title: Unusual space-time patterning of the Fallon, Nevada leukemia cluster: Evidence of an infectious etiology.
abstract: The town of Fallon within Churchill County, Nevada exhibited an unusually high incidence of childhood leukemia during the years 1997-2003. We examined the temporal and spatial patterning of the leukemia case homes in comparison to the distribution of the general population at risk, other cancer incidence, and features of land use. Leukemia cases were predominantly diagnosed during the early to mid summer, exhibiting a seasonal bias. Leukemia cases lived outside of the "developed/urban" area of Fallon, predominantly in the "agriculture/pasture" region of Churchill County, circumscribing downtown Fallon. This pattern was different from the distribution of the underlying population (p-value<0.01) and different from the distribution of other cancers, which were evenly distributed when compared to the population (p-value=0.74). The unusual space-time patterning of childhood leukemia is consistent with the involvement of an infectious disease. A possible mode of transmission for such an infectious disease is by means of a vector, and mosquitoes are abundant in Churchill County outside of the urban area of Fallon. This region harbors a US Navy base, and a temporally concordant increase in military wide childhood leukemia rates suggests the base a possible source of the virus. Taken together, our current understanding of the etiology of childhood leukemia, the rural structure combined with temporal and geospatial patterning of these leukemia cases, and the high degree of population mixing in Fallon, suggest a possible infectious cause.
authors.affiliation: Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, United States.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Francis
authors.forename: Steve
authors.initials: S
authors.lastname: Selvin
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Buffler
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Wiemels
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D009033:Culicidae / Q000821:virology*; D006801:Humans; D015994:Incidence; D007223:Infant; D009505:Nevada / Q000453:epidemiology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000453:epidemiology* / Q000821:virology*; D012424:Rural Population; D012621:Seasons; D013029:Space-Time Clustering; D014902:West Nile virus / Q000302:isolation & purification*; D055815:Young Adult