Sporadic Shiga Toxin-Producing Escherichia coli-Associated Pediatric Hemolytic Uremic Syndrome, France, 2012-2021.

Shiga toxin-producing Escherichia coli-associated pediatric hemolytic uremic syndrome (STEC-HUS) remains an important public health risk in France. Cases are primarily sporadic, and geographic heterogeneity has been observed in crude incidence rates. We conducted a retrospective study of 1,255 sporadic pediatric STEC-HUS cases reported during 2012-2021 to describe spatiotemporal dynamics and geographic patterns of higher STEC-HUS risk. Annual case notifications ranged from 109 to 163. Most cases (n = 780 [62%]) were in children <3 years of age. STEC serogroups O26, O80, and O157 accounted for 78% (559/717) of cases with serogroup data. We identified 13 significant space-time clusters and 3 major geographic zones of interest; areas of southeastern France were included in >5 annual space-time clusters. The results of this study have numerous implications for outbreak detection and investigation and research perspectives to improve knowledge of environmental risk factors associated with geographic disparities in STEC-HUS in France.

Temporal trend and factors associated with spatial distribution of congenital syphilis in Brazil: An ecological study.

Objective: The study aimed to analyze the temporal trend of congenital syphilis in Brazil in the period from 2008 to 2018 and its spatial distribution in the Immediate Regions of Urban Articulation, and to identify spatial correlations with socioeconomic factors and prenatal care. Methods: Spatial correlations between the incidence of congenital syphilis and socioeconomic conditions and access to prenatal care were assessed. This ecological study conducted a time series analysis in Brazil and spatial analysis in 482 Immediate Regions of Urban Articulation. Cases of congenital syphilis reported in the Notifiable Diseases Information System and the Live Birth Information System from January 1, 2008, to December 31, 2018 were included. Socioeconomic conditions (percentage of individuals with inadequate water supply and sanitation) were extracted from the 2010 census, whereas the Live Birth Information System provided data on access to prenatal care (percentage of live births with 1-3 prenatal care appointments). The Joinpoint Regression software performed the temporal trend analysis, while the GeoDa software assessed territorial clusters using the Moran's I and Local Spatial Association Indicator. Results: The incidence of congenital syphilis showed an upward trend (annual percent change 1 = 26.96; 95% CI: 18.2-36.3; annual percent change 2 = 10.25; 95% CI: 2.7-28.4) and was unevenly distributed across Immediate Regions of Urban Articulation in Brazil (Moran's I = 0.264, p ≤ 0.05). It also presented a direct spatial correlation with the percentage of individuals with inadequate water supply and sanitation (Moran's I = 0.02, p ≤ 0.05) and the percentage of live births with 1-3 prenatal care appointments (Moran's I = 0.03, p ≤ 0.05). Conclusion: Agrowth trend of congenital syphilis in Brazil was observed between 2008 and 2018. Moreover, inequalities in socioeconomic conditions and access to prenatal care influenced the spatial distribution of this disease.

Spatial patterns and epidemiological characterization of suicides in the micro-region of Chapecó, Santa Catarina, Brazil: ecological study, 1996- 2018 / Patrones espaciales y caracterización epidemiológica de los suicidios en la micro-región de Chapecó, Santa Catarina, Brasil: estudio ecológico, 1996- 2018 / Padrões espaciais e caracterização epidemiológica dos suicídios na microrregião de Chapecó, Santa Catarina: estudo ecológico, 1996-2018

Objective: To identify spatial clusters of suicide and the epidemiological profile in the microregion of Chapecó (SC), between 1996-2018. Methods: Exploratory ecological study, with data from the Mortality Information System. Specific suicide rates and relative risks (RR) were calculated with a 95% confidence interval (95%CI). For spatial analysis, the scan statistic was used. Results: There were 1,034 suicides (13.7/100,000 inhabitants), with a male/female ratio of 3.79. The age group ≥60 was at higher risk for both sexes. A high risk cluster was observed in the southwest region (RR=1.57) and a low risk cluster in the southeast, including Chapecó (RR=0.68). The risk of suicide among widowed (RR=3.05;CI95%:1.99;4.67), separated (RR=2.48;CI95%:1.44;4.27), and married (RR= 1.97;CI95%:1.54;2.51) were higher than among singles. The main methods was hanging (81.2%), followed by firearms (9.7%). Conclusion: There was a higher risk of suicide in the elderly, men and widowers. Hanging was the most frequent method and risk clustering was observed to the Southwest.

