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Lantos PM, Janko M, Nigrovic LE, Ruffin F, Kobayashi T, Higgins Y, Auwaerter PG. Mapping the distribution of Lyme disease at a mid-Atlantic site in the United States using electronic health data. PLoS One 2024; 19:e0301530. [PMID: 38820472 PMCID: PMC11142662 DOI: 10.1371/journal.pone.0301530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 03/18/2024] [Indexed: 06/02/2024] Open
Abstract
Lyme disease is a spatially heterogeneous tick-borne infection, with approximately 85% of US cases concentrated in the mid-Atlantic and northeastern states. Surveillance for Lyme disease and its causative agent, including public health case reporting and entomologic surveillance, is necessary to understand its endemic range, but currently used case detection methods have limitations. To evaluate an alternative approach to Lyme disease surveillance, we have performed a geospatial analysis of Lyme disease cases from the Johns Hopkins Health System in Maryland. We used two sources of cases: a) individuals with both a positive test for Lyme disease and a contemporaneous diagnostic code consistent with a Lyme disease-related syndrome; and b) individuals referred for a Lyme disease evaluation who were adjudicated to have Lyme disease. Controls were individuals from the referral cohort judged not to have Lyme disease. Residential address data were available for all cases and controls. We used a hierarchical Bayesian model with a smoothing function for a coordinate location to evaluate the probability of Lyme disease within 100 km of Johns Hopkins Hospital. We found that the probability of Lyme disease was greatest in the north and west of Baltimore, and the local probability that a subject would have Lyme disease varied by as much as 30-fold. Adjustment for demographic and ecological variables partially attenuated the spatial gradient. Our study supports the suitability of electronic medical record data for the retrospective surveillance of Lyme disease.
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Affiliation(s)
- Paul M. Lantos
- Duke University School of Medicine, Durham, NC, United States of America
- Duke Global Health Institute, Durham, NC, United States of America
| | - Mark Janko
- Duke Global Health Institute, Durham, NC, United States of America
| | - Lise E. Nigrovic
- Boston Children’s Hospital, Boston, MA, United States of America
| | - Felicia Ruffin
- Duke University School of Medicine, Durham, NC, United States of America
| | - Takaaki Kobayashi
- University of Iowa Hospital and Clinics, Iowa City, IA, United States of America
| | - Yvonne Higgins
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Paul G. Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
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Narvaez ZE, Rainey T, Puelle R, Khan A, Jordan RA, Egizi AM, Price DC. Detection of multiple tick-borne pathogens in Ixodes scapularis from Hunterdon County, NJ, USA. CURRENT RESEARCH IN PARASITOLOGY & VECTOR-BORNE DISEASES 2023; 4:100140. [PMID: 37680762 PMCID: PMC10481180 DOI: 10.1016/j.crpvbd.2023.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/07/2023] [Accepted: 08/17/2023] [Indexed: 09/09/2023]
Abstract
Several human pathogens vectored by the blacklegged tick (Ixodes scapularis Say; Acari: Ixodidae) are endemic in the state of New Jersey. Disease incidence data suggest that these conditions occur disproportionately in the northwestern portion of the state, including in the county of Hunterdon. We conducted active surveillance at three forested sites in Hunterdon County during 2020 and 2021, collecting 662 nymphal and adult I. scapularis. Ticks were tested for five pathogens by qPCR/qRT-PCR: Anaplasma phagocytophilum, Babesia microti, Borrelia burgdorferi, Borrelia miyamotoi, and Powassan virus (POWV) lineage 2. Over 2 years, 25.4% of nymphs and 58.4% of adults were found infected with at least one pathogen, with 10.6% of all ticks infected with more than one pathogen. We report substantial spatial and temporal variability of A. phagocytophilum and B. burgdorferi, with high relative abundance of the human-infective A. phagocytophilum variant Ap-ha. Notably, POWV was detected for the first time in Hunterdon, a county where human cases have not been reported. Based on comparisons with active surveillance initiatives in nearby counties, further investigation of non-entomological factors potentially influencing rates of tick-borne illness in Hunterdon is recommended.
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Affiliation(s)
- Zoe E. Narvaez
- Rutgers University Center for Vector Biology, 180 Jones Ave, New Brunswick, NJ, 08901, USA
| | - Tadhgh Rainey
- Hunterdon County Department of Health, 314 State Route 12, Flemington, NJ, 08822, USA
| | - Rose Puelle
- Hunterdon Healthcare Partners, 114 Broad St, Flemington, NJ, 08822, USA
| | - Arsala Khan
- Rutgers University Center for Vector Biology, 180 Jones Ave, New Brunswick, NJ, 08901, USA
| | - Robert A. Jordan
- Tick-borne Diseases Laboratory, Monmouth County Mosquito Control Division, 1901 Wayside Rd, Tinton Falls, NJ, 07724, USA
| | - Andrea M. Egizi
- Rutgers University Center for Vector Biology, 180 Jones Ave, New Brunswick, NJ, 08901, USA
- Tick-borne Diseases Laboratory, Monmouth County Mosquito Control Division, 1901 Wayside Rd, Tinton Falls, NJ, 07724, USA
| | - Dana C. Price
- Rutgers University Center for Vector Biology, 180 Jones Ave, New Brunswick, NJ, 08901, USA
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Diallo M, Traore A, Nzioki MM, Richelot A, Stephane K, Okeibunor J, Pascal M, Okiror S, Ticha J. Auto Visual AFP Detection and Response (AVADAR) Improved Polio Surveillance in Lake Chad Polio Outbreak Priority Districts. ACTA ACUST UNITED AC 2021; Spec Issue:1101. [PMID: 33997859 PMCID: PMC7610764 DOI: 10.29245/2578-3009/2021/s2.1101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Auto Visual AFP Detection and Response (AVADAR) is a community-based digital platform that deals with the collection and distribution of real-time information. AVADAR makes it possible to report suspected cases of paralysis in the field at the central level. Once a suspected Acute Flaccid Paralysis (AFP) case is detected, a series of reports are sent to the following stakeholders: the nearest training officer, the district focal point, the district AVADAR team, the regional focal point, the central level of the Ministry of Health (MoH) and World Health Organization Country Office (WCO) by SMS and email. The health worker will go to the field to join the community informant who notified the case for a clinical investigation. At the end of this investigation, the health worker via a smartphone will submit an investigation report validating or invalidating the suspected case notified as a true case of AFP or False case. A small server called a gateway is positioned at the central level to ensure the information link between community informants and health workers in each district. A large server is placed in Geneva at Novel-T which allows all countries to connect and view the data in real time. The geolocation of all alerts and investigations of AFP cases is the cornerstone of AVADAR data.
