title: Modeling and detection of respiratory-related outbreak signatures.
abstract: BACKGROUND
  Time series methods are commonly used to detect disease outbreak signatures (e.g., signals due to influenza outbreaks and anthrax attacks) from varying respiratory-related diagnostic or syndromic data sources. Typically this involves two components: (i) Using time series methods to model the baseline background distribution (the time series process that is assumed to contain no outbreak signatures), (ii) Detecting outbreak signatures using filter-based time series methods.
  
  
  METHODS
  We consider time series models for chest radiograph data obtained from Midwest children's emergency departments. These models incorporate available covariate information such as patient visit counts and smoothed ambient temperature series, as well as time series dependencies on daily and weekly seasonal scales. Respiratory-related outbreak signature detection is based on filtering the one-step-ahead prediction errors obtained from the time series models for the respiratory-complaint background.
  
  
  RESULTS
  Using simulation experiments based on a stochastic model for an anthrax attack, we illustrate the effect of the choice of filter and the statistical models upon radiograph-attributed outbreak signature detection.
  
  
  CONCLUSIONS
  We demonstrate the importance of using seasonal autoregressive integrated average time series models (SARIMA) with covariates in the modeling of respiratory-related time series data. We find some homogeneity in the time series models for the respiratory-complaint backgrounds across the Midwest emergency departments studied. Our simulations show that the balance between specificity, sensitivity, and timeliness to detect an outbreak signature differs by the emergency department and the choice of filter. The linear and exponential filters provide a good balance.
authors.affiliation: Department of Statistics, 404 Cockins Hall, 1958 Neil Avenue, Columbus, OH 43210, USA. pfc@stat.osu.edu
authors.forename: Peter F
authors.initials: PF
authors.lastname: Craigmile
authors.forename: Namhee
authors.initials: N
authors.lastname: Kim
authors.forename: Soledad A
authors.initials: SA
authors.lastname: Fernandez
authors.forename: Bema K
authors.initials: BK
authors.lastname: Bonsu
mesh_terms: D000881:Anthrax / Q000000981:diagnostic imaging / Q000453:epidemiology; D023482:Bioterrorism; D002648:Child; D021821:Communicable Diseases, Emerging / Q000453:epidemiology; D003198:Computer Simulation; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005544:Forecasting; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015146:Midwestern United States / Q000453:epidemiology; D016012:Poisson Distribution; D013902:Radiography, Thoracic / Q000706:statistics & numerical data*; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D013269:Stochastic Processes; D013696:Temperature