Objetivo: Identificar agregados espaciales de suicidio y el perfil epidemiológico en la microrregión de Chapecó (SC), 1996-2018. Métodos: Estudio ecológico exploratorio, con datos del Sistema de Información de Mortalidad. Fueron calculadas tasas específicas de suicidio y riesgos relativos (RR) con intervalo de confianza 95% (IC95%). Para el análisis espacial se utilizó la estadística scan. Resultados: Hubo 1.034 suicidios (13,7/100.000 habitantes), razón hombre/mujer de 3,79. El grupo de ≥ 60 años presentó mayor riesgo para ambos sexos. Se observó un agregado de alto riesgo en la región suroeste (RR=1,57) y un agregado de menor riesgo en el sureste (RR=0,68). El riesgo de suicidio entre viudos (RR=3.05; IC95% 1.99;4.67), separados (RR=2.48; IC95% 1.44;4.27) y casados (RR= 1.97;IC95%:1.54;2.51) fueron mayores que entre solteros. El principal medio fue el ahorcamiento (81,2%), seguido de las armas de fuego (9,7%). Conclusión: Hubo mayor riesgo de suicidio en ancianos, hombres y viudos. Ahorcamiento fue el método más frecuente y se observó agrupación de riesgos hacia el Suroeste.

Objetivo: identificar conglomerados espaciais do suicídio e características epidemiológicas na microrregião de Chapecó, SC, Brasil, 1996-2018. Métodos: estudo ecológico exploratório, com dados do Sistema de Informações sobre Mortalidade; foram calculadas taxas específicas de suicídio, e riscos relativos (RR) com intervalo de confiança de 95% (IC95%); na análise espacial, utilizou-se estatística scan. Resultados: 1.034 suicídios (13,7/100 mil habitantes), à razão homem/mulher de 3,79; a idade ≥ 60 anos apresentou maior risco para ambos os sexos; observou-se um conglomerado de alto risco na região sudoeste (RR = 1,57) e um de menor risco a sudeste, incluindo Chapecó (RR = 0,68); risco de suicídio entre viúvos (RR = 3,05 ­ IC95% 1,99;4,67), separados (RR = 2,48 ­ IC95% 1,44;4,27) e casados (RR = 1,97 ­ IC95% 1,54;2,51) maior que entre solteiros; principal método, enforcamento (81,2%), seguido por uso de arma de fogo (9,7%). Conclusão: maior risco de suicídio para idosos, homens e viúvos; enforcamento foi mais frequente; conglomerado de risco a sudoeste.

Associations of Anaplasma phagocytophilum Bacteria Variants in Ixodes scapularis Ticks and Humans, New York, USA.

Anaplasmosis, caused by the tickborne bacterium Anaplasma phagocytophilum, is an emerging public health threat in the United States. In the northeastern United States, the blacklegged tick (Ixodes scapularis) transmits the human pathogenic genetic variant of A. phagocytophilum (Ap-ha) and a nonpathogenic variant (Ap-V1). New York has recently experienced a rapid and geographically focused increase in cases of anaplasmosis. We analyzed A. phagocytophilum-infected I. scapularis ticks collected across New York during 2008-2020 to differentiate between variants and calculate an entomological risk index (ERI) for each. Ap-ha ERI varied between regions and increased in all regions during the final years of the study. Space-time scan analyses detected expanding clusters of Ap-ha located within documented anaplasmosis hotspots. Ap-ha ERI was more positively correlated with anaplasmosis incidence than non-genotyped A. phagocytophilum ERI. Our findings help elucidate the relationship between the spatial ecology of A. phagocytophilum variants and anaplasmosis.

Epidemic Characteristics, High-Risk Areas and Space-Time Clusters of Human Brucellosis - China, 2020-2021.

Introduction: Analyze the recent epidemiological and temporal-spatial characteristics of human brucellosis in China and provide information for adjusting strategies for brucellosis control. Methods: Human brucellosis data were obtained from the National Notifiable Disease Reporting System (NNDRS). A geographical information system (GIS) was used to visualize high-risk areas with annual incidence based on county (district) polygons. The space-time scan statistic (STSS) was applied to detect the space-time clusters of human brucellosis. Results: A total of 69,767 cases were reported from 2,083 counties in the mainland of China in 2021, a 47.7% increase from 2020 (47,425). About 95.5% of the total cases were centralized in northern China and 31.8% in Inner Mongolia (IM). The number of counties with an incidence exceeding 100 per 100,000 was 34 in 2020 and 65 in 2021. From 2020 to 2021, 24 space-time clusters were detected. The two primary clusters were located northeast of IM, including 109 counties. The secondary clusters affected 208 counties in 2020 and spread to 297 counties in 2021, the majority of which were located in the middle of IM, exhibiting a trend spreading west from IM to neighboring provincial-level administrative divisions (PLADs). Conclusions: From 2020 to 2021, the incidence of human brucellosis nationwide was exponential, demonstrating distinct spatiotemporal characteristics. Space-time clusters were located in IM and neighboring areas. Therefore, considerable efforts are required to curb this momentum.

