Towards integrated surveillance of zoonoses : spatiotemporal joint modeling of rodent population data and human tularemia cases in Finland

Abstract Background There are an increasing number of geo-coded information streams available which could improve public health surveillance accuracy and efficiency when properly integrated. Specifically, for zoonotic diseases, knowledge of spatial and temporal patterns of animal host distribution can be used to raise awareness of human risk and enhance early prediction accuracy of human incidence. Methods To this end, we develop a spatiotemporal joint modeling framework to integrate human case data and animal host data to offer a modeling alternative for combining multiple surveillance data streams in a novel way. A case study is provided of spatiotemporal modeling of human tularemia incidence and rodent population data from Finnish health care districts during years 1995–2012. Results Spatial and temporal information of rodent abundance was shown to be useful in predicting human cases and in improving tularemia risk estimates in 40 and 75% of health care districts, respectively. The human relative risk estimates’ standard deviation with rodent’s information incorporated are smaller than those from the model that has only human incidence. Conclusions These results support the integration of rodent population variables to reduce the uncertainty of tularemia risk estimates. However, more information on several covariates such as environmental, behavioral, and socio-economic factors can be investigated further to deeper understand the zoonotic relationship

A shared neighbour conditional autoregressive model for small area spatial data

The use of conditional autoregressive (CAR) models for spatial effects is commonplace, especially when dealing with aggregated count data in health studies. CAR models are convenient and relatively easy to implement but suffer from the fact that they have limited flexibility in modeling correlation. We introduce a new CAR model that can accommodate different neighborhood features (including shared neighbors). Further, we examine via simulation how this model performs in comparison with standard CAR models. We also consider the application to a small area health data example

Bayesian spatio-temporal distributed lag modeling for delayed climatic effects on sparse malaria incidence data

Background In many areas of the Greater Mekong Subregion (GMS), malaria endemic regions have shrunk to patches of predominantly low-transmission. With a regional goal of elimination by 2030, it is important to use appropriate methods to analyze and predict trends in incidence in these remaining transmission foci to inform planning efforts. Climatic variables have been associated with malaria incidence to varying degrees across the globe but the relationship is less clear in the GMS and standard methodologies may not be appropriate to account for the lag between climate and incidence and for locations with low numbers of cases. Methods In this study, a methodology was developed to estimate the spatio-temporal lag effect of climatic factors on malaria incidence in Thailand within a Bayesian framework. A simulation was conducted based on ground truth of lagged effect curves representing the delayed relation with sparse malaria cases as seen in our study population. A case study to estimate the delayed effect of environmental variables was used with malaria incidence at a fine geographic scale of sub-districts in a western province of Thailand. Results From the simulation study, the model assumptions which accommodated both delayed effects and excessive zeros appeared to have the best overall performance across evaluation metrics and scenarios. The case study demonstrated lagged climatic effect estimation of the proposed modeling with real data. The models appeared to be useful to estimate the shape of association with malaria incidence. Conclusions A new method to estimate the spatiotemporal effect of climate on malaria trends in low transmission settings is presented. The developed methodology has potential to improve understanding and estimation of past and future trends in malaria incidence. With further development, this could assist policy makers with decisions on how to more effectively distribute resources and plan strategies for malaria elimination

Bayesian spatiotemporal modeling with sliding windows to correct reporting delays for real-time dengue surveillance in Thailand

Background: The ability to produce timely and accurate estimation of dengue cases can significantly impact disease control programs. A key challenge for dengue control in Thailand is the systematic delay in reporting at different levels in the surveillance system. Efficient and reliable surveillance and notification systems are vital to monitor health outcome trends and early detection of disease outbreaks which vary in space and time. Methods: Predicting the trend in dengue cases in real-time is a challenging task in Thailand due to a combination of factors including reporting delays. We present decision support using a spatiotemporal nowcasting model which accounts for reporting delays in a Bayesian framework with sliding windows. A case study is presented to demonstrate the proposed nowcasting method using weekly dengue surveillance data in Bangkok at district level in 2010. Results: The overall real-time estimation accuracy was 70.69% with 59.05% and 79.59% accuracy during low and high seasons averaged across all weeks and districts. The results suggest the model was able to give a reasonable estimate of the true numbers of cases in the presence of delayed reports in the surveillance system. With sliding windows, models could also produce similar accuracy to estimation with the whole data. Conclusions: A persistent challenge for the statistical and epidemiological communities is to transform data into evidence-based knowledge that facilitates policy making about health improvements and disease control at the individual and population levels. Improving real-time estimation of infectious disease incidence is an important technical development. The effort in this work provides a template for nowcasting in practice to inform decision making for dengue control.</br

A shared neighbor conditional autoregressive model for small area spatial data

The use of conditional autoregressive (CAR) models for spatial effects is commonplace, especially when dealing with aggregated count data in health studies. CAR models are convenient and relatively easy to implement but suffer from the fact that they have limited flexibility in modeling correlation. We introduce a new CAR model that can accommodate different neighborhood features (including shared neighbors). Further, we examine via simulation how this model performs in comparison with standard CAR models. We also consider the application to a small area health data example. Copyright (c) 2015 John Wiley & Sons, Ltd