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Affiliation(s)
- Mamadou Diallo
- WHO Regional Office for Africa (WHO AFRO), Brazzaville, Congo
| | | | | | | | | | | | - Mkanda Pascal
- WHO Regional Office for Africa (WHO AFRO), Brazzaville, Congo
| | - Samuel Okiror
- WHO Horn of Africa Coordination Office (HOA), Nairobi KENYA
| | - Johnson Ticha
- WHO Regional Office for Africa (WHO AFRO), Brazzaville, Congo
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Atagbaza A, Okeibunor J, Amadou F, Kalilou S, Esanga AM, Bagayoko AN, Bohoussou P, Igweonu O, Seid MM, Aliyu AJ, Ntezayabo EB, Traore MA, Nzioki M, Olaleye A, Aluma ADL, Sedick DA, Seid AM, Tahir MS, de Medeiros N, Rabenarivo B, Diomande F, Mkanda P. Vaccinations and Vaccinators' Tracking System in Island Settlements: CHAD 2017-2018. JOURNAL OF IMMUNOLOGICAL SCIENCES 2021; Spec Issue:1116. [PMID: 33954308 PMCID: PMC7610726 DOI: 10.29245/2578-3009/2021/s2.1116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Chad is a country within the Lake Chad sub region, currently at risk for poliovirus infection. The Lake Chad Task Team on polio eradication in this sub region made significant efforts to reduce the risk of polio transmission in Chad by tacking immunization teams in the Island Settlement using a Geographic Information System (GIS) technology. This article demonstrates the application of GIS technology to track vaccination teams to monitor immunization coverage in the Island settlements, reduce the number of missed settlements, to provide evidence for vaccination implementation and accountability and improve team performance. METHODS In each district where tracking was conducted, global positioning system-enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. RESULTS In 2018, tracking covered 30 immunization days, in six rounds. Approximately average of 1173 Island settlements were tracked and covered in each of the six rounds. A total of 806,999 persons aged 0-10 years were immunized, out of which 4273 were zero dose cases at the point of their immunization. Tracking activities were conducted. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. CONCLUSIONS The tracking of vaccination teams and Island settlements ensured useful information for planning and implementation of polio campaigns and enabled supervisors to evaluate performance of vaccination teams.
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Affiliation(s)
- Ajiri Atagbaza
- WHO Regional Office for African (WHO AFRO), Brazzaville, Congo
| | | | | | | | | | | | | | | | | | | | | | | | - Mwanza Nzioki
- WHO Regional Office for African (WHO AFRO), Brazzaville, Congo
| | | | | | | | | | | | | | | | | | - Pascal Mkanda
- WHO Regional Office for African (WHO AFRO), Brazzaville, Congo
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Rebman AW, Wang L, Yang T, Marsteller JA, Murphy SME, Uriyo M, Mihm EA, Weinstein ER, Fagan P, Aucott JN. Incidence of Lyme Disease Diagnosis in a Maryland Medicaid Population, 2004-2011. Am J Epidemiol 2018; 187:2202-2209. [PMID: 29955850 DOI: 10.1093/aje/kwy133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/25/2018] [Indexed: 11/13/2022] Open
Abstract
The epidemiology of Lyme disease has been examined utilizing insurance claims from privately insured individuals; however, it is unknown whether reported patterns vary among the publicly insured. We examined trends in incidence rates of first Lyme disease diagnosis among 384,652 Maryland Medicaid recipients enrolled from July 2004 to June 2011. Age-, sex-, county-, season-, and year-specific incidence rates were calculated, and mixed-effects multiple logistic regression models were used to study the relationship between Lyme disease diagnosis and these variables. The incidence rate in our sample was 97.65 cases per 100,000 person-years (95% confidence interval (CI): 91.53, 104.06), and there was a 13% average annual increase in the odds of a Lyme disease diagnosis (odds ratio = 1.13, 95% CI: 1.09, 1.17; P < 0.001). Incidence rates for males and females were not significantly different, though males were significantly more likely to be diagnosed during high-season months (relative risk (RR) = 1.24, 95% CI: 1.06, 1.44) and less likely to be diagnosed during low-season months (RR = 0.63, 95% CI: 0.46, 0.87) than females. Additionally, adults were significantly more likely than children to be diagnosed during low-season months (RR = 1.59, 95% CI: 1.19, 2.12). While relatively rare in this study sample, Lyme disease diagnoses do occur in a Medicaid population in a Lyme-endemic state.