Padrões espaciais e caracterização epidemiológica dos suicídios na microrregião de Chapecó, Santa Catarina: estudo ecológico, 1996-2018 / Patrones espaciales y caracterización epidemiológica de los suicidios en la micro-región de Chapecó, Santa Catarina, Brasil: estudio ecológico, 1996-2018 / Spatial patterns and epidemiological characterization of suicides in the Chapecó micro-region, Santa Catarina, Brazil: an ecological study, 1996-2018

Objective: to identify spatial clusters of suicide and its epidemiological characteristics in the Chapecó (SC) micro-region from 1996 to 2018. Methods: this was an exploratory ecological study, using data from the Mortality Information System; specific suicide rates and relative risks (RR) were calculated with a 95% confidence interval (95%CI); the scan statistic was used for spatial analysis. Results: there were 1,034 suicides (13.7/100,000 inhabitants), with a male/female ratio of 3.79; the ≥ 60 age group was at higher risk for both sexes; a high risk cluster was found in the southwest region (RR = 1.57) and a low risk cluster in the southeast region, including Chapecó itself (RR = 0.68); risk of suicide among widowed (RR = 3.05; 95%CI 1.99;4.67), separated (RR = 2.48; 95%CI 1.44;4.27), and married (RR = 1.97; 95%CI 1.54;2.51) people was higher than among single people. The main methods were hanging (81.2%) and firearms (9.7%). Conclusion: there was a higher risk of suicide in the elderly, male and widowed people. Hanging was the most frequent method and risk clustering was found in the southwest.

Objetivo: identificar agregados espaciales de suicidio y el perfil epidemiológico en la microrregión de Chapecó (SC), 1996-2018. Métodos: estudio ecológico exploratorio, con datos del Sistema de Información de Mortalidad. Fueron calculadas tasas específicas de suicidio y riesgos relativos (RR) con intervalo de confianza 95% (IC95%). Para el análisis espacial se utilizó la estadística scan. Resultados: hubo 1.034 suicidios (13,7/100.000 habitantes), razón sexo masculino/femenino de 3,79. El grupo de ≥ 60 años presentó mayor riesgo para ambos sexos. Se observó un agregado de alto riesgo en la región suroeste (RR = 1,57) y un agregado de menor riesgo en el sureste (RR = 0,68). El riesgo de suicidio entre viudos (RR = 3.05; IC95% 1,99;4,67), separados (RR = 2.48; IC95% 1,44;4,27) y casados (RR = 1.97; IC95% 1,54;2,51) fueron mayores que entre solteros. El principal medio fue el ahorcamiento (81,2%), seguido de las armas de fuego (9,7%). Conclusión: hubo mayor riesgo de suicidio en ancianos, sexo masculino y viudos. Ahorcamiento fue el método más frecuente y se observó agrupación de riesgos hacia el Suroeste.

Objetivo: identificar conglomerados espaciais do suicídio e características epidemiológicas na microrregião de Chapecó, SC, Brasil, 1996-2018. Métodos: estudo ecológico exploratório, com dados do Sistema de Informações sobre Mortalidade; foram calculadas taxas específicas de suicídio, e riscos relativos (RR) com intervalo de confiança de 95% (IC95%); na análise espacial, utilizou-se estatística scan. Resultados: 1.034 suicídios (13,7/100 mil habitantes), a razão sexo masculino/feminino de 3,79; a idade ≥ 60 anos apresentou maior risco para ambos os sexos; observou-se um conglomerado de alto risco na região sudoeste (RR = 1,57) e um de menor risco a sudeste, incluindo Chapecó (RR = 0,68); risco de suicídio entre viúvos (RR = 3,05; IC95% 1,99;4,67), separados (RR = 2,48; IC95% 1,44;4,27) e casados (RR = 1,97; IC95% 1,54;2,51) maior que entre solteiros; principal método, enforcamento (81,2%), seguido por uso de arma de fogo (9,7%). Conclusão: maior risco de suicídio para idosos, sexo masculino e viúvos; enforcamento foi mais frequente; conglomerado de risco a sudoeste.

Spatial temporal feature of tuberculosis among high school students in Gansu Province from 2018 to 2022 / 中国学校卫生

