Category Archives: Twitter

Fighting Influenza: Web 2.0 Tools for Public Health Professionals and the Public

Post by: Kim Stephens

The Boston Mayor has declared a public health emergency due to the deadly flu outbreak that has killed 18 people to date.  Public Health organizations are pulling out the stops to communicate protective action information to the public and social media is just one of the tools in the toolbox. The public, however, is also using social media to talk about the flu. They state such things as whether or not they are sick; whether or not they had a shot; and “Google” what they should do after they become ill, just to name a few of the topics of conversation. People can even download a new Facebook app titled “Help, My Friend Gave me the Flu” to figure out who they need to blame for feeling miserable. (As an aside the app is actually quite cool. After you give it permission to access your newsfeed it looks for key words from friends that have posted content related to feeling sick. From a public health standpoint, if people know some of their friends are ill they might be spurred to get a flu shot, or at a minimum keep their distance. I’m happy to report all of my friends are healthy!)

All of this web and social data, in turn, is being “mined” by public health organizations and researchers in order to determine both the geographic spread of the virus, as well as the rate of infection. Some organizations are also asking the public to self-report how they are feeling. Below I outline five tools that are interesting aggregators of social flu data.

flunearyou1. FluNearYou is a tool that allows the public to participate in tracking the spread of flu by filling out a survey each week. The survey is quite simple and asks the respondent if they have had any symptoms during the past week and whether or not they have had the flu shot either this year or last year. Respondents can include family members and the questions are asked about each person individually. This user contributed data is then aggregated and displayed on a map with pins that are either green for no symptoms, yellow for some  and red for “at least one person with Influenza-like” symptoms. The pins are clickable and display the number of users in that zipcode that have reported their condition, but no personal information whatsoever. The number of participants in the state is displayed (1294 in Massachusetts) as well as locations and addresses where people can get vaccinated. Links to local public health agencies are also provided. People can also sign up to receive location-based disease alerts via email. Social sharing of the site and its content is encouraged by the addition of prominently social media buttons.

This site is administered by Healthmap of Boston Children’s Hospital in partnership with the American Public Health Association and the Skoll Global Threats Fund.

2. Google Flu Trends is another site that provides geographically based information about the spread of the influenza virus. Their data is aggregated from the search terms people are using versus self-reporting. In fact, the graph of the tracked searches (see below) related to the flu compared to the actual reported cases of the virus is so close that they almost overlap.


Google explains how this works:

Each week, millions of users around the world search for health information online. As you might expect, there are more flu-related searches during flu season… You can explore all of these phenomena using Google Insights for Search. But can search query trends provide the basis for an accurate, reliable model of real-world phenomena?

We have found a close relationship between how many people search for flu-related topics and how many people actually have flu symptoms. Of course, not every person who searches for “flu” is actually sick, but a pattern emerges when all the flu-related search queries are added together. We compared our query counts with traditional flu surveillance systems and found that many search queries tend to be popular exactly when flu season is happening. By counting how often we see these search queries, we can estimate how much flu is circulating in different countries and regions around the world. Our results have been published in the journal Nature.

In fact, the current flu trend data for Massachusetts reflects the declared state of emergency.


3.  MappyHealth is another tool that tracks keywords related to health but instead of using data from searches in Google, this system utilizes the Twitter data stream. Their stated reason for the site: “It is hypothesized that social data could be a predictor to outbreaks of disease. We track disease terms and associated qualifiers to present these social trends.” Although this blog post is focused on influenza, the MappyHealth site tracks 27 different categories of illness. They explain how all of this is done on their FAQ page.

The graph below displays Tweets by the hour and day that are related to influenza. The last full day on the chart is January 9, which shows a significant spike in the number of tweets on the topic.


What is everyone talking about? The user can actually see the individual Tweets by clicking on any point on the graph. The associated Tweets then populate a table beneath the graph (profanity and all). The table includes the time, tweeter, complete text of the tweet, location (if available) condition match and qualifier match. The last two terms need a little bit of explanation. If someone states “I don’t have the flu” the condition match will state “flu” but the qualifier will state “don’t.” Location data is not included in all Tweets, however, MappyHealth does provide a sorting mechanism by location and this content is displayed on a map.

