public health added value of gis/spatial analysis for some infectious diseases
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Public Health added value of GIS/spatial analysis for some infectious diseases. Wilfrid van Pelt, Agnetha Hofhuis, Ingrid Friesema, Jan van de Kassteele and many many others. - PowerPoint PPT PresentationTRANSCRIPT
National Institutefor Public Healthand the Environment
Public Health added value of GIS/spatial analysis for some infectious diseases.
Wilfrid van Pelt, Agnetha Hofhuis, Ingrid Friesema, Jan van de Kassteele and many many others
1. Simple type of clustering in space and time implemented in 1999 with an internet interface, of 1000 salmonella types for weekly signaling and retrospective inspection.
2. Simple ecologic analysis of Lyme disease among NL general practices (1995, 2001 en 2006).
3. Provisional Bayesian analysis of regional densities of cattle, pigs and poultry and the occurrence of patients with STEC (1999-2007).
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Course avian influenza epidemic, 2003poultryfarms, contaminated, culled
Thanks to Michiel van Boven
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Rubella notifications by 4 digit postal code The Netherlands, 1-9-2004 – 13-9-2005
National Institutefor Public Healthand the Environment
MMR-1 coverage by municipality The Netherlands, 2004
National Institutefor Public Healthand the Environment
Votes for SGP party by municipality National Elections, The Netherlands, 2003
Percentage of those allowed to vote
Thanks to Susan Hahne
National Institutefor Public Healthand the Environment
Outbreak detection by searching for clusters in region & time for
Salmonella
National Institutefor Public Healthand the Environment
Intranet Catalogue / Atlas since Mai 1998
• human/ animal/ food/ environment
• All sero and phagetypes
• Resistance
• Actual trends, Early Warning, GIS-clusters
Each week backcalculated starting in 1984
• >10.000 Tables and Figures
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Explosions of S. Typhimurium ft 20
october 1997Groningen
April 1998Roermond October 1999
Twente
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7-Ja
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26-M
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20-J
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7-Dec
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26-A
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Jul
13-S
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22-N
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7-Nov
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29-J
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week
Fre
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16
PH
L's
(4
-wk
su
m)
ObservedExpectedTolerance
Region clusters
Age deviating
Time clusters
Early-Warning application
National Institutefor Public Healthand the Environment
1st step signal verification:
region
Silver wedding:
• Case-control study rPHA
• Coburgerham, salting process insufficient
National Institutefor Public Healthand the Environment
1st stepsignalverification:
region-crossing
Place, Age, Gender
National Institutefor Public Healthand the Environment
1st step signalverification:
precedent
No cause found:
• RIVM trawling questionnair, too late
• Animal Health Service, no clou in region
National Institutefor Public Healthand the Environment
Say CHEESE
National Institutefor Public Healthand the Environment
Explosion of Salmonella Typhimurium DT7 cases
In January 2006 up to April 2007 an explosion of S.T. DT7 infections occurred, resulting in an extra 297 lab-confirmed cases of salmonellosis.
(tip of the Iceberg).
Labconfirmed: 297 cases
Hospitalized: 60-75 cases
Death (<2jr): 5 - 6
Symptomatic InfectedGeneral population
General Practices
Laboratories
Hospital
†
Doctor visits: +/- 650
General Population:+/- 4455 GE-cases
COI: € 0.6 milj
DALY: 54
Schattingen!!
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
1 jan 2006
half mei 2006
april 2007
Automatische geografische outbreak detectieKaas affaire Twente Salmonella Typhimurium Ft561
National Institutefor Public Healthand the Environment
Automated geographic outbreak detectionKaas affaire Twente Salmonella Typhimurium Ft561
Januari to half
mei 2006
half mai to
end 2006
National Institutefor Public Healthand the Environment
Not automated, by hand for publication,
looks better
Kaas affaire Twente Salmonella Typhimurium Ft561/DT7januari-december 2006
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Lyme disease in the NetherlandsAgnetha Hofhuis & Wilfrid van Pelt and many others
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Lyme disease in Europe is caused by the Borrelia burgdorferi sensu lato group;
B. burgdorferi sensu stricto, B. afzelii, B. garinii
Transmission of Lyme disease
Transmission by the sheep tick (Ixodes ricinus).
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Lyme disease
Early local infection:
erythema migrans (EM) 75 - 90% of B. burgdorferi infections
Early disseminated infection:
manifestations in nervous system, skin, joints and heart
Chronic Lyme borreliosis…
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
retrospective studies among general practitioners (GP’s)
