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Rubén Solano 1, 2, D. Gómez-Barroso 4,2, F. Simón 2, 4, S. Lafuente 3, J. Caylà 3 1 Field Epidemiology Training Program (PEAC-Spain). 2 National Centre.

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Presentation on theme: "Rubén Solano 1, 2, D. Gómez-Barroso 4,2, F. Simón 2, 4, S. Lafuente 3, J. Caylà 3 1 Field Epidemiology Training Program (PEAC-Spain). 2 National Centre."— Presentation transcript:

1 Rubén Solano 1, 2, D. Gómez-Barroso 4,2, F. Simón 2, 4, S. Lafuente 3, J. Caylà 3 1 Field Epidemiology Training Program (PEAC-Spain). 2 National Centre for Epidemiology, Carlos III Institute of Health. Madrid, Spain. 3 Epidemiology Department, Public Health Agency of Barcelona, Barcelona, Spain. 4 CIBER en Epidemiología y Salud Pública (CIBERESP), Spain. Space-Time clusters analysis of cases of whooping cough- Barcelona, Spain, 2000-2011

2 Upper Respitarory TractWidespread vaccination Endemic Worldwide Whooping Cough Tan T,Trindade E, Skowronski D. Epidemiology of Pertussis. Pediatric Infect Dis J. 2005;24:10-18.

3 Whooping cough Surveillance in Spain 1997, National Epidemiological Surveillance Network (RENAVE) Agregated Cases Reported Cantabria Catalonia Madrid

4 Catalonia (Barcelona) Global increasing of cases Barcelona Rates/100 000 p 2007 3.92 2008 6.61 Whooping cough Surveillance in Catalonia-Barcelona

5 National Local Impact

6 Objective To identify space-time clusters of whooping cough in the period 2000-2011 in order to identify high risk areas in Barcelona

7 Methods Design: Retrospective Space-Time analysis Case definition: All cases of whooping cough individual reported to the Public Health Agency of Barcelona during the study period Population: census of 2006 of the National Statistics Institute stratified by age and sex and census tracts

8 Methods Temporal and Spatial Criteria: 7 days and 500 meters maximum distance Maps have been developed: - Most likely cluster (with maximum likelihood ratio). Others clusters with statistical significance (p<0.05) Scan Statistic analysis assuming a Poisson distribution

9 Results

10 N=646Age Groups (Years) Distribution of cases of whooping cough by sex and age groups, Barcelona, Spain-2000-2011

11 Age Groups (Years) Reporting Year N=646 Annual distribution of cases of whooping cough by age groups, Barcelona, Spain-2000-2011

12 Space-Time distribution of Clusters of whooping cough, Barcelona-Spain, 2000-2011 Clusters, p<0.05 Most likely cluster Secondary N=283 Cluster 4 Cluster 1

13 Space-Time distribution of Clusters of whooping cough- Barcelona, Spain, 2000-2011 ClustersDateObservedExpectedP-valueNCT 117/8/2011-23/8/201150.00210.00000265 230/3/2011-5/4/201130.000450.00071 37/11/2007-13/11/200730.000630.00121 429/6/2011-5/7/201140.0110.005025 522/9/2010-28/9/201030.00170.00591 66/8/2003-12/8/200330.00340.0181 715/6/2011-21/6/201120.000450.0191 811/2/2004-17/2/200420.000500.0251 914/7/2010-20/7/201020.000540.0301 1028/1/2004-3/2/200420.000610.0401 1126/9/2007-2/10/200720.000640.0441 1211/5/2011-17/5/201120.000660.0461 NCT, Number Census Tracts included

14 Strengths You can study the entire population or a representative sample More power in generalising Limitations Susceptible to selection bias We included only cases with complete epidemiological and space-time information

15 Conclusions Spatial statistics methods: - are useful to identify outbreaks not reported to the surveillance system - can be complementary tools in epidemiological surveillance systems We identified 12 Space-time clusters The most likely cluster: - included 5 census tracts - was not reported as an outbreak

16 Recommendations Enhanced surveillance of whooping cough in regions with high incidence rates Better control of immunization of persons aged 0 to 18 in high incidence areas Understanding of person-to-person inter-individual contact patterns and the spread of epidemics

17 Thank You !!!

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