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Affiliation(s)
- Alison W Rebman
- Division of Rheumatology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Lin Wang
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland
| | - Ting Yang
- Division of Rheumatology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Jill A Marsteller
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | - Maria Uriyo
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland
| | - Erica A Mihm
- Division of Rheumatology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Eric R Weinstein
- Division of Rheumatology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Peter Fagan
- Johns Hopkins HealthCare LLC, Glen Burnie, Maryland
| | - John N Aucott
- Division of Rheumatology, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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Sharareh N, Sabounchi NS, Roome A, Spathis R, Garruto RM. Model-based risk assessment and public health analysis to prevent Lyme disease. ROYAL SOCIETY OPEN SCIENCE 2017; 4:170841. [PMID: 29291075 PMCID: PMC5717649 DOI: 10.1098/rsos.170841] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/12/2017] [Indexed: 06/03/2023]
Abstract
The number of Lyme disease (LD) cases in the northeastern United States has been dramatically increasing with over 300 000 new cases each year. This is due to numerous factors interacting over time including low public awareness of LD, risk behaviours and clothing choices, ecological and climatic factors, an increase in rodents within ecologically fragmented peri-urban built environments and an increase in tick density and infectivity in such environments. We have used a system dynamics (SD) approach to develop a simulation tool to evaluate the significance of risk factors in replicating historical trends of LD cases, and to investigate the influence of different interventions, such as increasing awareness, controlling clothing risk and reducing mouse populations, in reducing LD risk. The model accurately replicates historical trends of LD cases. Among several interventions tested using the simulation model, increasing public awareness most significantly reduces the number of LD cases. This model provides recommendations for LD prevention, including further educational programmes to raise awareness and control behavioural risk. This model has the potential to be used by the public health community to assess the risk of exposure to LD.
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Affiliation(s)
- Nasser Sharareh
- Systems Science and Industrial Engineering Department, The State University of New York at Binghamton, Binghamton, NY, USA
| | - Nasim S. Sabounchi
- Systems Science and Industrial Engineering Department, The State University of New York at Binghamton, Binghamton, NY, USA
| | - Amanda Roome
- Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
- Laboratory of Biomedical Anthropology and Neurosciences, Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
| | - Rita Spathis
- Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
- Laboratory of Biomedical Anthropology and Neurosciences, Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
| | - Ralph M. Garruto
- Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
- Laboratory of Biomedical Anthropology and Neurosciences, Anthropology Department, The State University of New York at Binghamton, Binghamton, NY, USA
- Biological Sciences Department, The State University of New York at Binghamton, Binghamton, NY, USA
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7
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Kugeler KJ, Farley GM, Forrester JD, Mead PS. Geographic Distribution and Expansion of Human Lyme Disease, United States. Emerg Infect Dis 2016. [PMID: 26196670 PMCID: PMC4517724 DOI: 10.3201/eid2108.141878] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Lyme disease occurs in specific geographic regions of the United States. We present a method for defining high-risk counties based on observed versus expected number of reported human Lyme disease cases. Applying this method to successive periods shows substantial geographic expansion of counties at high risk for Lyme disease.
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Auwaerter PG. Lyme disease: knowing good evidence to help inform practice. Infect Dis Clin North Am 2016; 29:xi-xvi. [PMID: 25999231 DOI: 10.1016/j.idc.2015.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Paul G Auwaerter
- Johns Hopkins University School of Medicine, Sherrilyn and Ken Fisher Professor of Medicine, Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, 725 North Wolfe Street, Room # 231, Baltimore, MD 21205, USA.
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Touray K, Mkanda P, Tegegn SG, Nsubuga P, Erbeto TB, Banda R, Etsano A, Shuaib F, Vaz RG. Tracking Vaccination Teams During Polio Campaigns in Northern Nigeria by Use of Geographic Information System Technology: 2013-2015. J Infect Dis 2015; 213 Suppl 3:S67-72. [PMID: 26609004 PMCID: PMC4818548 DOI: 10.1093/infdis/jiv493] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Nigeria is among the 3 countries in which polio remains endemic. The country made significant efforts to reduce polio transmission but remains challenged by poor-quality campaigns and poor team performance in some areas. This article demonstrates the application of geographic information system technology to track vaccination teams to monitor settlement coverage, reduce the number of missed settlements, and improve team performance. METHODS In each local government area where tracking was conducted, global positioning system-enabled Android phones were given to each team on a daily basis and were used to record team tracks. These tracks were uploaded to a dashboard to show the level of coverage and identify areas missed by the teams. RESULTS From 2012 to June 2015, tracking covered 119 immunization days. A total of 1149 tracking activities were conducted. Of these, 681 (59%) were implemented in Kano state. There was an improvement in the geographic coverage of settlements and an overall reduction in the number of missed settlements. CONCLUSIONS The tracking of vaccination teams provided significant feedback during polio campaigns and enabled supervisors to evaluate performance of vaccination teams. The reports supported other polio program activities, such as review of microplans and the deployment of other interventions, for increasing population immunity in northern Nigeria.
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Affiliation(s)
- Kebba Touray
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Pascal Mkanda
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Sisay G Tegegn
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Tesfaye B Erbeto
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Richard Banda
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | | | - Rui G Vaz
- World Health Organization, Country Representative Office, Abuja, Nigeria
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Nadolny RM, Feldman KA, Pagac B, Stromdahl EY, Rutz H, Wee SB, Richards AL, Smith J, Armolt M, Gaff HD. Review of the Mid-Atlantic Tick Summit III: A model for regional information sharing. Ticks Tick Borne Dis 2015; 6:435-8. [PMID: 25920376 DOI: 10.1016/j.ttbdis.2015.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 11/16/2022]
Abstract
Ticks are the most significant vectors of infectious diseases in the United States, inspiring many researchers to study aspects of their biology, ecology, and their effects on public health. However, regional differences in tick abundance and pathogen infection prevalence result in the inability to assume results from one area are relevant in another. Current local information on tick ranges, infection rates, and human cases is needed to assess tick-borne disease risk in any given region. The Mid-Atlantic Tick Summit III brought together over 100 area experts and researchers to share regional updates on ticks and their associated pathogens. We report some meeting highlights here. Regional meetings foster cross-disciplinary collaborations that benefit the community, and open novel lines of inquiry so that tick-bite risk can be reduced and tick-borne diseases can be treated effectively.