? Incidence of tick bites and erythema migrans
? Geographical distribution in the Netherlands
? Ecological risk factors for tick bites and erythema migrans
retrospective analysis of hospital admissions for Lyme disease
? Occurrence of hospital admissions for Lyme disease
? Seasonal and annual trends in hospital admissions for Lyme disease
collecting ticks in 4 different biotopes
? Density of ticks & infection rate of ticks with Borrelia
? Seasonal & annual trends
Studies on Lyme disease in the Netherlands
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
All (± 8.000) general practitioners (GP’s) in 1995, 2002 & 2006
received pre-coded questionnaire about previous year
1. How many patients with tick bites have you seen?
2. How many erythema migrans case-patients have you seen?
3. How many people are included in your practice population?
Retrospective GP-study postal questionnaire
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
74,3
103,8
38,6
371,9
446,3
191,3
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140
160
1994 1996 1998 2000 2002 2004 2006
0
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Response, coverage: 88% in 1994
68% in 2001
71% in 2005
Tick bite consultations:
1994 30.000
2005 73.000
EM consultations:
1994 6.000
2005 17.000
Retrospective GP-study results
Incidence of EM & tick bites per 100.000 inhabitants
National Institutefor Public Healthand the Environment
National Institutefor Public Healthand the Environment
Information on risk factors per municipality
Roe deerRabbitsHorsesSheep & goatsCattleWoodsDegree of urbanizationTourist nights per yearPrecipitationParks & public gardensSandy soilUncultivated wet soilUncultivated dry soilDunes
Retrospective GP-study ecological risk factors
Risk analysis for GP-studies of 1994, 2001 & 2005 together:
Poisson regression: (offset: city population) city repeated measure year “confounder” no random (un)structered effects, sofar no Bayesian smoothing, sofar
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Retrospective GP-study ecological risk factors
Risk factors for tick bites
area with sandy soil
mean precipitation
density of roe deer
rural areas ( houses/ km2)
tourist areas
cattle / km2
rabbits / km2
Risk factors for erythema migrans
area covered with woods
area with sandy soil
mean precipitation
roe deer / km2
rural area ( houses/ km2)
tourist areas
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Geographical distribution of STEC in the Netherlands
Wilfrid van Pelt ,Loes Bertens, Ingrid Friesema, Jan van de Kassteele (spatial statistician)
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Known, mentioned riskfactors: Consumption raw milk/cheese (16%) Contact farmanimal (21%) Person-to-person transmission (18%) Consumption ready-to-eat vegetables (28%)
Most important reservoir: Dairy cattle and veals
Acute gastroenteritis with Complications HUS (15%) and Hospital-uptake (41%), accent 0-4 year
olds
Generalities STEC-O157 infections
Provisionary analysis:Spatial relation Cattle density and STEC incidence
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
STEC season in Veals (1st), 1-2 weeks later in Humans and Dairy cattle
1999-2007
0
1
2
3
4
5
6
7
8
9
1-4 5-8 9-12 13-16 17-20 21-24 25-28 29-32 33-36 37-40 41-44 45-48 49-52
4-weekly periods
Hu
man
ST
EC
O15
7 / 4
wk,
199
9-20
07
0%
3%
6%
9%
12%
15%
18%
21%
24%
jan feb mrt apr mei jun jul aug sep okt nov dec
Po
siti
ve s
tap
les
Dairy Cattle
Veals
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Average (1997-2006) densities of farm animals / km2
Poultry densityAnimals / km2
[0,974](974-2700](2700-5440](5440-9400](9400,15500](15500-23500](23500-28800]
Poultry densityAnimals / km2
[0,974](974-2700](2700-5440](5440-9400](9400,15500](15500-23500](23500-28800]
Pigs densityAnimals/ km2
[0-204](204-561](561-1040](1040-1770](1770-2490](2490-3290](3290-4760]
Pigs densityAnimals/ km2
[0-204](204-561](561-1040](1040-1770](1770-2490](2490-3290](3290-4760]
Cattle densityAnimals / km2
[0,35.7](35.7,75.4](75.4,121](121,172](172,230](230,325](325,547]
[0,35.7](35.7,75.4](75.4,121](121,172](172,230](230,325](325,547]
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
RR P2.5 P97.5(Intercept) 0,6 0,4 0,8Cattle: 1000/km2 6,4 1,0 45,2Pig: 1000/km2 1,0 0,7 1,4Poultry:1000/km2 1,0 0,9 1,0Age 0-4 4,5 3,4 5,9Age 5-9 1,6 1,2 2,1Age 10-49 0,5 0,4 0,7Age 50+ 1,0
Males 1,0Females 1,3 1,0 1,6
Neighbour matrix of 496 communities
WinBUGS model called from R using R2WinBUGS library Model results
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
RR total
[0.202,0.734](0.734,0.969](0.969,1.24](1.24,1.6](1.6,2.11](2.11,3](3,4.25]
STEC casesIncidence / 1.000.000
[0,1.62](1.62,4.7](4.7,7.34](7.34,11.1](11.1,16.8](16.8,22.4](22.4,31.6]
STEC-O157 in NL 1999-2006 (2.4 / 106 inhabitants; 40-50 / yr.; N=400)
Bayesian “smoothed” version (SMR)
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
STEC-O157 model:Structured and unstructured random effects (residuals)
RR unstructured
[0.418,0.975](0.975,1.19](1.19,1.41](1.41,1.68](1.68,2.05](2.05,2.55](2.55,3.62]
RR structured
[0.356,0.614](0.614,0.878](0.878,1.02](1.02,1.14](1.14,1.26](1.26,1.48](1.48,10.3]
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.
National Institutefor Public Healthand the Environment
Web-based GIS-tool for questioning both numerators (disease, risk
factor) and denominators (underlying population size):
• Physicians (EU wide): practice size (denominator), number of Lyme
consults (numerator)
• Children DayCare Centres (NL): weekly reporting children at risk
(denominator) and absenteism infectious diseases (numerator) Immediately mapping and feeding back the rates to GP or DCC,
regional PH-body (GGD) and national PH-body (RIVM)• Accurate incidence figures for regional comparison and analysis of regional
risk factors Condition:
• Small, fast web-based application ignoring the artistic selfrespect of GIS developers
GIS wishes
Hotel Mitland, 5 mrt 2009EUROHEIS2 GIS workshop, Wilfrid van Pelt et al.