Another feature on the site includes a link to a “Realtime Twitter Search.” This link takes the user to an advanced search MappyHealth has already created that includes many different keywords Tweeters  might use when talking about influenza, including: flu, influenza, h1n1, h5n1, H3N2, adenovirus, etc. This search is available for every illness category. This feature alone is worthy of a bookmark.

cdcapp4. Not to be outdone, the Center for Disease Control has released a Influenza smartphone application. The intended audience is clinicians and other health care professionals, with a stated purpose of making it easier to find CDC’s latest recommendations and influenza activity updates. Some of the reviews, however, point to a few problems, such as dated information on flu activity.

5. was involved in the design and development of “FluNearYou” and therefore has a similar look and feel to it. However, the site does have a very different process for gathering data. HealthMap states that they

“…bring together disparate data sources, including online news aggregators, eyewitness reports, expert-curated discussions and validated official reports, to achieve a unified and comprehensive view of the current global state of infectious diseases and their effect on human and animal health. Through an automated process, updating 24/7/365, the system monitors, organizes, integrates, filters, visualizes and disseminates online information about emerging diseases in nine languages, facilitating early detection of global public health threats.” also has a mobile application that includes all of the features found on their website, but I actually find the app easier to use. Using the smartphone’s touch screen zooming capability it is easy to hone in on specific locations and view all of the associated alerts. The alert content, however, is a bit heavy with information from traditional media.

+1. #FluChat: News organizations are not only providing the public with information about the effects of the influenza virus this year, some are also providing a public health awareness function via their presence on social networks. On Thursday, January 10th, for example, a #FluChat was sponsored by @USATodayHealth.

Health based Twitter chats offer the public the opportunity to post questions that are addressed by healthcare professionals or researchers. The CDC, for instance, has conducted many chats on a wide variety of topics. Watching the questions that are posted in these chats offers local public health organizations an opportunity to “hear” the concerns of the public. Knowing this information can help with message formulation and coordination. Here are a few questions posted to the #fluchat:

Bonus: Reviewing the #fluchat stream I found “A Flu With a View” from This visualization of flu data comes from a process they use to filter Tweets, Facebook updates and self-reporting on their website. They state: “This amount of real-time data, combined with historical data from the CDC and Google Flu Trends, is what gave us a crystal-ball-like view of the flu this year. In fact, our data of flu season to date shows that we are still near the peak of flu season, but possibly (hopefully) starting to level off.”

See this visualization:

None of these tools will help people feel better once they are already stricken with the virus, but they might alert the public to how prevalent the virus is in their community and possibly persuade folks to take preventive measures. Tell me what you think. How could your agency put this information to use?


Western Mass First Twitter Chat

Post by: Kim Stephens

On Monday Jeff Phillips and I  facilitated a Twitter chat and simultaneous phone discussion with WRHSAC stakeholders (the tweet below includes the hyperlink to the archive).

Although we only had a few folks participate, the conversation was quite good. Bob Labrie (@goshenBob on Twitter) who is both a first responder and the social media director with the Goshen Fire Department, asked this question:

He stated that he didn’t see how he could use this tool, which from his perspective seems geared for real-time information dissemination,  while he is responding. Jeff, who is also the Emergency Manager for Los Ranchos, New Mexico, noted how he has seen Fire Departments  use Twitter.

WRHSAC also tweeted about how they are using the platform:

In other words, Twitter does not have to be used every minute you are responding, but it can be utilized before and after an event to provide information to the community. But who has time to post to both Twitter and Facebook? The good news is that you CAN automate your Facebook and Twitter posts (although I don’t think this is ideal since the culture of the platforms is a bit different–no one puts hashtags in Facebook posts, for instance). However, it can be useful service for resource-strapped agencies.

The Lay of the Land

The discussion turned to another concern,  the usefulness of Twitter in general in Western Massachusetts: is there an audience?  This is an excellent point. It is really important to determine what Jeff calls “The Lay of the Land” which means not only finding who might be “listening” but also who the active social media users are in the community. Word of caution, don’t dismiss people based on their profession listed in their profiles. I’ve found that it often doesn’t matter if a person is a realtor, for instance; if they are active social media users they WILL be posting information after a crisis.

WRHSAC  made a great point about how to find local users.

@HilltwnFamilies  (Hilltown Families) is  “an online, grassroots communication network for families in Western Massachusetts. Connecting & supporting community through the common thread of our children.” I encourage readers to click on the hyperlink of their name to see the type of content they are providing to their 1802 followers. So who is following them? In order to find out who their follower are, go to their full profile and click on “followers,” although the word does not appear at first blush to be a hyperlink, it is.

