For disease outbreak detection, the public health community has historically relied on the watchful eyes of doctors, who have reported individual cases or clusters of cases of particular diseases to the authorities. But these days, the availability of electronic health-care data should facilitate more automated and earlier outbreak detection and intervention. Besides diagnoses of known diseases, other indicators--such as primary complaints of patients coming to the emergency room or calling a nurse hotline--are being collected in electronic formats and could be analyzed if suitable methods existed.

Martin Kulldorff and colleagues have developed and operated real-time disease surveillance systems based on electronic records. In an article published in the open-access medical journal PLoS Medicine, they now report a new and very flexible approach for early disease outbreak detection.

The method, called the "space time permutation scan statistic," is an extension of a previous method of detecting outbreaks called scan statistic. The problem with this previous method is that it works only under certain circumstances, for example if there is a uniform population at risk (with the same number of expected disease cases in every square kilometer), or if quite a bit is known about the variation in factors such as age and disease susceptibility that occurs in that population. The new method doesn't need any of that: it can detect disease outbreaks when only the number of cases is available.

In their article, Kulldorff and colleagues illustrate the utility of the new method by applying it to data collected from hospital emergency departments in New York City. The researchers analyzed diarrhea records from 2002, and did both a "residential analysis" (based on the home address of the patients) and a "hospital analysis" (based on hospital locations). The former has more detailed geographical information, the latter maybe be better able to
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Contact: Paul Ocampo
pocampo@plos.org
1-415-624-1224
Public Library of Science
14-Feb-2005

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