Bayesian outbreak detection algorithm for monitoring reported cases of campylobacteriosis in Germany.

In infectious disease epidemiology, statistical methods are an indispensable component for the automated detection of outbreaks in routinely collected surveillance data. So far, methodology in this area has been largely of frequentist nature and has increasingly been taking inspiration from statistical process control. The present work is concerned with strengthening Bayesian thinking in this field. We extend the widely used approach of Farrington et al. and Heisterkamp et al. to a modern Bayesian framework within a time series decomposition context. This approach facilitates a direct calculation of the decision-making threshold while taking all sources of uncertainty in both prediction and estimation into account. More importantly, with the methodology it is now also possible to integrate covariate processes, e.g. weather influence, into the outbreak detection. Model inference is performed using fast and efficient integrated nested Laplace approximations, enabling the use of this method in routine surveillance at public health institutions. Performance of the algorithm was investigated by comparing simulations with existing methods as well as by analysing the time series of notified campylobacteriosis cases in Germany for the years 2002-2011, which include absolute humidity as a covariate process. Altogether, a flexible and modern surveillance algorithm is presented with an implementation available through the R package 'surveillance'.