To Tweet or Not to Tweet - A Review of the Viral Power of Twitter for Infectious Diseases

"Twitter has no hierarchy or barriers, serves as a conduit for global collaboration, and is a way for both HCPs [healthcare professionals] and the public to 'social'ize on healthcare topics, if used appropriately."

As has been evident during the COVID-19 outbreak, real-time reporting to alert and empower relevant public health surveillance systems, authorities, and the public about taking appropriate actions to control and minimise the potential harmful effects of infectious diseases (ID) is critical. This review highlights the value of Twitter in ID through exploration of relevant research studies and examples.

The authors point out that Twitter allows for quick, timely sharing of educational resources before, during, and after scientific conferences, enabling individuals who are not able to attend in person to follow the proceedings from a distance at any time, while also stimulating discussion around topics of interest with experts from across the globe. Relatedly, Twitter can serve as a platform for disseminating and discussing current ID research; when the new publications shared on Twitter populate directly into your feed, and some of the authors are available to interact on Twitter, keeping up with the literature can be easier and more engaging. While there is value in engaging with people who have similar interests, Twitter can also be a tool for introducing a non-ID person to the work of someone from another, related field (e.g., surgery) - and vice versa.

In addition, Twitter has been useful for engaging, educating, and advocating around the global public health crisis of anti-microbial resistance (AMR). It is frequently used by patients or families who have been impacted by AMR or antibiotic-associated adverse events. For example, Vanessa Carter, who survived a methicillin-resistant Staphylococcus aureus (MRSA) infection and is an e-Patient Scholar at Stanford University Medicine, tweets regularly to over 5,400 followers. The founder of #hcsmSA (HealthCare Communications and Social Media South Africa), she was invited as a civil guest to present her e-Patient story at a meeting at the Africa Centers for Disease Control and Prevention (CDC)/African Union in Ethiopia, which focused on the implementation of the AMR strategy for Africa.

Twitter can serve as a site for dissemination of vaccine information, whether informally (by advocates and physicians) or formally (by government entities). For instance, during a measles outbreak in late 2019 in Samoa, Twitter acted as a repository of information, an avenue to discuss the outbreak, and a way to dispel the rumour that the outbreak was caused by the vaccine. Moreover, during that same year, Dr. Thomas File (@theIDFile), President of the Infectious Diseases Society of America (IDSA), put out the following message about vaccines: "One of the significant accomplishments of the year is the successful Why I Vaccinate twitterstorm IDSA created during ID Week 2019....Vaccine hesitancy threatens to undo so many of the greatest accomplishments of our field. As ID professionals, we have an obligation to turn the tide on this frightening trend, and I think we made a major statement within a platform that is too often used to spread misinformation....We will continue to make our voices heard on this critical issue in the months and years ahead including pursing legislation for vaccine access and education."

The authors discuss some limitations of the use of Twitter for ID. Centrally, no systematic process exists to check for incorrect material on Twitter, which has been a go-to site for convening anti-vaccine political activism and for promoting misinformation. Twitter's only pushback has been to redirect individuals searching for vaccine-associated keywords to a reputable site (e.g., vaccines.gov, run by the United States Department of Health and Human Services). Unfortunately, the anti-vaccine movement has gained traction, in part because the anti-vaccine posts are not being policed by the site and not reportable as a group. Even when misinformation is corrected, the mere exposure to such material may cause it to spread. In addition, those tweeting pro-vaccine information are vulnerable to attacks by anti-vaccine activists and/or bots.

While the COVID-19 outbreak has been exacerbated by misinformation that has spread quickly through social media channels such as Twitter, individuals can always go to credible resources on the platform that the authors identify: @WHO, @CDCgov, and @IDSAInfo.

The authors conclude that, particularly in ID, where bacteria and viruses can enter and exit borders anytime, anywhere, global, real-time information about outbreaks for both clinicians and the public is critical.