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Affiliation(s)
- Robyn M Nadolny
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, United States; U.S. Army Public Health Command, Aberdeen Proving Ground, MD, United States
| | - Katherine A Feldman
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
| | - Benedict Pagac
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, United States
| | - Ellen Y Stromdahl
- U.S. Army Public Health Command, Aberdeen Proving Ground, MD, United States
| | - Heather Rutz
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
| | - Siok-Bi Wee
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
| | - Allen L Richards
- Viral and Rickettsial Diseases Department, Naval Medical Research Center, Silver Spring, MD, United States
| | - Joshua Smith
- Fairfax County Health Department, Fairfax, VA, United States
| | - Mary Armolt
- Center for Zoonotic and Vector-borne Diseases, Maryland Department of Health and Mental Hygiene, Baltimore, MD, United States
| | - Holly D Gaff
- Department of Biological Sciences, Old Dominion University, Norfolk, VA, United States.
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Zhang S, Zhao J. Spatio-temporal epidemiology of hand, foot and mouth disease in Liaocheng City, North China. Exp Ther Med 2015; 9:811-816. [PMID: 25667633 PMCID: PMC4316912 DOI: 10.3892/etm.2015.2207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 12/01/2014] [Indexed: 01/04/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) has posed a notable threat to public health and become a public health priority in China. This study was based on the reported cases of HFMD between 2007 and 2011. A total of 34,176 HFMD cases were geo-coded at town level (n=134). Firstly, a descriptive analysis was conducted to evaluate the epidemic characteristics of HFMD. Then, the Kulldorff scan statistic based on a discrete Poisson model was used to detect spatial-temporal clusters. Spatial distribution of HFMD in Liaocheng City, China from 2007 to 2011 was mapped at town level in the aspects of crude incidence, excess hazard and spatial smoothed incidence. The spatial distribution of HFMD was non-random and clustered with a significant Moran’s I value every year. The local Moran’s I Z-score detected three significant spatial clusters for high incidence of HFMD. The space-time analysis identified one most likely cluster and twenty-five secondary clusters for high incidence of HFMD. We demonstrate evidence of the existence of statistically significant HFMD clusters in Liaocheng City. Our results provide better guidance for formulating regional prevention and control strategies.
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Affiliation(s)
- Shiying Zhang
- Department of Communicable Disease Control and Prevention, Center for Disease Control and Prevention of Liaocheng City, Liaocheng, Shandong 252000, P.R. China
| | - Jinxing Zhao
- Department of Communicable Disease Control and Prevention, Center for Disease Control and Prevention of Liaocheng City, Liaocheng, Shandong 252000, P.R. China
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Cameron DJ, Johnson LB, Maloney EL. Evidence assessments and guideline recommendations in Lyme disease: the clinical management of known tick bites, erythema migrans rashes and persistent disease. Expert Rev Anti Infect Ther 2014; 12:1103-35. [PMID: 25077519 PMCID: PMC4196523 DOI: 10.1586/14787210.2014.940900] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions - the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1-13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.
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Affiliation(s)
- Daniel J Cameron
- International Lyme and Associated Diseases Society,PO Box 341461, Bethesda MD, 20827-1461,USA
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Bhunia GS, Kesari S, Chatterjee N, Kumar V, Das P. Spatial and temporal variation and hotspot detection of kala-azar disease in Vaishali district (Bihar), India. BMC Infect Dis 2013; 13:64. [PMID: 23375077 PMCID: PMC3577657 DOI: 10.1186/1471-2334-13-64] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 01/25/2013] [Indexed: 12/02/2022] Open
Abstract
Background An improved understanding in transmission variation of kala-azar is fundamental to conduct surveillance and implementing disease prevention strategies. This study investigated the spatio-temporal patterns and hotspot detection for reporting kala-azar cases in Vaishali district based on spatial statistical analysis. Methods Epidemiological data from the study area during 2007–2011 was used to examine the dynamic space-time pattern of kala-azar outbreaks, and all cases were geocoded at a village level. Spatial smoothing was applied to reduce random noise in the data. Inverse distance weighting (IDW) is used to interpolate and predict the pattern of VL cases distribution across the district. Moran’s I Index (Moran’s I) statistics was used to evaluate autocorrelation in kala-azar spatial distribution and test how villages were clustered or dispersed in space. Getis-Ord Gi*(d) was used to identify the hotspot and cold spot areas within the study site. Results Mapping kala-azar cases or incidences reflects the spatial heterogeneity in the incidence rate of kala-azar affected villages in Vaishali district. Kala-azar incidence rate map showed most of the highest endemic villages were located in southern, eastern and northwestern part of the district; in the middle part of the district generally show the medium occurrence of VL. There was a significant positive spatial autocorrelation of kala-azar incidences for five consecutive years, with Moran’s I statistic ranging from 0.04-0.17 (P <0.01). The results revealed spatially clustered patterns with significant differences by village. The hotspots showed the spatial trend of kala-azar diffusion (P < 0.01). Conclusions The results pointed to the usefulness of spatial statistical approach to improve our understanding the spatio-temporal dynamics and control of kala-azar. The study also showed the north-western and southern part of Vaishali district is most likely endemic cluster region. To employ exact and geographically suitable risk-reduction programmes, apply of such spatial analysis tools should suit a vital constituent in epidemiology research and risk evaluation of kala-azar.
