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A Spatio-Temporal Modeling Framework for Surveillance Data of Multiple Infectious Pathogens with Small Laboratory Validation Sets.

ABSTRACT: Many surveillance systems of infectious diseases are syndrome-based, capturing patients by clinical manifestation. Only a fraction of patients, mostly severe cases, undergo laboratory validation to identify the underlying pathogen. Motivated by the need to understand transmission dynamics and associate risk factors of enteroviruses causing the hand, foot and mouth disease (HFMD) in China, we developed a Bayesian spatio-temporal modeling framework for surveillance data of infectious diseases with small validation sets. A novel approach was proposed to sample unobserved pathogen-specific patient counts over space and time and was compared to an existing sampling approach. The practical utility of this framework in identifying key parameters was assessed in simulations for a range of realistic sizes of the validation set. Several designs of sampling patients for laboratory validation were compared with and without aggregation of sparse validation data. The methodology was applied to the 2009 HFMD epidemic in southern China to evaluate transmissibility and the effects of climatic conditions for the leading pathogens of the disease, enterovirus 71 and Coxsackie A16.

SUBMITTER: Tang X

PROVIDER: S-EPMC6959856 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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A Spatio-Temporal Modeling Framework for Surveillance Data of Multiple Infectious Pathogens with Small Laboratory Validation Sets.

Tang Xueying X Yang Yang Y Yu Hong-Jie HJ Liao Qiao-Hong QH Bliznyuk Nikolay N

Journal of the American Statistical Association 20190430 528

Many surveillance systems of infectious diseases are syndrome-based, capturing patients by clinical manifestation. Only a fraction of patients, mostly severe cases, undergo laboratory validation to identify the underlying pathogen. Motivated by the need to understand transmission dynamics and associate risk factors of enteroviruses causing the hand, foot and mouth disease (HFMD) in China, we developed a Bayesian spatio-temporal modeling framework for surveillance data of infectious diseases with ...[more]

PMID: 31937981

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Project description:Random forest and similar Machine Learning techniques are already used to generate spatial predictions, but spatial location of points (geography) is often ignored in the modeling process. Spatial auto-correlation, especially if still existent in the cross-validation residuals, indicates that the predictions are maybe biased, and this is suboptimal. This paper presents a random forest for spatial predictions framework (RFsp) where buffer distances from observation points are used as explanatory variables, thus incorporating geographical proximity effects into the prediction process. The RFsp framework is illustrated with examples that use textbook datasets and apply spatial and spatio-temporal prediction to numeric, binary, categorical, multivariate and spatiotemporal variables. Performance of the RFsp framework is compared with the state-of-the-art kriging techniques using fivefold cross-validation with refitting. The results show that RFsp can obtain equally accurate and unbiased predictions as different versions of kriging. Advantages of using RFsp over kriging are that it needs no rigid statistical assumptions about the distribution and stationarity of the target variable, it is more flexible towards incorporating, combining and extending covariates of different types, and it possibly yields more informative maps characterizing the prediction error. RFsp appears to be especially attractive for building multivariate spatial prediction models that can be used as "knowledge engines" in various geoscience fields. Some disadvantages of RFsp are the exponentially growing computational intensity with increase of calibration data and covariates and the high sensitivity of predictions to input data quality. The key to the success of the RFsp framework might be the training data quality-especially quality of spatial sampling (to minimize extrapolation problems and any type of bias in data), and quality of model validation (to ensure that accuracy is not effected by overfitting). For many data sets, especially those with lower number of points and covariates and close-to-linear relationships, model-based geostatistics can still lead to more accurate predictions than RFsp.

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Project description:BackgroundThe complexity of influenza seasonal patterns in the inter-tropical zone impedes the establishment of effective routine immunization programs. China is a climatologically and economically diverse country, which has yet to establish a national influenza vaccination program. Here we characterize the diversity of influenza seasonality in China and make recommendations to guide future vaccination programs.Methods and findingsWe compiled weekly reports of laboratory-confirmed influenza A and B infections from sentinel hospitals in cities representing 30 Chinese provinces, 2005-2011, and data on population demographics, mobility patterns, socio-economic, and climate factors. We applied linear regression models with harmonic terms to estimate influenza seasonal characteristics, including the amplitude of annual and semi-annual periodicities, their ratio, and peak timing. Hierarchical Bayesian modeling and hierarchical clustering were used to identify predictors of influenza seasonal characteristics and define epidemiologically-relevant regions. The annual periodicity of influenza A epidemics increased with latitude (mean amplitude of annual cycle standardized by mean incidence, 140% [95% CI 128%-151%] in the north versus 37% [95% CI 27%-47%] in the south, p<0.0001). Epidemics peaked in January-February in Northern China (latitude ≥33°N) and April-June in southernmost regions (latitude <27°N). Provinces at intermediate latitudes experienced dominant semi-annual influenza A periodicity with peaks in January-February and June-August (periodicity ratio >0.6 in provinces located within 27.4°N-31.3°N, slope of latitudinal gradient with latitude -0.016 [95% CI -0.025 to -0.008], p<0.001). In contrast, influenza B activity predominated in colder months throughout most of China. Climate factors were the strongest predictors of influenza seasonality, including minimum temperature, hours of sunshine, and maximum rainfall. Our main study limitations include a short surveillance period and sparse influenza sampling in some of the southern provinces.ConclusionsRegional-specific influenza vaccination strategies would be optimal in China; in particular, annual campaigns should be initiated 4-6 months apart in Northern and Southern China. Influenza surveillance should be strengthened in mid-latitude provinces, given the complexity of seasonal patterns in this region. More broadly, our findings are consistent with the role of climatic factors on influenza transmission dynamics. Please see later in the article for the Editors' Summary.

Dataset Information

A Spatio-Temporal Modeling Framework for Surveillance Data of Multiple Infectious Pathogens with Small Laboratory Validation Sets.

Publications

A Spatio-Temporal Modeling Framework for Surveillance Data of Multiple Infectious Pathogens with Small Laboratory Validation Sets.

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