title: Use of spatiotemporal analysis of laboratory submission data to identify potential outbreaks of new or emerging diseases in cattle in Great Britain.
abstract: BACKGROUND
  New and emerging diseases of livestock may impact animal welfare, trade and public health. Early detection of outbreaks can reduce the impact of these diseases by triggering control measures that limit the number of cases that occur. The aim of this study was to investigate whether prospective spatiotemporal methods could be used to identify outbreaks of new and emerging diseases in scanning surveillance data. SaTScan was used to identify clusters of unusually high levels of submissions where a diagnosis could not be reached (DNR) using different probability models and baselines. The clusters detected were subjected to a further selection process to reduce the number of false positives and a more detailed epidemiological analysis to ascertain whether they were likely to represent real outbreaks.
  
  
  RESULTS
  187,925 submissions of clinical material from cattle were made to the Regional Laboratory of the Veterinary Laboratories Agency (VLA) between 2002 and 2007, and the results were stored on the VLA FarmFile database. 16,925 of these were classified as DNRs and included in the analyses. Variation in the number and proportion of DNRs was found between syndromes and regions, so a spatiotemporal analysis for each DNR syndrome was done. Six clusters were identified using the Bernoulli model after applying selection criteria (e.g. size of cluster). The further epidemiological analysis revealed that one of the systemic clusters could plausibly have been due to Johne's disease. The remainder were either due to misclassification or not consistent with a single diagnosis.
  
  
  CONCLUSIONS
  Our analyses have demonstrated that spatiotemporal methods can be used to detect clusters of new or emerging diseases, identify clusters of known diseases that may not have been diagnosed and identify misclassification in the data, and highlighted the impact of data quality on the ability to detect outbreaks. Spatiotemporal methods should be used alongside current temporal methods for analysis of scanning surveillance data. These statistical analyses should be followed by further investigation of possible outbreaks to determine whether cases have common features suggesting that these are likely to represent real outbreaks, or whether issues with the collection or processing of information have resulted in false positives.
authors.affiliation: Centre for Epidemiology & Risk Analysis, Veterinary Laboratories Agency, New Haw, Addlestone, Surrey, UK. kieran.hyder@cefas.co.uk
authors.forename: Kieran
authors.initials: K
authors.lastname: Hyder
authors.forename: Alberto
authors.initials: A
authors.lastname: Vidal-Diez
authors.forename: Joanna
authors.initials: J
authors.lastname: Lawes
authors.forename: A Robin
authors.initials: AR
authors.lastname: Sayers
authors.forename: Ailsa
authors.initials: A
authors.lastname: Milnes
authors.forename: Linda
authors.initials: L
authors.lastname: Hoinville
authors.forename: Alasdair J C
authors.initials: AJ
authors.lastname: Cook
mesh_terms: D000818:Animals; D002417:Cattle; D002418:Cattle Diseases / Q000175:diagnosis* / Q000453:epidemiology; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000662:veterinary*; D016208:Databases, Factual; D004196:Disease Outbreaks / Q000662:veterinary*; D010283:Paratuberculosis / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D015203:Reproducibility of Results; D013029:Space-Time Clustering; D006113:United Kingdom / Q000453:epidemiology