Waterborne Disease Outbreak Detection: A Simulation-Based Study.

Damien Mouly,Michael Mounié,Christian Ducrot,Catherine Galey,Yann Le Strat,Sarah Goria,Anne Gallay,Pascal Beaudeau

doi:10.3390/ijerph15071505

Abstract

Waterborne disease outbreaks (WBDOs) remain a public health issue in developed countries, but to date the surveillance of WBDOs in France, mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities, is characterized by low sensitivity. In this context, a detection algorithm using health insurance data and based on a space–time method was developed to improve WBDO detection. The objective of the present simulation-based study was to evaluate the performance of this algorithm for WBDO detection using health insurance data. The daily baseline counts of acute gastrointestinal infections were simulated. Two thousand simulated WBDO signals were then superimposed on the baseline data. Sensitivity (Se) and positive predictive value (PPV) were both used to evaluate the detection algorithm. Multivariate regression was also performed to identify the factors associated with WBDO detection. Almost three-quarters of the simulated WBDOs were detected (Se = 73.0%). More than 9 out of 10 detected signals corresponded to a WBDO (PPV = 90.5%). The probability of detecting a WBDO increased with the outbreak size. These results underline the value of using the detection algorithm for the implementation of a national surveillance system for WBDOs in France.

Highlights

Outbreaks of infectious waterborne diseases are still a public health concern in developed countries [1,2]
There is concern in France with respect to Waterborne disease outbreaks (WBDOs) [6], but to date, in the absence of a specific nationwide surveillance system, the detection of these events is mainly based on the voluntary reporting of clusters of acute gastrointestinal infections (AGIs) by general practitioners to health authorities
To evaluate the performance of the WBDO detection method we considered the sensitivity (Se) and the positive predictive value (PPV)

Summary

Introduction

Outbreaks of infectious waterborne diseases are still a public health concern in developed countries [1,2]. Tens of thousands of people were affected. This occurred for example in two waterborne cryptosporidiosis outbreaks which occurred in 2010 and 2011 in Sweden, infecting 27,000 and 20,000 people, respectively [3,4], and in the 1993 disaster in Milwaukee, which affected 400,000 people [5]. There is concern in France with respect to WBDOs [6], but to date, in the absence of a specific nationwide surveillance system, the detection of these events is mainly based on the voluntary reporting of clusters of AGIs by general practitioners to health authorities. The mean outbreak size of reported WBDOs

Objectives

Methods

Results

Discussion

Conclusion