Syndrome Surveillance Using Parametric Space-Time Clustering

As demonstrated by the anthrax attack through the United States mail, people infected by the biological agent itself will give the first indication of a bioterror attack. Thus, a distributed information system that can rapidly and efficiently gather and analyze public health data would aid epidemiologists in detecting and characterizing emerging diseases, including bioterror attacks. We propose using clusters of adverse health events in space and time to detect possible bioterror attacks. Space-time clusters can indicate exposure to infectious diseases or localized exposure to toxins. Most space-time clustering approaches require individual patient data. To protect the patient's privacy, we have extended these approaches to aggregated data and have embedded this extension in a sequential probability ratio test (SPRT) framework. The real-time and sequential nature of health data makes the SPRT an ideal candidate. The result of space-time clustering gives the statistical significance of a cluster at every location in the surveillance area and can be thought of as a ''health-index'' of the people living in this area. As a surrogate to bioterrorism data, we have experimented with two flu data sets. For both databases, we show that space-time clustering can detect a flu epidemic up to 21 to 28 days earlier than a conventional periodic regression technique. We have also tested using simulated anthrax attack data on top of a respiratory illness diagnostic category. Results show we do very well at detecting an attack as early as the second or third day after infected people start becoming severely symptomatic