Comparison of statistical methods for the early detection of disease outbreaks in small population settings

Adam T Craig; Robert Neil F Leong; Mark W Donoghoe; David Muscatello; Vio Jianu C Mojica; Christine Joy M Octavo

doi:10.1016/j.ijregi.2023.08.007

Comparison of statistical methods for the early detection of disease outbreaks in small population settings

IJID Reg. 2023 Aug 18:8:157-163. doi: 10.1016/j.ijregi.2023.08.007. eCollection 2023 Sep.

Authors

Adam T Craig^{1

2}, Robert Neil F Leong², Mark W Donoghoe³, David Muscatello², Vio Jianu C Mojica⁴, Christine Joy M Octavo⁴

Affiliations

¹ School of Public Health, The University of Queensland, Herston, Australia.
² School of Population Health, University of New South Wales, Sydney, Kensington, Australia.
³ Mark Wainwright Analytical Centre, University of New South Wales, Sydney, Kensington, Australia.
⁴ Department of Physical Sciences and Mathematics, University of the Philippines, Manila, Philippines.

Abstract

Objectives: This study examines the performance of 6 aberration detection algorithms for the early detection of disease outbreaks in small population settings using syndrome-based early warning surveillance data collected by the Pacific Syndromic Surveillance System (PSSS). Although previous studies have proposed statistical methods for detecting aberrations in larger datasets, there is limited knowledge about how these perform in the presence of small numbers of background cases.

Methods: To address this gap a simulation model was developed to test and compare the performance of the 6 algorithms in detecting outbreaks of different magnitudes, durations, and case distributions.

Results: The study found that while the Early Aberration Reporting System-C1 algorithm developed by Hutwagner et al. outperformed others, no single approach provided reliable monitoring across all outbreak types. Furthermore, aberration detection approaches could only detect very large and acute outbreaks with any reliability.

Conclusion: The findings of this study suggest that algorithm-based approaches to outbreak signal detection perform poorly when applied to settings with small numbers of background cases and should not be relied upon in these contexts. This highlights the need for alternative approaches for accurate and timely outbreak detection in small population settings, particularly those that are resource-constrained.

Keywords: Evaluation; Modelling; Outbreak; Pacific Islands; Performance; Simulation; Syndromic surveillance.