Detecting the start of an influenza outbreak using exponentially weighted moving average charts

Background. Influenza viruses cause seasonal outbreaks in temperate climates, usually during winter and early spring, and are endemic in tropical climates. The severity and length of influenza outbreaks vary from year to year. Quick and reliable detection of the start of an outbreak is needed to promote public health measures. Methods. We propose the use of an exponentially weighted moving average (EWMA) control chart of laboratory confirmed influenza counts to detect the start and end of influenza outbreaks. Results. The chart is shown to provide timely signals in an example application with seven years of data from Victoria, Australia. Conclusions. The EWMA control chart could be applied in other applications to quickly detect influenza outbreaks

Emergency Department Chief Complaint and Diagnosis Data to Detect Influenza-Like Illness with an Electronic Medical Record

Background: The purpose of syndromic surveillance is early detection of a disease outbreak. Such systems rely on the earliest data, usually chief complaint. The growing use of electronic medical records (EMR) raises the possibility that other data, such as emergency department (ED) diagnosis, may provide more specific information without significant delay, and might be more effective in detecting outbreaks if mechanisms are in place to monitor and report these data.Objective: The purpose of this study is to characterize the added value of the primary ICD-9 diagnosis assigned at the time of ED disposition compared to the chief complaint for patients with influenza-like illness (ILI).Methods: The study was a retrospective analysis of the EMR of a single urban, academic ED with an annual census of over 60, 000 patients per year from June 2005 through May 2006. We evaluate the objective in two ways. First, we characterize the proportion of patients whose ED diagnosis is inconsistent with their chief complaint and the variation by complaint. Second, by comparing time series and applying syndromic detection algorithms, we determine which complaints and diagnoses are the best indicators for the start of the influenza season when compared to the Centers for Disease Control regional data for Influenza-Like Illness for the 2005 to 2006 influenza season using three syndromic surveillance algorithms: univariate cumulative sum (CUSUM), exponentially weighted CUSUM, and multivariate CUSUM.Results: In the first analysis, 29% of patients had a different diagnosis at the time of disposition than suggested by their chief complaint. In the second analysis, complaints and diagnoses consistent with pneumonia, viral illness and upper respiratory infection were together found to be good indicators of the start of the influenza season based on temporal comparison with regional data. In all examples, the diagnosis data outperformed the chief-complaint data.Conclusion: Both analyses suggest the ED diagnosis contains useful information for detection of ILI. Where an EMR is available, the short time lag between complaint and diagnosis may be a price worth paying for additional information despite the brief potential delay in detection, especially considering that detection usually occurs over days rather than hours. [West J Emerg Med. 2010; 11(1):1-9]

Early detection of influenza outbreaks using the DC Department of Health's syndromic surveillance system

<p>Abstract</p> <p>Background</p> <p>Since 2001, the District of Columbia Department of Health has been using an emergency room syndromic surveillance system to identify possible disease outbreaks. Data are received from a number of local hospital emergency rooms and analyzed daily using a variety of statistical detection algorithms. The aims of this paper are to characterize the performance of these statistical detection algorithms in rigorous yet practical terms in order to identify the optimal parameters for each and to compare the ability of two syndrome definition criteria and data from a children's hospital versus vs. other hospitals to determine the onset of seasonal influenza.</p> <p>Methods</p> <p>We first used a fine-tuning approach to improve the sensitivity of each algorithm to detecting simulated outbreaks and to identifying previously known outbreaks. Subsequently, using the fine-tuned algorithms, we examined (i) the ability of unspecified infection and respiratory syndrome categories to detect the start of the flu season and (ii) how well data from Children's National Medical Center (CNMC) did versus all the other hospitals when using unspecified infection, respiratory, and both categories together.</p> <p>Results</p> <p>Simulation studies using the data showed that over a range of situations, the multivariate CUSUM algorithm performed more effectively than the other algorithms tested. In addition, the parameters that yielded optimal performance varied for each algorithm, especially with the number of cases in the data stream. In terms of detecting the onset of seasonal influenza, only "unspecified infection," especially the counts from CNMC, clearly delineated influenza outbreaks out of the eight available syndromic classifications. In three of five years, CNMC consistently flags earlier (from 2 days up to 2 weeks earlier) than a multivariate analysis of all other DC hospitals.</p> <p>Conclusions</p> <p>When practitioners apply statistical detection algorithms to their own data, fine tuning of parameters is necessary to improve overall sensitivity. With fined tuned algorithms, our results suggest that emergency room based syndromic surveillance focusing on unspecified infection cases in children is an effective way to determine the beginning of the influenza outbreak and could serve as a trigger for more intensive surveillance efforts and initiate infection control measures in the community.</p

Anomaly Detection in Time Series: Theoretical and Practical Improvements for Disease Outbreak Detection

