Abstract
Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.
Highlights
Detecting and responding to outbreaks of infectious diseases is a key role of front-line public health organisations [1]
We explore through a systematic literature review how methods of spatial visualisation and analysis have been employed in infectious disease outbreak investigations
We employed a broad search strategy of multiple electronic databases with few restrictions in order to minimise the risk of bias: We searched Embase, Medline and Web of Science for items with terms relating to spatial analysis (‘spatial’, ‘cluster’, ‘geographic information systems’, ‘Geographic information systems (GIS)’, ‘mapping’) and outbreaks (‘disease outbreak’, ‘outbreak’, ‘epidemic’)
Summary
Detecting and responding to outbreaks of infectious diseases is a key role of front-line public health organisations [1]. The primary reason for conducting an investigation into an outbreak is prevention of further cases through control measures, while other motivations include addressing public or political concerns, evaluating health programmes and advancing understanding of the disease [2]. John Snow famously demonstrated the power of plotting the spatial locations of individuals affected in an outbreak [3]. His map of cholera cases in London in 1854 showed a clear pattern that implicated a water pump as the likely source of the illness. Without considering the spatial aspects of an outbreak, important relationships and aetiological insights may be missed [8]
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