title: Levels of alarm thresholds of meningitis outbreaks in Hamadan Province, west of Iran.
abstract: BACKGROUND
  Few studies have focused on syndromic data to determine levels of alarm thresholds to detection of meningitis outbreaks. The purpose of this study was to determine threshold levels of meningitis outbreak in Hamadan Province, west of Iran.
  
  
  METHODS
  Data on both confirmed and suspected cases of meningitis (fever and neurological symptom) form 21 March 2010 to 20 March 2012 were used in Hamadan Province, Iran. Alarm threshold levels of meningitis outbreak were determined using four different methods including absolute values or standard method, relative increase, statistical cutoff points and upper control limit of exponentially weighted moving average (EWMA) algorithm.
  
  
  RESULTS
  Among 723 reported cases, 41 were diagnosed to have meningitis. Standard level of alarm thresholds for meningitis outbreak was determined as incidence of 5/100000 persons. Increasing 1.5 to two times in reported cases of suspected meningitis per week was known as the threshold levels according to relative increase method. An occurrence four cases of suspected meningitis per week that equals to 90th percentile was chosen as alarm thresholds by statistical cut off point method. The corresponding value according to EWMA algorithm was 2.57 i.e. three cases.
  
  
  CONCLUSIONS
  Policy makers and staff of syndromic surveillance systems are highly recommended to apply the above different methods to determine the levels of alarm threshold.
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Faryadres
authors.affiliation: Modeling of Non-communicable Diseases Research Center and Department of Biostatistics & Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. man.karami@yahoo.com.
authors.forename: Manoochehr
authors.initials: M
authors.lastname: Karami
authors.affiliation: Brucellosis Research Center, Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Moghimbeigi
authors.affiliation: Kurdistan Research Center for Social Determinants of Health, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Esmailnasab
authors.affiliation: Department of Biostatistics and Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
authors.forename: Khabat
authors.initials: K
authors.lastname: Pazhouhi
mesh_terms: D000465:Algorithms; D004196:Disease Outbreaks; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008581:Meningitis / Q000453:epidemiology*; D011159:Population Surveillance; D012016:Reference Values
keywords: Meningitis; Outbreak Detection; Statistical Process Control; Surveillance Systems