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Affiliation(s)
- Gouri Sankar Bhunia
- Department of Vector Biology and Control, Rajendra Memorial Research Institute of Medical Sciences (ICMR), Agamkuan, Patna 800007, Bihar, India
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Prevalence of haemorrhagic fever with renal syndrome in mainland China: analysis of National Surveillance Data, 2004-2009. Epidemiol Infect 2011; 140:851-7. [PMID: 21791148 DOI: 10.1017/s0950268811001063] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The monthly and annual incidence of haemorrhagic fever with renal syndrome (HFRS) in China for 2004-2009 was analysed in conjunction with associated geographical and demographic data. We applied the seasonal autoregressive integrated moving average (SARIMA) model to fit and forecast monthly HFRS incidence in China. HFRS was endemic in most regions of China except Hainan Province. There was a high risk of infection for male farmers aged 30-50 years. The fitted SARIMA(0,1,1)(0,1,1)12 model had a root-mean-square-error criterion of 0·0133 that indicated accurate forecasts were possible. These findings have practical applications for more effective HFRS control and prevention. The conducted SARIMA model may have applications as a decision support tool in HFRS control and risk-management planning programmes.
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Fine AM, Brownstein JS, Nigrovic LE, Kimia AA, Olson KL, Thompson AD, Mandl KD. Integrating spatial epidemiology into a decision model for evaluation of facial palsy in children. ACTA ACUST UNITED AC 2011; 165:61-7. [PMID: 21199982 DOI: 10.1001/archpediatrics.2010.250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To develop a novel diagnostic algorithm for Lyme disease among children with facial palsy by integrating public health surveillance data with traditional clinical predictors. DESIGN Retrospective cohort study. SETTING Children's Hospital Boston emergency department, 1995-2007. PATIENTS Two hundred sixty-four children (aged <20 years) with peripheral facial palsy who were evaluated for Lyme disease. MAIN OUTCOME MEASURES Multivariate regression was used to identify independent clinical and epidemiologic predictors of Lyme disease facial palsy. RESULTS Lyme diagnosis was positive in 65% of children from high-risk counties in Massachusetts during Lyme disease season compared with 5% of those without both geographic and seasonal risk factors. Among patients with both seasonal and geographic risk factors, 80% with 1 clinical risk factor (fever or headache) and 100% with 2 clinical factors had Lyme disease. Factors independently associated with Lyme disease facial palsy were development from June to November (odds ratio, 25.4; 95% confidence interval, 8.3-113.4), residence in a county where the most recent 3-year average Lyme disease incidence exceeded 4 cases per 100,000 (18.4; 6.5-68.5), fever (3.9; 1.5-11.0), and headache (2.7; 1.3-5.8). Clinical experts correctly treated 68 of 94 patients (72%) with Lyme disease facial palsy, but a tool incorporating geographic and seasonal risk identified all 94 cases. CONCLUSIONS Most physicians intuitively integrate geographic information into Lyme disease management, but we demonstrate quantitatively how formal use of geographically based incidence in a clinical algorithm improves diagnostic accuracy. These findings demonstrate potential for improved outcomes from investments in health information technology that foster bidirectional communication between public health and clinical settings.
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Affiliation(s)
- Andrew M Fine
- Division of Emergency Medicine, Children's Hospital Boston, Boston, MA 02115, USA.
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16
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Touray K, Adetifa IM, Jallow A, Rigby J, Jeffries D, Cheung YB, Donkor S, Adegbola RA, Hill PC. Spatial analysis of tuberculosis in an urban west African setting: is there evidence of clustering? Trop Med Int Health 2010; 15:664-72. [PMID: 20406427 DOI: 10.1111/j.1365-3156.2010.02533.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe the pattern of tuberculosis (TB) occurrence in Greater Banjul, The Gambia with Geographical Information Systems (GIS) and Spatial Scan Statistics (SaTScan) and to determine whether there is significant TB case clustering. METHODS In Greater Banjul, where 80% of all Gambian TB cases arise, all patients with TB registered at chest clinics between March 2007 and February 2008 were asked to participate. Demographic, clinical characteristics and GPS co-ordinates for the residence of each consenting TB case were recorded. A spatial scan statistic was used to identify purely spatial and space-time clusters of tuberculosis among permanent residents. RESULTS Of 1145 recruited patients with TB, 84% were permanent residents with 88% living in 37 settlements that had complete maps available down to settlement level. Significant high- and low-rate spatial and space-time clusters were identified in two districts. The most likely cluster of high rate from both the purely spatial analysis and the retrospective space-time analysis were from the same geographical area. A significant secondary cluster was also identified in one of the densely populated areas of the study region. CONCLUSIONS There is evidence of significant clustering of TB cases in Greater Banjul, The Gambia. Systematic use of cluster detection techniques for regular TB surveillance in The Gambia may aid effective deployment of resources. However, passive case detection dictates that community-based active case detection and risk factor surveys would help confirm the presence of true clusters and their causes.
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Affiliation(s)
- K Touray
- Bacterial Diseases Programme, MRC Laboratories, Banjul, The Gambia.
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17
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Carroll JF, Hill DE, Allen PC, Young KW, Miramontes E, Kramer M, Pound JM, Miller JA, George JE. The impact of 4-Poster deer self-treatment devices at three locations in Maryland. Vector Borne Zoonotic Dis 2010; 9:407-16. [PMID: 19650735 DOI: 10.1089/vbz.2008.0165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
From 1998-2002 twenty-five deer self-treatment devices (4-Posters), using 2% amitraz, were operated at three locations in Maryland to determine their effectiveness in controlling blacklegged ticks, Ixodes scapularis Say, and lone star ticks, Amblyomma americanum (L.). Each treatment site was approximately 518 ha and paired with a similar site lacking 4-Posters. Locations varied in deer density, tick abundance, and land use. Flagging for host-seeking ticks showed declines in tick populations at all treatment sites compared to control sites by the third year. By 2002, control of I. scapularis nymphs attributable to the 4-Poster intervention at the three sites was 69.0%, 75.8%, and 80%. Control of A. americanum nymphs at the two sites where they occurred was 99.5% and 95.3%. In 2003, the first posttreatment year, control of I. scapularis remained around 2001-2002 levels, but by 2004, an upward trend in nymphal numbers was detectable. Populations of A. americanum showed no increase posttreatment. These results demonstrate that control of these tick species is locally possible with 4-Poster intervention.
