Probabilistic Daily ILI Syndromic Surveillance with a Spatio-Temporal Bayesian Hierarchical Model

BACKGROUND: For daily syndromic surveillance to be effective, an efficient and sensible algorithm would be expected to detect aberrations in influenza illness, and alert public health workers prior to any impending epidemic. This detection or alert surely contains uncertainty, and thus should be evaluated with a proper probabilistic measure. However, traditional monitoring mechanisms simply provide a binary alert, failing to adequately address this uncertainty. METHODS AND FINDINGS: Based on the Bayesian posterior probability of influenza-like illness (ILI) visits, the intensity of outbreak can be directly assessed. The numbers of daily emergency room ILI visits at five community hospitals in Taipei City during 2006-2007 were collected and fitted with a Bayesian hierarchical model containing meteorological factors such as temperature and vapor pressure, spatial interaction with conditional autoregressive structure, weekend and holiday effects, seasonality factors, and previous ILI visits. The proposed algorithm recommends an alert for action if the posterior probability is larger than 70%. External data from January to February of 2008 were retained for validation. The decision rule detects successfully the peak in the validation period. When comparing the posterior probability evaluation with the modified Cusum method, results show that the proposed method is able to detect the signals 1-2 days prior to the rise of ILI visits. CONCLUSIONS: This Bayesian hierarchical model not only constitutes a dynamic surveillance system but also constructs a stochastic evaluation of the need to call for alert. The monitoring mechanism provides earlier detection as well as a complementary tool for current surveillance programs

Modelling the covariance structure in marginal multivariate count models: Hunting in Bioko Island.

The main goal of this article is to present a flexible statistical modelling framework to deal with multivariate count data along with longitudinal and repeated measures structures. The covariance structure for each response variable is defined in terms of a covariance link function combined with a matrix linear predictor involving known matrices. In order to specify the joint covariance matrix for the multivariate response vector, the generalized Kronecker product is employed. We take into account the count nature of the data by means of the power dispersion function associated with the Poisson–Tweedie distribution. Furthermore, the score information criterion is extended for selecting the components of the matrix linear predictor. We analyse a data set consisting of prey animals (the main hunted species, the blue duiker Philantomba monticola and other taxa) shot or snared for bushmeat by 52 commercial hunters over a 33-month period in Pico Basilé, Bioko Island, Equatorial Guinea. By taking into account the severely unbalanced repeated measures and longitudinal structures induced by the hunters and a set of potential covariates (which in turn affect the mean and covariance structures), our method can be used to indicate whether there was statistical evidence of a decline in blue duikers and other species hunted during the study period. Determining whether observed drops in the number of animals hunted are indeed true is crucial to assess whether species depletion effects are taking place in exploited areas anywhere in the world. We suggest that our method can be used to more accurately understand the trajectories of animals hunted for commercial or subsistence purposes and establish clear policies to ensure sustainable hunting practices

Spatial Random Slope Multilevel Modeling Using Multivariate Conditional Autoregressive Models: A Case Study of Subjective Travel Satisfaction in Beijing

This article explores how to incorporate a spatial dependence effect into the standard multilevel modeling (MLM). The proposed method is particularly well suited to the analysis of geographically clustered survey data where individuals are nested in geographical areas. Drawing on multivariate conditional autoregressive models, we develop a spatial random slope MLM approach to account for the within-group dependence among individuals in the same area and the spatial dependence between areas simultaneously. Our approach improves on recent methodological advances in the integrated spatial and MLM literature, offering greater flexibility in terms of model specification by allowing regression coefficients to be spatially varied. Bayesian Markov chain Monte Carlo (MCMC) algorithms are derived to implement the proposed model. Using two-level travel satisfaction data in Beijing, we apply the proposed approach as well as the standard nonspatial random slope MLM to investigate subjective travel satisfaction of residents and its determinants. Model comparison results show strong evidence that the proposed method produces a significant improvement against a nonspatial random slope MLM. A fairly large spatial correlation parameter suggests strong spatial dependence in district-level random effects. Moreover, spatial patterns of district-level random effects of locational variables have been identified, with high and low values clustering together

Letter to the editor regarding “Rotavirus infection beyond the gut”

Alejandro Orrico-Sánchez,1 Mónica López-Lacort,1 Cintia Muñoz-Quiles,1 Miguel Angel Martinez-Beneito,2 Javier Díez-Domingo1 1Vaccine Research, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain; 2Health Inequalities, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, FISABIO-Public Health, Valencia, Spain Gomez-Rial et al, in their review paper “Rotavirus infection beyond the gut”,1 concluded that there is some degree of protection of the RV vaccination against seizure hospitalizations. A detailed analysis of the potential biases of the literature could lead to a less optimistic position for the vaccine. For example, the protection found in the USA and Australia could be partly due to the uncontrolled influenza vaccine (where the coverage in children under 5 years in EEUU reached 66–75%2). Other studies have small sample sizes, or used poorly adjusted analyses.Beyond their different degrees of appraisal of the papers depending on the direction of the results, there is a lack of discussion of the publication bias, as this bias disrupts the literature promoting positive findings and hiding negative results. View the original paper by Gomez-Rial and colleagues

Do socioeconomic inequalities in mortality vary between different Spanish cities? a pooled cross-sectional analysis

Background: The relationship between deprivation and mortality in urban settings is well established. This relationship has been found for several causes of death in Spanish cities in independent analyses (the MEDEA project). However, no joint analysis which pools the strength of this relationship across several cities has ever been undertaken. Such an analysis would determine, if appropriate, a joint relationship by linking the associations found. Methods: A pooled cross-sectional analysis of the data from the MEDEA project has been carried out for each of the causes of death studied. Specifically, a meta-analysis has been carried out to pool the relative risks in eleven Spanish cities. Different deprivation-mortality relationships across the cities are considered in the analysis (fixed and random effects models). The size of the cities is also considered as a possible factor explaining differences between cities. Results: Twenty studies have been carried out for different combinations of sex and causes of death. For nine of them (men: prostate cancer, diabetes, mental illnesses, Alzheimer’s disease, cerebrovascular disease; women: diabetes, mental illnesses, respiratory diseases, cirrhosis) no differences were found between cities in the effect of deprivation on mortality; in four cases (men: respiratory diseases, all causes of mortality; women: breast cancer, Alzheimer’s disease) differences not associated with the size of the city have been determined; in two cases (men: cirrhosis; women: lung cancer) differences strictly linked to the size of the city have been determined, and in five cases (men: lung cancer, ischaemic heart disease; women: ischaemic heart disease, cerebrovascular diseases, all causes of mortality) both kinds of differences have been found. Except for lung cancer in women, every significant relationship between deprivation and mortality goes in the same direction: deprivation increases mortality. Variability in the relative risks across cities was found for general mortality for both sexes. Conclusions: This study provides a general overview of the relationship between deprivation and mortality for a sample of large Spanish cities combined. This joint study allows the exploration of and, if appropriate, the quantification of the variability in that relationship for the set of cities considered.This article was partially funded by Ministerio de Economia y Competitividad via the research grant MTM2010-19528 (jointly financed with European Regional Development Fund), the FIS-FEDER projects: PI042013, PI040041, PI040170, PI040069, PI042602, PI040388, PI040489, PI042098, PI041260, PI040399, PI08/1488, PI08/0330 and by the CIBER Epidemiología y Salud Publica (CIBERESP), Spain