Objective@#To analyze the spatial temporal distribution characteristics of tuberculosis among high school students at county levels in Gansu Province from 2018 to 2022,so as to provide a scientific basis for tuberculosis prevention and control in schools.@*Methods@#Tuberculosis data from high school students in counties (districts) reported in Gansu Province from 2018 to 2022 was collected from the Tuberculosis Information Management System and Infectious Disease Information Reporting System of the Chinese Disease Prevention and Control Information Management System. Demographic data of high school students in counties (districts) came from the General Management System of the Chinese Disease Prevention and Control Information Management System, and the spatial clustering of the reported incidence rate of pulmonary tuberculosis among high school students in Gansu Province in the past five years was analyzed using the methods of global spatial autocorrelation (Moran s I) and local indicators of spatial audocorrelation(LISA).@*Results@#A total of 41 885 pulmonary tuberculosis cases were reported in various counties of Gansu Province From 2018 to 2022, with an average reported incidence rate of 32.81/100 000. During the same period, 1 170 high school students cases were reported, with an average reported incidence rate of 13.72/100 000. With the exception of 2020, the reported incidence rate of pulmonary tuberculosis among high school students was non random distribution in other 4 years, showed a moderate intensity of spatial clustering. From 2018 to 2022, most counties in Gansu Province reported that the incidence rate of pulmonary tuberculosis among high school students was 10.00/100 000 or below, the counties with reported incidence rate >40.00/100 000 were mainly distributed in Luqu County, Maqu County, Diebu County, Hezuo City, Xiahe County of Gannan Prefecture, Gangu County and Wushan County of Tianshui Prefecture, Wenxian County and Kangxian County of Longnan Prefecture, Huachi County of Pingliang Prefecture, Huanxian County of Qingyang Prefecture. The number of counties where the reported incidence rate of tuberculosis among high school students more than 30.00/100 000 gradually decreased from 2018 to 2022. In the past five years, the reported incidence rate of tuberculosis among high school students in all counties of Gannan Prefecture remained above 40.00/ 100 000 . The LISA analysis results showed that the high incidence areas were mainly concentrated in Gannan Prefecture.@*Conclusions@#The epidemic situation of pulmonary tuberculosis among high school students in Gansu province from 2018 to 2022 is still a serious condition, showing the characteristics of unbalanced regional distribution. The reported incidence rate shows a strong spatial clustering, and the hot spots are concentrated in the counties (districts) of Gannan prefecture in Gansu Province.

Epidemiological Characteristics and Spatio-Temporal Distribution of Hepatitis A in Spain in the Context of the 2016/2017 European Outbreak.

The aim of our study was to describe the results of the epidemiological surveillance of hepatitis A infections in Spain in the context of the 2016/2017 European outbreak, particularly of hepatitis A outbreaks reported in the MSM population, incorporating the results of a spatio-temporal analysis of cases. Hepatitis A cases and outbreaks reported in 2016-2017 to the National Epidemiological Surveillance Network were reviewed: outbreaks in which some of the cases belonged to the MSM group were described, and clusters of hepatitis A cases in men and women were analysed using a space-time scan statistic. Twenty-six outbreaks were identified, with a median size of two cases per outbreak, with most of the outbreak-related cases belonging to the 15-44 years-old group. Nearly 85% occurred in a household setting, and in all outbreaks, the mode of transmission was direct person-to-person contact. Regarding space-time analysis, twenty statistically significant clusters were identified in the male population and eight in the female population; clusters in men presented a higher number of observed cases and affected municipalities, as well as a higher percentage of municipalities classified as large urban areas. The elevated number of cases detected in clusters of men indicates that the number of MSM-related outbreaks may be higher than reported, showing that spatio-temporal analysis is a complementary, useful tool which may improve the detection of outbreaks in settings where epidemiological investigation may be more challenging.

Spatio-temporal clustering analysis using two different scanning windows: A case study of dengue fever in Peninsular Malaysia.

Dengue fever is a mosquito-borne viral infection of humans caused by a virus of the Flaviviridae family. In Malaysia the annual incidence risk of dengue fever for the period 2000 to 2019 ranged from 30 to 390 cases per 100,000. The aim of this paper was to identify spatial, temporal and spatio-temporal clusters of dengue fever in Peninsular Malaysia for the period 2015 to 2017. Counts of confirmed incident cases of dengue fever for each of the 86 districts of Peninsular Malaysia for the period 1 January 2015 to 31 December 2017 (inclusive) and district-level census data allowed us to calculate the incidence rate of dengue fever, defined as the number of confirmed cases of dengue fever per 100,000 person-years at risk. We applied Kulldorff's cylindrical space-time scan statistic and Takahashi et al.'s prismatic space-time scan statistic to the data. We identified no major differences in the number and location of spatial clusters of dengue incidence for 2015, 2016 and 2017 using Kulldorff's and Takahashi et al.'s method. Spatio-temporal clusters of dengue occurred at several times throughout each year in various high population dense areas. These clusters not only included high population density districts but also their adjacent district neighbours. The temporal clustering of dengue cases during the monsoon season (mid September to late December each year) implies that there is a biologically plausible causal association between rainfall and the incidence of dengue. Identification of locations and time periods when the frequency of dengue is high allows Malaysian public health authorities to be more objective in their decision making around vector control and dengue public awareness campaigns. Future research will quantify the association between population density and rainfall on dengue incidence. This will allow health authorities to take a more proactive approach for dengue control.

