RESUMO
Outbreaks of infectious disease can pose a significant threat to human health. Thus, detecting and characterizing outbreaks quickly and accurately remains an important problem. This paper describes a Bayesian framework that links clinical diagnosis of individuals in a population to epidemiological modeling of disease outbreaks in the population. Computer-based diagnosis of individuals who seek healthcare is used to guide the search for epidemiological models of population disease that explain the pattern of diagnoses well. We applied this framework to develop a system that detects influenza outbreaks from emergency department (ED) reports. The system diagnoses influenza in individuals probabilistically from evidence in ED reports that are extracted using natural language processing. These diagnoses guide the search for epidemiological models of influenza that explain the pattern of diagnoses well. Those epidemiological models with a high posterior probability determine the most likely outbreaks of specific diseases; the models are also used to characterize properties of an outbreak, such as its expected peak day and estimated size. We evaluated the method using both simulated data and data from a real influenza outbreak. The results provide support that the approach can detect and characterize outbreaks early and well enough to be valuable. We describe several extensions to the approach that appear promising.
Assuntos
Doenças Transmissíveis/epidemiologia , Surtos de Doenças , Influenza Humana/epidemiologia , Informática em Saúde Pública/métodos , Algoritmos , Teorema de Bayes , Controle de Doenças Transmissíveis , Simulação por Computador , Registros Eletrônicos de Saúde , Serviços Médicos de Emergência , Humanos , Incidência , Infectologia , Modelos Estatísticos , Pennsylvania , Vigilância da População/métodos , ProbabilidadeRESUMO
Early detection and accurate characterization of disease outbreaks are important tasks of public health. Infectious diseases that present symptomatically like influenza (SLI), including influenza itself, constitute an important class of diseases that are monitored by public-health epidemiologists. Monitoring emergency department (ED) visits for presentations of SLI could provide an early indication of the presence, extent, and dynamics of such disease in the population. We investigated the use of daily over-the-counter thermometer-sales data to estimate daily ED SLI counts in Allegheny County (AC), Pennsylvania. We found that a simple linear model fits the data well in predicting daily ED SLI counts from daily counts of thermometer sales in AC. These results raise the possibility that this model could be applied, perhaps with adaptation, in other regions of the country, where commonly thermometer sales data are available, but daily ED SLI counts are not.
Assuntos
Comércio , Influenza Humana/fisiopatologia , Termômetros , Teorema de Bayes , Surtos de Doenças , Humanos , Incidência , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pennsylvania/epidemiologiaRESUMO
The Pittsburgh Center of Excellence in Public Health Informatics has developed a probabilistic, decision-theoretic system for disease surveillance and control for use in Allegheny County, PA and later in Tarrant County, TX. This paper describes the software components of the system and its knowledge bases. The paper uses influenza surveillance to illustrate how the software components transform data collected by the healthcare system into population level analyses and decision analyses of potential outbreak-control measures.