Spatial and Temporal Clustering of Chikungunya Virus Transmission in Dominica

Using geo-referenced case data, we present spatial and spatio-temporal cluster analyses of the early spread of the 2013–2015 chikungunya virus (CHIKV) in Dominica, an island in the Caribbean. Spatial coordinates of the locations of the first 417 reported cases observed between December 15th, 2013 and March 11th, 2014, were captured using the Global Positioning System (GPS). We observed a preponderance of female cases, which has been reported for CHIKV outbreaks in other regions. We also noted statistically significant spatial and spatio-temporal clusters in highly populated areas and observed major clusters prior to implementation of intensive vector control programs suggesting early vector control measures, and education had an impact on the spread of the CHIKV epidemic in Dominica. A dynamical identification of clusters can lead to local assessment of risk and provide opportunities for targeted control efforts for nations experiencing CHIKV outbreaks

Demographical characteristics of Chikungunya cases, Dominica, 2014.

<p>Demographical characteristics of Chikungunya cases, Dominica, 2014.</p

(a) Location of the ten Parishes of Dominica.

<p>(b) Spatial clusters identified by SaTScan. The clusters are located in St. Andrew and St. George Parishes.</p

Three statistically significant space-time clusters identified by SaTScan.

<p>The clusters are located in St. George and St. Andrew Parishes.</p

Spatial dispersion of chikungunya cases across the island of Dominica.

<p>The maroon dots represent new cases, while the orange dots represent previously reported cases. Data for 2013 and 2014 epidemiologic weeks 51, 6, and 11 are presented.</p

Epidemic curve by week of symptom onset; (a) case classification status and (b) sex.

<p>Reports start on epidemiologic week 51 of 2013 and end on week 11 of 2014.</p

Predicting Patients' Expectations of Hospital Chaplains: A Multisite Survey

OBJECTIVE: To identify patient expectations regarding chaplain visitation, characteristics of patients who want to be visited by a chaplain, and what patients deem important when a chaplain visits