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. 2018 Oct 18:147:e29.
doi: 10.1017/S0950268818002789.

Simulation of Legionnaires' disease prospective spatiotemporal cluster detection, Allegheny County, Pennsylvania, USA

L T Orkis  1   2 , E R Peterson  3 , M M Brooks  1 , K J Mertz  2 , L H Harrison  2   4 , J E Stout  5   6 , S K Greene  3
Affiliations

Simulation of Legionnaires' disease prospective spatiotemporal cluster detection, Allegheny County, Pennsylvania, USA

L T Orkis et al. Epidemiol Infect. .

Abstract

Legionnaires' disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014-2016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of ⩽30 and ⩽180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of ⩾20, ⩾100 and ⩾365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of ⩾100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.

Keywords: Epidemiology; Legionaire's disease; surveillance.

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Figures

Fig. 1.
Fig. 1.
Confirmed legionellosis cases and age-adjusted legionellosis incidence rates, Allegheny County, Pennsylvania, USA, 2006–2016.
Fig. 2.
Fig. 2.
(a–c) Observed baseline and simulated outbreak-associated legionellosis cases, Allegheny County, Pennsylvania, USA, 2016.
Fig. 3.
Fig. 3.
Simulated outbreak 1-associated Legionnaires’ disease cases, simulated outbreak radii and legionellosis cases by census tract, 2014–2016, Allegheny County, Pennsylvania, USA.
Fig. 4.
Fig. 4.
Simulated outbreak 2-associated Legionnaires’ disease cases, simulated outbreak radii and legionellosis cases by census tract, 2014–2016, Allegheny County, Pennsylvania, USA.
Fig. 5.
Fig. 5.
Simulated outbreak 3-associated Legionnaires’ disease cases, simulated outbreak radii and legionellosis cases by census tract, 2014–2016, Allegheny County, Pennsylvania, USA.
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