Abstract
BackgroundMolecular strain typing of tuberculosis isolates has led to increased understanding of the epidemiological characteristics of the disease and improvements in its control, diagnosis and treatment. However, molecular cluster investigations, which aim to detect previously unidentified cases, remain challenging. Interactive dot mapping is a simple approach which could aid investigations by highlighting cases likely to share epidemiological links. Current tools generally require technical expertise or lack interactivity.ResultsWe designed a flexible application for producing disease dot maps using Shiny, a web application framework for the statistical software, R. The application displays locations of cases on an interactive map colour coded according to levels of categorical variables such as demographics and risk factors. Cases can be filtered by selecting combinations of these characteristics and by notification date. It can be used to rapidly identify geographic patterns amongst cases in molecular clusters of tuberculosis in space and time; generate hypotheses about disease transmission; identify outliers, and guide targeted control measures.ConclusionsDotMapper is a user-friendly application which enables rapid production of maps displaying locations of cases and their epidemiological characteristics without the need for specialist training in geographic information systems. Enhanced understanding of tuberculosis transmission using this application could facilitate improved detection of cases with epidemiological links and therefore lessen the public health impacts of the disease. It is a flexible system and also has broad international potential application to other investigations using geo-coded health information.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1475-5) contains supplementary material, which is available to authorized users.
Highlights
Molecular strain typing of tuberculosis isolates has led to increased understanding of the epidemiological characteristics of the disease and improvements in its control, diagnosis and treatment
Careful consideration of the spatial locations of cases on a map can prompt infectious disease outbreak investigations; highlight important relationships between cases including clusters defined by molecular typing techniques; generate hypotheses about transmission, and guide control measures [1]
We describe our solution, DotMapper, and demonstrate its features and potential use with a case study based on molecular clusters of tuberculosis in London derived from Enhanced Tuberculosis Surveillance (ETS)
Summary
Molecular strain typing of tuberculosis isolates has led to increased understanding of the epidemiological characteristics of the disease and improvements in its control, diagnosis and treatment. Careful consideration of the spatial locations of cases on a map can prompt infectious disease outbreak investigations; highlight important relationships between cases including clusters defined by molecular typing techniques; generate hypotheses about transmission, and guide control measures [1]. For example, are a simple form of spatial data visualisation that can be used in preliminary exploration of data and may motivate more formal statistical cluster analysis. These maps display the locations of cases and can be colour coded to convey information on categorical variables such as demographics and risk factors. Production of dot maps for different time periods can describe the progression of the disease in space and time; and including data on contextual locations such as potential transmission venues can aid hypothesis generation
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