Int J Health Geogr - Novel measurement of spreading pattern of influenza epidemic by using weighted standard distance method: retrospective spatial statistical study of influenza, Japan, 1999-2009.


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CKGROUND: Annual influenza epidemics occur worldwide resulting in considerable morbidity and mortality. Spreading pattern of influenza is not well understood because it is often hampered by the quality of surveillance data that limits the reliability of analysis. In Japan, influenza is reported on a weekly basis from 5,000 hospitals and clinics nationwide under the scheme of the National Infectious Disease Surveillance. The collected data are available to the public as weekly reports which were summarized into number of patient visits per hospital or clinic in each of the 47 prefectures. From this surveillance data, we analyzed the spatial spreading patterns of influenza epidemics using weekly weighted standard distance (WSD) from the 1999/2000 through 2008/2009 influenza seasons in Japan. WSD is a single numerical value representing the spatial compactness of influenza outbreak, which is small in case of clustered distribution and large in case of dispersed distribution.RESULTS: We demonstrated that the weekly WSD value or the measure of spatial compactness of the distribution of reported influenza cases, decreased to its lowest value before each epidemic peak in nine out of ten seasons analyzed. The duration between the lowest WSD week and the peak week of influenza cases ranged from minus one week to twenty weeks. The duration showed significant negative association with the proportion of influenza A/H3N2 cases in early phase of each outbreak (correlation coefficient was -0.75, P = 0.012) and significant positive association with the proportion of influenza B cases in the early phase (correlation coefficient was 0.64, P = 0.045), but positively correlated with the proportion of influenza A/H1N1 strain cases (statistically not significant). It is assumed that the lowest WSD values just before influenza peaks are due to local outbreak which results in small standard distance values. As influenza cases disperse nationwide and an epidemic reaches its peak, WSD value changed to be a progressively increasing.CONCLUSIONS: The spatial distribution of nationwide influenza outbreak was measured by using a novel WSD method. We showed that spreading rate varied by type and subtypes of influenza virus using WSD as a spatial indicator. This study is the first to show a relationship between influenza epidemic trend by type/subtype and spatial distribution of influenza nationwide in Japan.

Resumo Limpo

ckground annual influenza epidem occur worldwid result consider morbid mortal spread pattern influenza well understood often hamper qualiti surveil data limit reliabl analysi japan influenza report week basi hospit clinic nationwid scheme nation infecti diseas surveil collect data avail public week report summar number patient visit per hospit clinic prefectur surveil data analyz spatial spread pattern influenza epidem use week weight standard distanc wsd influenza season japan wsd singl numer valu repres spatial compact influenza outbreak small case cluster distribut larg case dispers distributionresult demonstr week wsd valu measur spatial compact distribut report influenza case decreas lowest valu epidem peak nine ten season analyz durat lowest wsd week peak week influenza case rang minus one week twenti week durat show signific negat associ proport influenza ahn case earli phase outbreak correl coeffici p signific posit associ proport influenza b case earli phase correl coeffici p posit correl proport influenza ahn strain case statist signific assum lowest wsd valu just influenza peak due local outbreak result small standard distanc valu influenza case dispers nationwid epidem reach peak wsd valu chang progress increasingconclus spatial distribut nationwid influenza outbreak measur use novel wsd method show spread rate vari type subtyp influenza virus use wsd spatial indic studi first show relationship influenza epidem trend typesubtyp spatial distribut influenza nationwid japan

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