Near real-time space-time cluster analysis for detection of enteric disease outbreaks in a community setting.
To enhance timely surveillance of bacterial enteric pathogens, space-time cluster analysis was introduced in Israel in May 2013.



Stool isolation data of Salmonella, Shigella, and Campylobacter from patients of a large Health Maintenance Organization were analyzed weekly by ArcGIS and SaTScan, and cluster results were sent promptly to local departments of health (LDOHs).



During eighteen months, we identified 52 Shigella sonnei clusters, two Salmonella clusters, and no Campylobacter clusters. S. sonnei clusters lasted from one to 33 days and included three to 30 individuals. Thirty-one (60%) of the S. sonnei clusters were known to LDOHs prior to cluster analysis. Clusters not previously known by the LDOHs prompted epidemiologic investigations. In 31 of the 37 (84%) confirmed clusters, educational institutes (nursery schools, kindergartens, and a primary school) were involved.



Cluster analysis demonstrated capability to complement enteric disease surveillance. Scaling up the system can further enhance timely detection and control of outbreaks.
Infectious Diseases Unit, Israel Center for Disease Control, Tel-Hashomer, Israel; Department of Pediatrics, New York Medical College, Valhalla, NY, USA; Department of Family and Community Medicine, New York Medical College, Valhalla, NY, USA. Electronic address: Aharona.Freedman@MOH.HEALTH.GOV.IL.
Aharona
A
Glatman-Freedman
Infectious Diseases Unit, Israel Center for Disease Control, Tel-Hashomer, Israel.
Zalman
Z
Kaufman
Division of Epidemiology, Ministry of Health, Jerusalem, Israel.
Eran
E
Kopel
Infectious Diseases Unit, Israel Center for Disease Control, Tel-Hashomer, Israel.
Ravit
R
Bassal
Maccabi Healthcare Services, Tel-Aviv, Israel.
Diana
D
Taran
Government Central Laboratories, Ministry of Health, Jerusalem, Israel.
Lea
L
Valinsky
Government Central Laboratories, Ministry of Health, Jerusalem, Israel.
Vered
V
Agmon
Division of Epidemiology, Ministry of Health, Jerusalem, Israel.
Manor
M
Shpriz
School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Daniel
D
Cohen
Division of Epidemiology, Ministry of Health, Jerusalem, Israel.
Emilia
E
Anis
Infectious Diseases Unit, Israel Center for Disease Control, Tel-Hashomer, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Tamy
T
Shohat
D000328:Adult; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004405:Dysentery, Bacillary / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000382:microbiology; D062665:Epidemiological Monitoring; D005243:Feces / Q000382:microbiology; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification; D013029:Space-Time Clustering
Cluster analysis; Enteric pathogens; Geographical information system (GIS); Outbreak detection; Public health