Disclaimer: Early release articles are not considered as final versions. Any changes will be reflected in the online version in the month the article is officially released.
Author affiliation: Saint Louis University, St. Louis, Missouri, USA
Lower respiratory tract infections, including pneumonia and influenza (P&I), are the leading cause of infectious diseaserelated death worldwide (1). Annually, up to 95,000 persons might die from P&I in the United States alone (2). Ongoing surveillance of risk factors for influenza acquisition, incident influenza disease, and clinical outcomes of influenza infection are a global public health priority (3). Ensuring that public health professionals and the public at large are informed about the incidence and severity of disease in the community is an important benefit of these surveillance programs. To fulfill surveillance needs in the United States, the Centers for Disease Control and Prevention maintains FluView (4), a public-facing web interface providing detailed results of their influenza surveillance program. Reports maintained on FluView range from spatial analytics of influenza-like illness to virologic surveillance, virus characterization, hospitalization rates, and P&I mortality. Each report is useful for focused interventions and planning at a personal, local, state, regional, and national level.
Mortality reporting in FluView is a particularly critical public health endpoint for P&I because early interventions can lessen these catastrophic outcomes. Currently, mortality is monitored and reported as epidemic if the percentage of total deaths is above a value termed the epidemic threshold. This threshold is defined at a P&I death rate 1.645 SDs above the seasonal baseline mortality (5) as measured by the National Center for Health Statistics mortality surveillance system. These statistics are useful but limited in their ability to detect abnormally high death rates because they do not rigorously account for common statistical issues inherent in influenza surveillance data, such as within- and between-season seasonality and autocorrelation (6). Without accounting for the complex temporal fluctuations (seasonality) and nonindependence of period-to-period data points (autocorrelation), traditional statistical methodologies might provide spurious results, leading to inappropriate conclusions. Because an essential aspect of surveillance is ensuring that robust statistical methods are used to provide a valid view of the state of disease or outcome, the exploration of innovative methods for computational surveillance of P&I outcomes is warranted. The objective of our study was to evaluate the utility of a novel anomaly detection algorithm for P&I mortality surveillance.
For our study, we obtained national P&I mortality data from FluView for a 350-week period ranging from week 40 of 2013 through week 24 of 2020. First, we recreated the current FluView P&I mortality plot, shading areas above the epidemic threshold to more easily delineate mortality rates higher than this limit. Next, we used Twitters time-series decomposition and the generalized extreme studentized deviate anomaly detection algorithm to identify anomalous P&I mortality rates (7,8). For anomaly detection, default (0.05) and maximum anomalies (20%) were used as options. Anomaly plots identify anomalies using red dots. We analyzed data using R version 4.0.1 (R Foundation for Statistical Computing, https://www.r-project.org).
Figure
Figure. Pneumonia and influenza mortality surveillance using anomaly detection analysis versus threshold method, United States. A) Line chart representing anomaly detection analysis of surveillance. Red points indicate anomalous data points. B)...
Using current epidemic threshold methodologies, we found that 72 (20.6%) of weekly P&I mortality rates were beyond the epidemic threshold (Figure, panel A). P&I mortality rates spiked above the epidemic threshold in approximately the same weeks every year since week 40 of 2013. Anomaly detection identified 17 (4.9%) P&I mortality rates as abnormally high (Figure, panel B). To ensure that this methodology can be continually used into the future, we also created a free, open-source, web-based application to recreate both figures on demand as data are updated (https://surveillance.shinyapps.io/fluview). Once loaded, the current national data are pulled from FluView and analyzed on the first tab. The anomaly plot and the updated current FluView P&I mortality surveillance plots are then displayed. For this web application, we included the options to modify some basic functionality of the anomaly detection algorithm with brief discussions of how they can be used (7,8). A second tab was created to enable upload of state-level P&I mortality data from FluView Interactive (https://gis.cdc.gov/grasp/fluview/mortality.html), providing the same anomaly detection plot.
The current epidemic threshold for documenting P&I mortality in the United States cannot differentiate characteristic mortality rates during peak influenza season from unusually high mortality attributable to P&I. An important benefit of mortality surveillance is the identification of periods where rates are beyond a reasonable expectation such that adequate interventions can be developed to lower death rates in the community. Currently, P&I mortality rates are compared with a basic SD statistic obtained and averaged over seasonal baseline mortality estimates. This traditional approach does not account for seasonality or autocorrelative functions within and across influenza seasons (6). Given the advancements in computational power and the development of easy-to-interpret algorithms capable of filtering out these biases, alternative approaches for surveillance of P&I mortality at a national level should be considered to complement the current FluView methods. Our approach is one such alternative. Others such as the European EuroMoMo modeling (https://www.euromomo.eu) might also be applicable methods for bolstering our understanding of P&I mortality.
Although this particular anomaly detection might underestimate the frequency of abnormally high mortality rates, our approach is also likely to produce an additional, more focused message for public health professionals. Currently, P&I mortality peaks above the epidemic threshold at approximately the same time each year. Therefore, the existing approach might have a limited ability to provide public health professionals with the reports necessary to make informed interventions to limit mortality, such as through recalibrating targeted screening and preventative approaches, and to more accurately develop focused interventions such as vaccination campaigns. To accomplish this task, a computational method motivated by identifying outlying mortality rates should be used, with the caveat that mortality data must be reported in near real-time. Our approach provides such an outcome and might be useful for public health professionals in their quest to prevent and control P&I-related death. Our approach might also be useful for computational surveillance of other respiratory diseases, such as coronavirus.
Dr. Wiemken is an associate professor at Saint Louis University School of Medicine, Division of Infectious Diseases, Allergy, and Immunology, as well as the Center for Health Outcomes Research. His primary research interests include emerging infectious diseases, influenza, vaccinology, healthcare-associated infections, and data science.