Spatiotemporal distribution characteristics of syphilis in Zhejiang province, 2016—2020 / 中华皮肤科杂志

Objective:To analyze spatiotemporal distribution characteristics of syphilis in Zhejiang province from 2016 to 2020, to explore cluster areas of syphilis cases, and to provide a theoretical basis for accurate prevention and control of syphilis.Methods:Data on reported syphilis cases in Zhejiang province from 2016 to 2020 were collected from the notifiable infectious disease surveillance system in China Disease Control and Prevention Information System. The ArcGIS10.2 software was used as a data management and presentation platform to establish a database for spatial analysis of syphilis in Zhejiang province from 2016 to 2020, and spatial autocorrelation analysis of reported syphilis incidence was conducted. The SaTScan 9.6 software was used for spatiotemporal scanning analysis.Results:A total of 158 420 cases of syphilis were reported in Zhejiang province from 2016 to 2020, and the average annual reported incidence rate was 49.07 per 100 000 in all counties and districts (range: 20.52 per 100 000-124.29 per 100 000) . The overall spatial distribution pattern of syphilis cases in Zhejiang province was characterized by higher reported syphilis incidence in the West area and lower incidence in the middle area. Global autocorrelation analysis showed that all the global Moran′s I indices from 2016 to 2020 were over 0, Z values were over 1.96, and P values were below 0.001, suggesting the spatial clustering of reported syphilis cases. Local autocorrelation analysis showed that there were 2 high-high clustering areas (Tonglu and Chun′an counties in Hangzhou city, Jingning county in Lishui city) , and 1 low-low clustering area (Jindong district, Dongyang and Yongkang county-level cities in Jinhua city) . Local hot-spot analysis with G statistic showed that there were 6 positive hot-spot areas and 8 negative hot-spot areas of syphilis cases in Zhejiang province. SaTScan spatiotemporal scanning analysis revealed 3 clustering areas, mainly distributed in Taizhou and Zhoushan cities along the eastern coast, and some counties and districts in the southwestern mountainous areas. Conclusions:The reported incidence rate of syphilis in Zhejiang province is characterized by spatial clustering. In the future, prevention and control of syphilis should be strengthened in southwestern mountainous areas, eastern islands, and other remote areas as well as areas with poor transportation.

COVID-19 y adultos mayores: comparación espaciotemporal entre mortalidad y vacunación en la provincia de Buenos Aires, Argentina / COVID-19 and older adults: spatiotemporal comparison between mortality and vaccination in the province of Buenos Aires, Argentina

RESUMEN El objetivo de este estudio fue analizar las variaciones espaciotemporales de la mortalidad por COVID-19 en adultos mayores y de la vacunación contra la COVID-19 en esta población. Se utilizaron datos de defunciones por COVID-19 y de personas de 70 a más años inmunizadas con la primera dosis de vacunas contra esta enfermedad, en partidos de la provincia de Buenos Aires, desde el 29 de diciembre del 2020 al 30 de junio de 2021. Se emplearon técnicas de escaneo espaciotemporal para detectar conglomerados. Los partidos del Gran Buenos Aires que tuvieron mayor vacunación con la primera dosis de la vacuna Sputnik V en población de 70 a más años, entre mediados de marzo y principios de abril de 2021, coincidieron mayormente en registrar una disminución de la mortalidad en esta población, entre finales de abril y finales de junio de 2021. Este estudio mostró algunos indicios del impacto positivo de la aplicación de la primera dosis de la vacuna Sputnik V en el Gran Buenos Aires.

ABSTRACT The aim of this study was to analyze the spatiotemporal variations of COVID-19 mortality and vaccination against COVID-19 in older adults. We used data from deaths due to COVID-19 and persons aged 70 years and older immunized with the first dose of vaccines against this disease, from districts of the province of Buenos Aires, between December 29, 2020, and June 30, 2021. Spatiotemporal scanning techniques were used to detect clusters. The parties of Greater Buenos Aires that had the highest vaccination rate with the first dose of the Sputnik V vaccine in population aged 70 years and older, between mid-March and early April 2021, also registered a decrease in mortality in this population, between the end of April and the end of June 2021. This study showed some signs of the positive impact associated with the application of the first dose of Sputnik V vaccine in Greater Buenos Aires.

Basic reproduction number of African swine fever in wild boars (Sus scrofa) and its spatiotemporal heterogeneity in South Korea.