Another approach to find who is actively tweeting in Western Mass is search through lists. For instance, click on Hilltown’s Lists and then click on List members. (Side note: Click here for a tutorial on how to use Twitter lists.) The Hilltown Families account is a member of 6 lists. One list, WesternMA_local, yields some great information about who is active in the area. Here is a tweet from one of the members:

I also found that someone in Western Mass is using PaperLi. is defined by the company as a content curation service that enables anyone become Editor-in-Chief of their own news site and publish material  from content they find anywhere on the web. So your tweet could become their next headline. The title of the PaperLi in Western Mass is simply: “The Folks of #westernma Daily.” Click on the link, is there a story about your agency?


It is important to connect with these active Twitter users because they can become a great asset. During the preparedness phase, when not much is happening, it is harder to get people interested in your content.  For instance, if you want people to know about a public meeting to discuss hazards and vulnerabilities, active social media users in your community might repeat your message to their  large following…but only if you ask them to. During a crisis, you can enlist these active users to repeat your vetted and official content.

The next conference call will be this Thursday, December 20 at 11:00am. The call-in information has been emailed to all participants of the September 21 social media summit. If you need the number, let us know. The topic: how to monitor social media and why it is important. See you then!

Module 17: Twitter’s SMS Text “40404” Capability

In August of 2010 Twitter announced via their blog, their fast follow (40404) service:

“We’ve always been big fans of trusty SMS messaging. In fact, sending a text was originally the only way users could tweet. This is why Tweets are 140 characters — they need to fit into a text message. We value SMS because it’s simple, instant and universal. Recently, we’ve added a few new features to make Twitter even more useful with SMS.

Fast Follow. Anyone in the US can receive Tweets on their phone even if they haven’t signed up for Twitter (emphasis added). This is a simple way for people to get information they care about in real-time. For example, let’s say you want to get Tweets from New York City’s office of emergency management (@NotifyNYC). Just text ‘follow NotifyNYC’to 40404 in the US. “

I love how in their announcement, they even mention emergency management.  They further explain how to use the service, step-by-step.

Tell Twitter to be quiet. Turn text messages on or off by sending ‘on’ or ‘off’ to Twitter. You can also go to our settings page if you want to turn off text message updates during a certain time period. (The pic on the right shows the message the user receives.)

Keep up with the latest Tweet. If you text ‘Get [username]’, that user’s most recent Tweet will be sent to your phone, even if you don’t follow them. There are a bunch of other fun commands you can use with Twitter on your phone.”

On Twitter’s “SMS Commands” Help Center page they further state: 

  • Using ON/OFF [username] from your phone only stops notifications coming to your mobile phone; you’ll still collect a person’s updates on the web since you’re still following them.
    • Use UNFOLLOW [username] to unfollow a user via SMS.
    • Use BLOCK [username] to block a user via SMS.
  • The following commands perform the same actions: FOLLOW = ON. And LEAVE = OFF.
  • Following someone from a phone for the first time will also cause you to follow them on the web.
  • You don’t have to use ON/OFF [username] from your phone, you can also set individual notifications from a person’s profile page on the web, or check your following page and manage all phone notification settings there.

Who uses this?

FEMA really likes this functionality and mentions it often in their communications with impacted communities. For example, in the aftermath of the tornadoes in Alabama in April of 2011, they explain this capability in their blog:

“People can also receive Twitter updates via text message from their respective emergency management agencies. You don’t need your own Twitter account to receive these updates, but keep in mind that standard text messaging rates apply:

  • For the Alabama Emergency Management Agency Twitter updates text follow AlabamaEMA to 40404 (this is Twitter’s text message number).
  • For the Mississippi Emergency Management Agency Twitter updates text follow MSEMA to 40404
  • For the Georgia Emergency Management Agency Twitter updates text follow GeorgiaEMA to 40404
  • For FEMA Twitter updates text follow FEMA to 40404.”

Educating Your Community

Telling people how to fast follow you after a disaster is good, but educating them on how to use the service before something occurs is even better. For example, if you have a booth at the local county fair, pass out cards with information about how to follow via text message and sweeten the deal: send out a Tweet that includes information about where to receive a prize. You could even have people participate in a county fair scavenger hunt. Once you have them using the service you could let people know if a storm was approaching, for instance, or what streets to avoid when exiting the parking lot. Be sure to let them know how to STOP receiving messages!

Consider: This capability would be quite good for the deaf and hard of hearing community, who, for instance, would be unable to hear announcements over the loud-speaker at the fair.

Your Turn