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Affiliation(s)
- John F Carroll
- Animal Parasitic Diseases Laboratory, Beltsville Area, Beltsville Agricultural Research Center, Agricultural Research Service, U.S. Department of Agriculture, Beltsville, Maryland 20705, USA.
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18
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GIS-based spatial, temporal, and space–time analysis of haemorrhagic fever with renal syndrome. Epidemiol Infect 2009; 137:1766-75. [DOI: 10.1017/s0950268809002659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYWe obtained a list of all reported cases of haemorrhagic fever with renal syndrome (HFRS) in Shenyang, China, during 1990–2003, and used GIS-based scan statistics to determine the distribution of HFRS cases and to identify key areas and periods for future risk-factor research. Spatial cluster analysis suggested three areas were at increased risk for HFRS. Temporal cluster analysis suggested one period was at increased risk for HFRS. Space–time cluster analysis suggested six areas from 1995 to 1996 and four areas from 1998 to 2003 were at increased risk for HFRS. We also discussed the likely reasons for these clusters. We conclude that GIS-based scan statistics may provide an opportunity to classify the epidemic situation of HFRS, and we can pursue future investigations to study the likely factors responsible for the increased disease risk based on the classification.
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Zhang W, Wang L, Fang L, Ma J, Xu Y, Jiang J, Hui F, Wang J, Liang S, Yang H, Cao W. Spatial analysis of malaria in Anhui province, China. Malar J 2008; 7:206. [PMID: 18847489 PMCID: PMC2572066 DOI: 10.1186/1475-2875-7-206] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Accepted: 10/10/2008] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Malaria has re-emerged in Anhui Province, China, and this province was the most seriously affected by malaria during 2005-2006. It is necessary to understand the spatial distribution of malaria cases and to identify highly endemic areas for future public health planning and resource allocation in Anhui Province. METHODS The annual average incidence at the county level was calculated using malaria cases reported between 2000 and 2006 in Anhui Province. GIS-based spatial analyses were conducted to detect spatial distribution and clustering of malaria incidence at the county level. RESULTS The spatial distribution of malaria cases in Anhui Province from 2000 to 2006 was mapped at the county level to show crude incidence, excess hazard and spatial smoothed incidence. Spatial cluster analysis suggested 10 and 24 counties were at increased risk for malaria (P < 0.001) with the maximum spatial cluster sizes at < 50% and < 25% of the total population, respectively. CONCLUSION The application of GIS, together with spatial statistical techniques, provide a means to quantify explicit malaria risks and to further identify environmental factors responsible for the re-emerged malaria risks. Future public health planning and resource allocation in Anhui Province should be focused on the maximum spatial cluster region.
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Affiliation(s)
- Wenyi Zhang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Liping Wang
- Center for Public Health Information, National Center for Disease Control and Prevention, Beijing, PR China
| | - Liqun Fang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Jiaqi Ma
- Center for Public Health Information, National Center for Disease Control and Prevention, Beijing, PR China
| | - Youfu Xu
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Jiafu Jiang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Fengming Hui
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Jianjun Wang
- Anhui Center for Disease Control and Prevention, Hefei, PR China
| | - Song Liang
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Hong Yang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
| | - Wuchun Cao
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, PR China
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Zhang Z, Carpenter TE, Chen Y, Clark AB, Lynn HS, Peng W, Zhou Y, Zhao G, Jiang Q. Identifying high-risk regions for schistosomiasis in Guichi, China: a spatial analysis. Acta Trop 2008; 107:217-23. [PMID: 18722565 DOI: 10.1016/j.actatropica.2008.04.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Revised: 03/25/2008] [Accepted: 04/28/2008] [Indexed: 11/28/2022]
Abstract
Schistosomiasis epidemic is reemerging in some areas of China. The extensive snail habitat is a major challenge for a sustainable schistosomiasis control. Direct surveillance on snails for the disease control is no longer a desirable disease control approach due to current low density of infected snails and reduced funding. In this study the benefit of indirect monitoring of acute schistosomiasis cases, using spatial methods including disease mapping and spatial clustering analysis was explored in Guichi, China. Significant global clustering existed for acute cases and two statistically significant spatial clusters were detected, and subsequently validated by field surveys. Our study indicates that the application of geographic information system (GIS) and spatial methods are useful in the epidemiologic surveillance and risk assessment for acute schistosomiasis, providing an alternative approach with minimal funds required.
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Affiliation(s)
- Zhijie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, People's Republic of China
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21
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Swanson KI, Norris DE. Co-circulating microorganisms in questing Ixodes scapularis nymphs in Maryland. JOURNAL OF VECTOR ECOLOGY : JOURNAL OF THE SOCIETY FOR VECTOR ECOLOGY 2007; 32:243-51. [PMID: 18260514 DOI: 10.3376/1081-1710(2007)32[243:cmiqis]2.0.co;2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Ixodes scapularis can be infected with Borrelia burgdorferi, Anaplasma phagocytophilum, Bartonella spp., Babesia microti, and Rickettsia spp., including spotted-fever group Rickettsia. As all of these microorganisms have been reported in Maryland, the potential for these ticks to have concurrent infections exists in this region. To assess the frequency of these complex infections, 348 I. scapularis nymphs collected in 2003 were screened for these microorganisms by PCR with positives being confirmed by DNA sequencing. Borrelia burgdorferi was detected in 14.7% of nymphs. Anaplasma phagocytophilum (0.3%), Rickettsia spp. (19.5%), and an uncategorized agent (0.9%) was also detected. Dual infections were detected with B. burgdorferi and Rickettsia spp. as well as a triple infection with B. burgdorferi, Rickettsia spp., and an uncategorized agent. Infections with B. burgdorferi and Rickettsia spp. were statistically independent of one another. However, infection with B. burgdorferi and any one of these other microorganisms appears to occur more frequently than by chance alone, probably as a result of shared enzootic cycles. This study confirms that multiple microorganisms co-circulate with B. burgdorferi in I. scapularis in Maryland and demonstrates that Rickettsia spp. and B. burgdorferi circulate independently and at nearly equal frequencies, while A. phagocytophilum and other unrecognized organisms are less common.
