title: Accounting for seasonal patterns in syndromic surveillance data for outbreak detection.
abstract: BACKGROUND
  Syndromic surveillance (SS) can potentially contribute to outbreak detection capability by providing timely, novel data sources. One SS challenge is that some syndrome counts vary with season in a manner that is not identical from year to year. Our goal is to evaluate the impact of inconsistent seasonal effects on performance assessments (false and true positive rates) in the context of detecting anomalous counts in data that exhibit seasonal variation.
  
  
  METHODS
  To evaluate the impact of inconsistent seasonal effects, we injected synthetic outbreaks into real data and into data simulated from each of two models fit to the same real data. Using real respiratory syndrome counts collected in an emergency department from 2/1/94-5/31/03, we varied the length of training data from one to eight years, applied a sequential test to the forecast errors arising from each of eight forecasting methods, and evaluated their detection probabilities (DP) on the basis of 1000 injected synthetic outbreaks. We did the same for each of two corresponding simulated data sets. The less realistic, nonhierarchical model's simulated data set assumed that "one season fits all," meaning that each year's seasonal peak has the same onset, duration, and magnitude. The more realistic simulated data set used a hierarchical model to capture violation of the "one season fits all" assumption.
  
  
  RESULTS
  This experiment demonstrated optimistic bias in DP estimates for some of the methods when data simulated from the nonhierarchical model was used for DP estimation, thus suggesting that at least for some real data sets and methods, it is not adequate to assume that "one season fits all."
  
  
  CONCLUSIONS
  For the data we analyze, the "one season fits all " assumption is violated, and DP performance claims based on simulated data that assume "one season fits all," for the forecast methods considered, except for moving average methods, tend to be optimistic. Moving average methods based on relatively short amounts of training data are competitive on all three data sets, but are particularly competitive on the real data and on data from the hierarchical model, which are the two data sets that violate the "one season fits all" assumption.
authors.affiliation: Statistical Sciences, Mail Stop F600, Los Alamos National Laboratory, Los Alamos, NM 87545, USA. tburr@lanl.gov
authors.forename: Tom
authors.initials: T
authors.lastname: Burr
authors.forename: Todd
authors.initials: T
authors.lastname: Graves
authors.forename: Richard
authors.initials: R
authors.lastname: Klamann
authors.forename: Sarah
authors.initials: S
authors.lastname: Michalak
authors.forename: Richard
authors.initials: R
authors.lastname: Picard
authors.forename: Nicolas
authors.initials: N
authors.lastname: Hengartner
mesh_terms: D003198:Computer Simulation; D003625:Data Collection; D003627:Data Interpretation, Statistical; D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005544:Forecasting / Q000379:methods; D006785:Hospitals, University; D006801:Humans; D016013:Likelihood Functions; D015233:Models, Statistical; D009516:New Mexico / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D011237:Predictive Value of Tests; D012120:Respiration Disorders / Q000453:epidemiology* / Q000473:pathology; D018570:Risk Assessment / Q000379:methods*; D012621:Seasons; D013577:Syndrome