BACKGROUND: African swine fever (ASF) is a hemorrhagic fever occurring in wild boars (Sus scrofa) and domestic pigs. The epidemic situation of ASF in South Korean wild boars has increased the risk of ASF in domestic pig farms. Although basic reproduction number (R0) can be applied for control policies, it is challenging to estimate the R0 for ASF in wild boars due to surveillance bias, lack of wild boar population data, and the effect of ASF-positive wild boar carcass on disease dynamics. OBJECTIVES: This study was undertaken to estimate the R0 of ASF in wild boars in South Korea, and subsequently analyze the spatiotemporal heterogeneity. METHODS: We detected the local transmission clusters using the spatiotemporal clustering algorithm, which was modified to incorporate the effect of ASF-positive wild boar carcass. With the assumption of exponential growth, R0 was estimated for each cluster. The temporal change of the estimates and its association with the habitat suitability of wild boar were analyzed. RESULTS: Totally, 22 local transmission clusters were detected, showing seasonal patterns occurring in winter and spring. Mean value of R0 of each cluster was 1.54. The estimates showed a temporal increasing trend and positive association with habitat suitability of wild boar. CONCLUSIONS: The disease dynamics among wild boars seems to have worsened over time. Thus, in areas with a high elevation and suitable for wild boars, practical methods need to be contrived to ratify the control policies for wild boars.

Epidemiological characteristics and spatiotemporal analysis of hand-foot-mouth diseases from 2010 to 2019 in Zibo city, Shandong, China.

BACKGROUND: Hand-foot-mouth disease (HFMD) is a global public health issues, especially in China. It has threat the health of children under 5 years old. The early recognition of high-risk districts and understanding of epidemic characteristics can facilitate health sectors to prevent the occurrence of HFMD effectively. METHODS: Descriptive analysis was used to summarize epidemic characteristics, and the spatial autocorrelation analysis and space-time scan analysis were utilized to explore distribution pattern of HFMD and identify hot spots with statistical significance. The result was presented in ArcMap. RESULTS: A total of 52,095 HFMD cases were collected in Zibo city from 1 Jan 2010 to 31 Dec 2019. The annual average incidence was 129.72/100,000. The distribution of HFMD was a unimodal trend, with peak from April to September. The most susceptible age group was children under 5 years old (92.46%), and the male-to-female ratio is 1.60: 1. The main clusters were identified in Zhangdian District from 12 April 2010 to 18 September 2012. Spatial autocorrelation analysis showed that the global spatial correlation in Zibo were no statistical significance, except in 2012, 2014, 2015, 2016 and 2018. Cold spots were gathered in Boshan county and Linzi district, while hot spots only in Zhangdian District in 2018, but other years were no significance. CONCLUSION: Hot spots mainly concentrated in the central and surrounding city of Zibo city. We suggest that imminent public health planning and resource allocation should be focused within those areas.

Detection of Spatiotemporal Clusters of COVID-19-Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study.

BACKGROUND: The early detection of clusters of infectious diseases such as the SARS-CoV-2-related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. OBJECTIVE: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19-associated symptoms, and to examine (a posteriori) the association between the clusters' characteristics and sociodemographic and environmental determinants. METHODS: This report presents the methodology and development of the @choum (English: "achoo") study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19-associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19-associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. RESULTS: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool's user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool's launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. CONCLUSIONS: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19-associated symptoms. @choum collects precise geographic information while protecting the user's privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/30444.

[Space-time spread of COVID-19 deaths in ArgentinaDistribuição espaço-temporal de mortes por COVID-19 na Argentina]. / Difusión espacio-temporal de muertes por COVID-19 en Argentina.

OBJECTIVES: Describe the space-time spread of COVID-19 deaths and analyze its socio-spatial inequalities in Argentina. METHODS: COVID-19 deaths in Argentina as of October 17, 2020 were analyzed using data onday, month, and year, and place of residence. The space-time permutation scan method was used to detect the presence of space-time clusters. Poverty levels, population densities, and percentage of older adults in the population were compared for areas in high-mortality clusters and low-mortality clusters. RESULTS: Five high-mortality clusters were detected between March 21 and August 27 in the Greater Buenos Aires conurbation and the northeast of the province of Buenos Aires. Low-mortality clusters were located on the periphery of the urban area from mid-September to mid-October and in central and northwestern Argentina between late April and late August. High-mortality clusters were located in areas with higher population densities and higher percentages of older adults in population, comparedto low-mortality clusters. CONCLUSIONS: No high-mortality clusters were detected between September and mid-October. Norhave we detected a spatial spread of deaths to areas of low socioeconomic status at the national level. Our results support the first phase of the mortality spread model, affecting the largest urban area in Argentina.