The automatic collection and increasing availability of health data provides a new opportunity for techniques to monitor this information. By monitoring pre-diagnostic data sources, such as over-the-counter cough medicine sales or emergency room chief complaints of cough, there exists the potential to detect disease outbreaks earlier than traditional laboratory disease confirmation results. This research is particularly important for a modern, highly-connected society, where the onset of disease outbreak can be swift and deadly, whether caused by a naturally occurring global pandemic such as swine flu or a targeted act of bioterrorism. In this dissertation, we first describe the problem and current state of research in disease outbreak detection, then provide four main additions to the field. First, we formalize a framework for analyzing health series data and detecting anomalies: using forecasting methods to predict the next day's value, subtracting the forecast to create residuals, and finally using detection algorithms on the residuals. The formalized framework indicates the link between the forecast accuracy of the forecast method and the performance of the detector, and can be used to quantify and analyze the performance of a variety of heuristic methods. Second, we describe improvements for the forecasting of health data series. The application of weather as a predictor, cross-series covariates, and ensemble forecasting each provide improvements to forecasting health data. Third, we describe improvements for detection. This includes the use of multivariate statistics for anomaly detection and additional day-of-week preprocessing to aid detection. Most significantly, we also provide a new method, based on the CuScore, for optimizing detection when the impact of the disease outbreak is known. This method can provide an optimal detector for rapid detection, or for probability of detection within a certain timeframe. Finally, we describe a method for improved comparison of detection methods. We provide tools to evaluate how well a simulated data set captures the characteristics of the authentic series and time-lag heatmaps, a new way of visualizing daily detection rates or displaying the comparison between two methods in a more informative way

A DATA ANALYTICAL FRAMEWORK FOR IMPROVING REAL-TIME, DECISION SUPPORT SYSTEMS IN HEALTHCARE

In this dissertation we develop a framework that combines data mining, statistics and operations research methods for improving real-time decision support systems in healthcare. Our approach consists of three main concepts: data gathering and preprocessing, modeling, and deployment. We introduce the notion of offline and semi-offline modeling to differentiate between models that are based on known baseline behavior and those based on a baseline with missing information. We apply and illustrate the framework in the context of two important healthcare contexts: biosurveillance and kidney allocation. In the biosurveillance context, we address the problem of early detection of disease outbreaks. We discuss integer programming-based univariate monitoring and statistical and operations research-based multivariate monitoring approaches. We assess method performance on authentic biosurveillance data. In the kidney allocation context, we present a two-phase model that combines an integer programming-based learning phase and a data-analytical based real-time phase. We examine and evaluate our method on the current Organ Procurement and Transplantation Network (OPTN) waiting list. In both contexts, we show that our framework produces significant improvements over existing methods

Exploring a proposed WHO method to determine thresholds for seasonal influenza surveillance

INTRODUCTION Health authorities find thresholds useful to gauge the start and severity of influenza seasons. We explored a method for deriving thresholds proposed in an influenza surveillance manual published by the World Health Organization (WHO). METHODS For 2002-2011, we analysed two routine influenza-like-illness (ILI) datasets, general practice sentinel surveillance and a locum medical service sentinel surveillance, plus laboratory data and hospital admissions for influenza. For each sentinel dataset, we created two composite variables from the product of weekly ILI data and the relevant laboratory data, indicating the proportion of tested specimens that were positive. For all datasets, including the composite datasets, we aligned data on the median week of peak influenza or ILI activity and assigned three threshold levels: seasonal threshold, determined by inspection; and two intensity thresholds termed average and alert thresholds, determined by calculations of means, medians, confidence intervals (CI) and percentiles. From the thresholds, we compared the seasonal onset, end and intensity across all datasets from 2002-2011. Correlation between datasets was assessed using the mean correlation coefficient. RESULTS The median week of peak activity was week 34 for all datasets, except hospital data (week 35). Means and medians were comparable and the 90% upper CIs were similar to the 95(th) percentiles. Comparison of thresholds revealed variations in defining the start of a season but good agreement in describing the end and intensity of influenza seasons, except in hospital admissions data after the pandemic year of 2009. The composite variables improved the agreements between the ILI and other datasets. Datasets were well correlated, with mean correlation coefficients of >0.75 for a range of combinations. CONCLUSIONS Thresholds for influenza surveillance are easily derived from historical surveillance and laboratory data using the approach proposed by WHO. Use of composite variables is helpful for describing influenza season characteristics.The General Practitioner Sentinel Surveillance system is funded by the Victorian Government Department of Health. Ee Laine Tay was supported by a Master of Philosophy in Applied Epidemiology Scholarship funded by the Victorian Infectious Diseases Reference Laboratory and the Victorian Department of Health

Enhancing the monitoring of fallen stock at different hierarchical administrative levels: an illustration on dairy cattle from regions with distinct husbandry, demographical and climate traits

Background: The automated collection of non-specific data from livestock, combined with techniques for data mining and time series analyses, facilitates the development of animal health syndromic surveillance (AHSyS). An example of AHSyS approach relates to the monitoring of bovine fallen stock. In order to enhance part of the machinery of a complete syndromic surveillance system, the present work developed a novel approach for modelling in near real time multiple mortality patterns at different hierarchical administrative levels. To illustrate its functionality, this system was applied to mortality data in dairy cattle collected across two Spanish regions with distinct demographical, husbandry, and climate conditions. Results: The process analyzed the patterns of weekly counts of fallen dairy cattle at different hierarchical administrative levels across two regions between Jan-2006 and Dec-2013 and predicted their respective expected counts between Jan-2014 and Jun- 2015. By comparing predicted to observed data, those counts of fallen dairy cattle that exceeded the upper limits of a conventional 95% predicted interval were identified as mortality peaks. This work proposes a dynamic system that combines hierarchical time series and autoregressive integrated moving average models (ARIMA). These ARIMA models also include trend and seasonality for describing profiles of weekly mortality and detecting aberrations at the region, province, and county levels (spatial aggregations). Software that fitted the model parameters was built using the R statistical packages. Conclusions: The work builds a novel tool to monitor fallen stock data for different geographical aggregations and can serve as a means of generating early warning signals of a health problem. This approach can be adapted to other types of animal health data that share similar hierarchical structures.info:eu-repo/semantics/publishedVersio