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Affiliation(s)
- Katherine I Swanson
- W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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22
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Lin H, Liu Q, Guo J, Zhang J, Wang J, Chen H. Analysis of the geographic distribution of HFRS in Liaoning Province between 2000 and 2005. BMC Public Health 2007; 7:207. [PMID: 17697362 PMCID: PMC2194774 DOI: 10.1186/1471-2458-7-207] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2006] [Accepted: 08/15/2007] [Indexed: 11/10/2022] Open
Abstract
Background Hemorrhagic fever with renal syndrome (HFRS) is endemic in Liaoning Province, China, and this province was the most serious area affected by HFRS during 2004 to 2005. In this study, we conducted a spatial analysis of HFRS cases with the objective to determine the distribution of HFRS cases and to identify key areas for future public health planning and resource allocation in Liaoning Province. Methods The annual average incidence at the county level was calculated using HFRS cases reported between 2000 and 2005 in Liaoning Province. GIS-based spatial analyses were conducted to detect spatial distribution and clustering of HFRS incidence at the county level, and the difference of relative humidity and forestation between the cluster areas and non-cluster areas was analyzed. Results Spatial distribution of HFRS cases in Liaoning Province from 2000 to 2005 was mapped at the county level to show crude incidence, excess hazard, and spatial smoothed incidence. Spatial cluster analysis suggested 16 and 41 counties were at increased risk for HFRS (p < 0.01) with the maximum spatial cluster sizes at ≤ 50% and ≤ 30% of the total population, respectively, and the analysis showed relative humidity and forestation in the cluster areas were significantly higher than in other areas. Conclusion Some clustering of HFRS cases in Liaoning Province may be etiologically linked. There was strong evidence some HFRS cases in Liaoning Province formed clusters, but the mechanism underlying it remains unknown. In this study we found the clustering was consistent with the relative humidity and amount of forestation, and showed data indicating there may be some significant relationships.
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Affiliation(s)
- Hualiang Lin
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiyong Liu
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Junqiao Guo
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Jibo Zhang
- Liaoning Provincial Center for Disease Control and Prevention, Shenyang, China
| | - Jinfeng Wang
- State Key Laboratory of Resources & Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Huaxin Chen
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Anderson JM, Norris DE. Genetic diversity of Borrelia burgdorferi sensu stricto in Peromyscus leucopus, the primary reservoir of Lyme disease in a region of endemicity in southern Maryland. Appl Environ Microbiol 2006; 72:5331-41. [PMID: 16885284 PMCID: PMC1538722 DOI: 10.1128/aem.00014-06] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In the north central and northeastern United States, Borrelia burgdorferi sensu stricto, the etiologic agent of Lyme disease (LD), is maintained in an enzootic cycle between the vector, Ixodes scapularis, and the primary reservoir host, Peromyscus leucopus. Genetic diversity of the pathogen based on sequencing of two plasmid-located genes, those for outer surface protein A (ospA) and outer surface protein C (ospC), has been examined in both tick and human specimens at local, regional, and worldwide population scales. Additionally, previous studies have only been conducted with tick or human specimens at the local population level in areas with high LD transmission rates. This study examined the genetic diversity of circulating borreliae in the reservoir population from a large region of the western coastal plains of southern Maryland, where moderate numbers of human LD cases are reported. Six ospA mobility classes, including two that were not previously described, and eight ospC groups were found among the P. leucopus samples. Twenty-five percent of all specimens were infected with more than one ospA or ospC variant. The frequency distribution of variants was homogeneous, both locally and spatially. The spirochete diversity found in Maryland was not as high as that observed among northern tick populations, yet similar genotypes were observed in both populations. These results also show that mice are important for maintaining Borrelia variants, even rare variants, and that reservoir populations should therefore be considered when assessing the diversity of B. burgdorferi.
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Affiliation(s)
- Jennifer M Anderson
- The W.Harry Feinstone Department of Molecular Microbiology and Immunology, John Hopkins Bloomberg, School of Public Health, Baltimore, MD 21205, USA.
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Tiwari N, Adhikari CMS, Tewari A, Kandpal V. Investigation of geo-spatial hotspots for the occurrence of tuberculosis in Almora district, India, using GIS and spatial scan statistic. Int J Health Geogr 2006; 5:33. [PMID: 16901341 PMCID: PMC1557839 DOI: 10.1186/1476-072x-5-33] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2006] [Accepted: 08/10/2006] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The World Health Organization has declared tuberculosis a global emergency in 1993. It has been estimated that one third of the world population is infected with Mycobacterium tuberculosis, the causative agent of tuberculosis. The emergence of TB/HIV co-infection poses an additional challenge for the control of tuberculosis throughout the world. The World Health Organization is supporting many developing countries to eradicate tuberculosis. It is an agony that one fifth of the tuberculosis patients worldwide are in India. The eradication of tuberculosis is the greatest public health challenge for this developing country. The aim of the present population based study on Mycobacterium tuberculosis is to test a large set of tuberculosis cases for the presence of statistically significant geographical clusters. A spatial scan statistic is used to identify purely spatial and space-time clusters of tuberculosis. RESULTS Significant (p < 0.05 for primary clusters and p < 0.1 for secondary clusters) high rate spatial and space-time clusters were identified in three areas of the district. CONCLUSION There is sufficient evidence about the existence of statistically significant tuberculosis clusters in Almora district of Uttaranchal, India. The spatial scan statistics methodology used in this study has a potential use in surveillance of tuberculosis for detecting the true clusters of the disease.