OBJETIVO: Descrever a distribuição espaço-temporal de mortes por COVID-19 e analisar desigualdades socioespaciais na Argentina. MÉTODOS: As mortes por COVID-19 ocorridas na Argentina até 17 de outubro de 2020 foram analisadas a partir de dados referentes ao dia, mês e ano e local de residência. A estatística scan utilizando modelo de permutação espaço-tempo foi aplicada para detectar conglomerados espaço-temporais. Realizou-se a comparação do nível de pobreza, densidade populacional e percentual de população idosa entre as áreas pertencentes aos conglomerados com alta mortalidade e as áreas pertencentes aos conglomerados com baixa mortalidade. RESULTADOS: Cinco conglomerados com alta mortalidade foram detectados entre 21 de março e 27 de agosto na região da Grande Buenos Aires e no nordeste da província de Buenos Aires. Os conglomerados com baixa mortalidade estavam localizados na periferia da região da Grande Buenos Aires, de meados de setembro a meados de outubro, e nas regiões central e noroeste do país, entre o final de abril e final de agosto. Os conglomerados com alta mortalidade estavam localizados em áreas de maior densidade populacional e maior percentual de população idosa em comparação aos conglomerados com baixa mortalidade. CONCLUSÕES: Não foram detectados conglomerados com alta mortalidade entre setembro e meadosde outubro. Também não se observou a distribuição espacial de mortes em áreas com baixo nível socioeconômico em todo o país. Os resultados deste estudo respaldam omodelo de distribuição de mortes na primeira fase, atingindo a principal área urbana da Argentina.

Detecting COVID-19 Clusters at High Spatiotemporal Resolution, New York City, New York, USA, June-July 2020.

A surveillance system that uses census tract resolution and the SaTScan prospective space-time scan statistic detected clusters of increasing severe acute respiratory syndrome coronavirus 2 test percent positivity in New York City, NY, USA. Clusters included one in which patients attended the same social gathering and another that led to targeted testing and outreach.

Spatiotemporal clustering and meteorological factors affected scarlet fever incidence in mainland China from 2004 to 2017.

OBJECTIVE: To analyze the spatiotemporal dynamic distribution and detect the related meteorological factors of scarlet fever from an ecological perspective, which could provide scientific information for effective prevention and control of this disease. METHODS: The data on scarlet fever cases in mainland China were downloaded from the Data Center of the China Public Health Science, while monthly meteorological data were extracted from the official website of the National Bureau of Statistics. Global Moran's I, local Getis-Ord Gi⁎ hotspot statistics, and Kulldorff's retrospective space-time scan statistical analysis were used to detect the spatial and spatiotemporal clusters of scarlet fever across all settings. A spatial panel data model was conducted to estimate the impact of meteorological factors on scarlet fever incidence. RESULTS: Scarlet fever in China had obvious spatial, temporal, and spatiotemporal clustering, high-incidence spatial clusters were located mainly in the north and northeast of China. Nine spatiotemporal clusters were identified. A spatial lag fixed effects panel data model was the best fit for regression analysis. After adjusting for spatial individual effects and spatial autocorrelation (ρ = 0.5623), scarlet fever incidence was positively associated with a one-month lag of average temperature, precipitation, and total sunshine hours (all P-values < 0.05). Each 10 °C, 2 cm, and 10 h increase in temperature, precipitation, and sunshine hours, respectively, was associated with a 6.41% increment and 1.04% and 1.41% decrement in scarlet fever incidence, respectively. CONCLUSION: The incidence of scarlet fever in China showed an upward trend in recent years. It had obvious spatiotemporal clustering, with the high-risk areas mainly concentrated in the north and northeast of China. Areas with high temperature and with low precipitation and sunshine hours tended to have a higher scarlet fever incidence, and we should pay more attention to prevention and control in these places.

Congenital Hypothyroidism: Space-Time Clustering of Thyroid Dysgenesis Indicates a Role for Environmental Factors in Disease Etiology.

Background: The etiology of most cases of congenital hypothyroidism (CHT) due to thyroid dysgenesis (DG) is unknown. If transient environmental factors can impact on thyroid gland development, then clustering of cases in time and/or space may occur, and this would be more likely in thyroid DG than dyshormonogenesis (DHG). Methods: The newborn screening program for CHT in Scotland is linked to a central database that includes case details such as postcode. The etiology of CHT is investigated in many cases of CHT using scintigraphy and/or ultrasonography. We looked for evidence of a change in CHT incidence with year of birth and according to season of the year. We then undertook space-time clustering analysis (using a method based on K-functions, with nearest neighbor thresholds) of CHT in Scotland between 1979 and 2015. We also looked for evidence of overall changes associated with sex and area-based birth density. Results: Of 531 cases with CHT during the study period, 290 cases had been categorized as DG (n = 229) or DHG (n = 61) following more detailed investigation. The incidence of CHT increased with year of birth and was in part linked to changing methodology, but there was no seasonality. There was no evidence of overall space-time clustering (p = 0.06), but there was evidence of clustering in babies with DG (p = 0.007). This picture appeared to be most closely linked to underlying thyroid gland hypoplasia rather than thyroid gland agenesis or ectopia. There was significant space-time clustering for both males and females, but clustering was restricted to lesser birth density areas. There was also evidence of clustering for unknown cases (p < 0.001). Clustering of these cases was restricted to females but was present for cases from both greater and lesser birth density areas. There was no evidence of clustering in cases of DHG. Conclusions: These data suggest that an unidentified environmental factor or factors may be involved in the etiology of thyroid DG in Scotland. The variation in CHT incidence observed internationally may reflect environmental as well as genetic factors.

