties, the affected countries are called to deal with severe repercussions in all aspects of everyday life, from economic recession to national and international movement restrictions. Several regions managed to handle the pandemic more successfully than others in terms of life loss, while ongoing heated debates as to the right course of action for battling COVID-19 have divided the academic community as well as public opinion. To this direction, in this paper, an autoregressive COVID-19 prediction model with heterogeneous explanatory variables for Greece is proposed, taking past COVID-19 data, non-pharmaceutical interventions (NPIs), and Google query data as independent variables, from the day of the first confirmed case—February 26th—to the day before the announcement for the quarantine measures’ softening—April 24th. The analysis indicates that the early measures taken by the Greek officials positively affected the flattening of the epidemic curve, with Greece having recorded significantly decreased COVID-19 casualties per million population and managing to stay on the low side of the deaths over cases spectrum. In specific, the prediction model identifies the 7-day lag that is needed in order for the measures’ results to actually show, i.e., the optimal time-intervention framework for managing the disease’s spread, while our analysis also indicates an appropriate point during the disease spread where restrictive measures should be applied. Present results have significant implications for effective policy making and in the designing of the NPIs, as the second wave of COVID-19 is expected in fall 2020, and such multidisciplinary analyses are crucial in order to understand the evolution of the Daily Deaths to Daily Cases ratio along with its determinants as soon as possible, for the assessment of the respective domestic health authorities’ policy interventions as well as for the timely health resources allocation