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Affiliation(s)
- Neeraj Tiwari
- Department of Statistics, Kumaon University, S.S.J.Campus, Almora, Uttaranchal, India
| | | | - Ajoy Tewari
- Community Health Centre, Sidhauli, U.P., India
| | - Vineeta Kandpal
- Department of Anatomy, GSVM Medical College, Kanpur, U.P., India
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25
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Fang L, Yan L, Liang S, de Vlas SJ, Feng D, Han X, Zhao W, Xu B, Bian L, Yang H, Gong P, Richardus JH, Cao W. Spatial analysis of hemorrhagic fever with renal syndrome in China. BMC Infect Dis 2006; 6:77. [PMID: 16638156 PMCID: PMC1471792 DOI: 10.1186/1471-2334-6-77] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 04/26/2006] [Indexed: 11/16/2022] Open
Abstract
Background Hemorrhagic fever with renal syndrome (HFRS) is endemic in many provinces with high incidence in mainland China, although integrated intervention measures including rodent control, environment management and vaccination have been implemented for over ten years. In this study, we conducted a geographic information system (GIS)-based spatial analysis on distribution of HFRS cases for the whole country with an objective to inform priority areas for public health planning and resource allocation. Methods Annualized average incidence at a county level was calculated using HFRS cases reported during 1994–1998 in mainland China. GIS-based spatial analyses were conducted to detect spatial autocorrelation and clusters of HFRS incidence at the county level throughout the country. Results Spatial distribution of HFRS cases in mainland China from 1994 to 1998 was mapped at county level in the aspects of crude incidence, excess hazard and spatial smoothed incidence. The spatial distribution of HFRS cases was nonrandom and clustered with a Moran's I = 0.5044 (p = 0.001). Spatial cluster analyses suggested that 26 and 39 areas were at increased risks of HFRS (p < 0.01) with maximum spatial cluster sizes of ≤ 20% and ≤ 10% of the total population, respectively. Conclusion The application of GIS, together with spatial statistical techniques, provide a means to quantify explicit HFRS risks and to further identify environmental factors responsible for the increasing disease risks. We demonstrate a new perspective of integrating such spatial analysis tools into the epidemiologic study and risk assessment of HFRS.
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Affiliation(s)
- Liqun Fang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
| | - Lei Yan
- Institute of Remote Sensing Applications, Chinese Academy of Science, Beijing, China
| | - Song Liang
- Institute of Remote Sensing Applications, Chinese Academy of Science, Beijing, China
- School of Public Health, University of California, Berkeley, USA
| | - Sake J de Vlas
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Dan Feng
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
| | - Xiaona Han
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
| | - Wenjuan Zhao
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
| | - Bing Xu
- Institute of Remote Sensing Applications, Chinese Academy of Science, Beijing, China
| | - Ling Bian
- Department of Geography, University at Buffalo, USA
| | - Hong Yang
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
| | - Peng Gong
- Institute of Remote Sensing Applications, Chinese Academy of Science, Beijing, China
| | - Jan Hendrik Richardus
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Wuchun Cao
- Beijing Institute of Microbiology and Epidemiology, State Key Laboratory of Pathogen and Biosecurity, Beijing, China
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Tran A, Deparis X, Dussart P, Morvan J, Rabarison P, Remy F, Polidori L, Gardon J. Dengue spatial and temporal patterns, French Guiana, 2001. Emerg Infect Dis 2004; 10:615-21. [PMID: 15200850 PMCID: PMC3323097 DOI: 10.3201/eid1004.030186] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To study a 2001 dengue fever outbreak in Iracoubo, French Guiana, we recorded the location of all patients’ homes and the date when symptoms were first observed. A geographic information system was used to integrate the patient-related information. The Knox test, a classic space-time analysis technique, was used to detect spatiotemporal clustering. Analysis of the relative-risk (RR) variations when space and time distances vary, highlighted the maximum space and time extent of a dengue transmission focus. The results show that heterogeneity in the RR variations in space and time corresponds to known entomologic and epidemiologic factors, such as the mosquito feeding cycle and host-seeking behavior. This finding demonstrates the relevance and potential of the use of GIS and spatial statistics for elaborating a dengue fever surveillance strategy.
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Affiliation(s)
- Annelise Tran
- Institut de Recherche pour le Développement Guyane, Cayenne, Guyane.
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Chaput EK, Meek JI, Heimer R. Spatial analysis of human granulocytic ehrlichiosis near Lyme, Connecticut. Emerg Infect Dis 2002; 8:943-8. [PMID: 12194771 PMCID: PMC2732548 DOI: 10.3201/eid0809.020103] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Geographic information systems combined with methods of spatial analysis provide powerful new tools for understanding the epidemiology of diseases and for improving disease prevention and control. In this study, the spatial distribution of a newly recognized tick-borne disease, human granulocytic ehrlichiosis (HGE), was investigated for nonrandom patterns and clusters in an area known to be endemic for tick-borne diseases. Analysis of confirmed cases of HGE identified in 1997-2000 in a 12-town area around Lyme, Connecticut, showed that HGE infections are not distributed randomly. Smoothed HGE incidence was higher around the mouth of the Connecticut River and lower to the north and west. Cluster analysis identified one area of increased HGE risk (relative risk=1.8, p=0.001). This study demonstrates the utility of geographic information systems and spatial analysis to clarify the epidemiology of HGE.
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