Temporal trend of tuberculosis incidence and its spatial distribution in Macapá - Amapá / Tendência temporal da incidência de tuberculose e sua distribuição espacial em Macapá-AP

ABSTRACT OBJECTIVE: To evaluate the temporal trend of tuberculosis incidence after the implementation of the rapid molecular test (RMT-TB), to identify whether tuberculosis presents seasonal variation and to classify the territory according to case density and risk areas in Macapá, Amapá. METHODS: Ecological study of tuberculosis cases registered in the Sistema de Informação de Agravos de Notificação (SINAN - Information System for Notifiable Diseases) between 2001 and 2017. We used the Prais-Winsten test to classify the temporal trend of incidence and the interrupted time series to identify changes in the temporal trend before and after the implementation of the rapid molecular test, and to verify seasonality in the municipality. The Kernel estimator was used to classify case density and scan statistics to identify areas of tuberculosis risk. RESULTS: A total of 1,730 cases were identified, with a decreasing temporal trend of tuberculosis incidence (−0.27% per month, 95%CI −0.13 to −0.41). The time series showed no change in level after the implementation of the GeneXpert®MTB/RIF molecular test; however, the incidence increased in the post-test period (+2.09% per month, 95%CI 0.92 to 3.27). Regarding the seasonal variation, it showed growth (+13.7%/month, 95%CI 4.71 to 23.87) from December to June, the rainy season - called amazon winter season -, and decrease (−9.21% per month, CI95% −1.37 to −16.63) in the other periods. We classified areas with high density of cases in the Central and Northern districts using Kernel and identified three protection clusters, SC1 (RR = 0.07), SC2 (RR = 0.23) and SC3 (RR = 0.36), and a high-risk cluster, SC4 (RR = 1.47), with the scan statistics. CONCLUSION: The temporal trend of tuberculosis incidence was decreasing in the time series; however, detection increased after the introduction of RMT-TB, and tuberculosis showed seasonal behavior. The case distribution was heterogeneous, with a tendency to concentrate in vulnerable and risk territories, evidencing a pattern of disease inequality in the territory.

RESUMO OBJETIVO: Avaliar a tendência temporal da incidência da tuberculose após a implementação do teste rápido molecular, identificar se a tuberculose apresenta variação sazonal e classificar o território de acordo com a densidade de casos e as áreas de risco em Macapá-AP. MÉTODOS: Estudo ecológico composto por casos de tuberculose registrados no SINAN entre 2001 e 2017. Foi utilizado o teste Prais-Winsten para classificar a tendência temporal da incidência e a Série Temporal Interrompida para identificar mudanças na tendência temporal antes e depois da implementação do teste rápido molecular, além de verificar a sazonalidade no município. Utilizou-se o estimador de Kernel para classificar a densidade de casos e estatística de varredura para identificar áreas de risco da tuberculose. RESULTADOS: Foram identificados 1730 casos, observando-se que a tendência temporal da incidência de tuberculose foi decrescente (-0,27% por mês, IC95% −0,13 a −0,41). Não houve mudança de nível na série temporal após a implantação do teste molecular GeneXpert® MTB/RIF, porém, o período pós teste foi classificado como crescente em termos da incidência (+2,09% por mês, IC95% 0,92 a 3,27). Quanto à variação sazonal, apresentou crescimento (+13,7%/mês, IC95% 4,71 a 23,87) nos meses de dezembro a junho, referente ao período de chuvas - chamado inverno amazônico - e decréscimo (-9,21% por mês, IC95% −1,37 a −16,63) nos demais períodos. Por meio de Kernel, foram classificadas áreas com alta densidade de casos nos distritos Central e Norte e, com a estatística de varredura, foram identificados três aglomerados de proteção, AE1 (RR = 0,07), AE2 (RR = 0,23) e AE3 (RR = 0,36), e um aglomerado de alto risco, AE4 (RR = 1,47). CONCLUSÃO: A tendência temporal da incidência de tuberculose se revelou decrescente na série temporal, todavia, um crescimento na detecção foi observado após introdução do TRM-TB, e ainda se evidenciou que há comportamento sazonal da tuberculose. A distribuição dos casos foi heterogênea, com tendência de concentração em territórios vulneráveis e de risco, evidenciando um padrão de desigualdade da doença no território.