title: A flexibly shaped space-time scan statistic for disease outbreak detection and monitoring.
abstract: BACKGROUND
  Early detection of disease outbreaks enables public health officials to implement disease control and prevention measures at the earliest possible time. A time periodic geographical disease surveillance system based on a cylindrical space-time scan statistic has been used extensively for disease surveillance along with the SaTScan software. In the purely spatial setting, many different methods have been proposed to detect spatial disease clusters. In particular, some spatial scan statistics are aimed at detecting irregularly shaped clusters which may not be detected by the circular spatial scan statistic.
  
  
  RESULTS
  Based on the flexible purely spatial scan statistic, we propose a flexibly shaped space-time scan statistic for early detection of disease outbreaks. The performance of the proposed space-time scan statistic is compared with that of the cylindrical scan statistic using benchmark data. In order to compare their performances, we have developed a space-time power distribution by extending the purely spatial bivariate power distribution. Daily syndromic surveillance data in Massachusetts, USA, are used to illustrate the proposed test statistic.
  
  
  CONCLUSIONS
  The flexible space-time scan statistic is well suited for detecting and monitoring disease outbreaks in irregularly shaped areas.
authors.affiliation: Department of Technology Assessment and Biostatistics, National Institute of Public Health, Japan. kunihiko@niph.go.jp
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Takahashi
authors.forename: Martin
authors.initials: M
authors.lastname: Kulldorff
authors.forename: Toshiro
authors.initials: T
authors.lastname: Tango
authors.forename: Katherine
authors.initials: K
authors.lastname: Yih
mesh_terms: D003198:Computer Simulation; D004196:Disease Outbreaks; D006801:Humans; D008404:Massachusetts; D015233:Models, Statistical; D009010:Monte Carlo Method; D016012:Poisson Distribution; D011159:Population Surveillance / Q000379:methods; D013029:Space-Time Clustering