Top
Suggested citation for this article: Wiemken TL, Santos Rutschman A, Niemotka SL, Hoft D. Thresholds versus anomaly detection for surveillance of pneumonia and influenza mortality. Emerg Infect Dis. 2020 Nov [date cited]. https://doi.org/10.3201/eid2611.200706
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
Read more:
Thresholds versus Anomaly Detection for Surveillance of Pneumonia and Influenza Mortality - CDC
- Utilizing your free, preventative healthcare coverage - KELOLAND.com - February 18th, 2024
- Preventive Pros: the Podcast - Department of Population and Public Health Sciences - University of Southern California - February 18th, 2024
- Heart health awareness and preventative care with Jen Lewis on Coast Live - News 3 WTKR Norfolk - February 18th, 2024
- Heart disease risk factors in women highlight need for increased awareness, prevention - American Heart Association - February 18th, 2024
- Preventive health care benefits | Opinion | thecabin.net - Log Cabin Democrat - February 18th, 2024
- Menopause and migraines: New findings point to power of prevention - Medical Xpress - February 18th, 2024
- How Young Is Too Young For Preventative Skincare? Here's What Experts Want You To Know - Health.com - February 18th, 2024
- Potential prevention of rheumatoid arthritis with injection? Clinical study brings hope for millions - WION - February 18th, 2024
- Heart disease risk factors in women highlight need for increased awareness, prevention - Medical Xpress - February 18th, 2024
- Stay on top of your fur baby's health: the importance of scheduling routine vet visits - FoxReno.com - May 17th, 2023
- Preventive healthcare - May 9th, 2023
- What Is Preventive Health and Why Is It Important? - May 9th, 2023
- What Is Preventive Medicine & Why Do We Need It? | AUC - February 16th, 2023
- Preventive Medicine | Journal | ScienceDirect.com by Elsevier - December 3rd, 2022
- Migraine - Diagnosis and treatment - Mayo Clinic - December 3rd, 2022
- Functional Medicine of Idaho | Preventative Root Cause Medicine - December 3rd, 2022
- These 2 Staten Island nurses believe IV hydration drips and vitamin shots are key to long-term health - SILive.com - December 3rd, 2022
- CNBCTV-18 and IIM-K's India@2047 Leadership Series: Challenges and opportunities in the fintech and healthcare sectors - Forbes India - December 3rd, 2022
- As N.W.T. mulls health coverage changes, petition calls for preventative HIV drug to be free - CBC.ca - September 20th, 2022
- EU regulator backs wider use of AstraZeneca COVID therapy - Reuters - September 20th, 2022
- Choose integrative medicine for health and wellness - Technique - September 20th, 2022
- The high hospital bills we make victims of rape and sexual violence pay - Vox.com - September 20th, 2022
- 4 Anti-Aging Products Youre Using All Wrong, According To Skincare Experts - SheFinds - September 20th, 2022
- Why Now is the Time to Double Down on Virtual Care - HIT Consultant - September 20th, 2022
- Tell Giselle: The price of good help is priceless - Wilkes Barre Times-Leader - September 20th, 2022
- Heron Therapeutics Announces U.S. FDA Approval of APONVIE (HTX-019) for the Prevention of Postoperative Nausea and Vomiting (PONV) - BioSpace - September 20th, 2022
- Pickleball injuries are on the rise: 5 preventive tips to keep you on the court - The Manual - September 20th, 2022
- The next big social movement and other takeaways from our regular meeting - POLITICO - September 20th, 2022
- 15 Mushrooms and How to Use Them in Vegan Cooking - VegNews - September 20th, 2022
- Use of honey in the management of Chemotherapy | CMAR - Dove Medical Press - September 20th, 2022
- Celebrity Strategy Consultant Predicts What Will Be The Most Impactful Area In The Pharmaceutical Industry - Forbes - September 20th, 2022
- C2C Care Course The Preservation of Our Global Photographic Heritage: Here, There and Everywhere - aam-us.org - August 3rd, 2022
- Loneliness: Causes, Effects And Prevention Forbes Health - Forbes - August 3rd, 2022
- Prevention and wellness is the new model, a leader from Henry Ford Health System says - Becker's Hospital Review - August 3rd, 2022
- FACT SHEET: White House Summit on Building Lasting Eviction Prevention Reform - The White House - August 3rd, 2022
- Getting Back to Employer Health and Wellness Programs - Cone Health - August 3rd, 2022
- Do ICDs Still Work in Primary Prevention Given Today's HF Meds? - Medscape - August 3rd, 2022
- Alzheimer's-defying brain offers clues to treatment, prevention - Harvard Gazette - August 3rd, 2022
- Wind-fanned lightning fire prompted precautionary evacuation notices near Medical Springs Sunday evening - Baker City Herald - August 3rd, 2022
- Experts discuss importance of cancer screenings and early detection - Merck - August 3rd, 2022
- King Institute of Preventive Medicine and Research to test samples for monkeypox - The Hindu - August 3rd, 2022
- Consolidated guidelines on HIV, viral hepatitis and STI prevention, diagnosis, treatment and care for key populations - World - ReliefWeb - August 3rd, 2022
- Dr. Sanjay Gupta: While monkeypox cases rise, why are we waiting for the cavalry to rescue us? - CNN - August 3rd, 2022
- SCYNEXIS Announces U.S. Food and Drug Administration - GlobeNewswire - August 3rd, 2022
- Governor Whitmer declares August 2022 as Breastfeeding Month, highlights additional breastfeeding observances - Michigan (.gov) - August 3rd, 2022
- New student education program supports drug and alcohol abuse prevention - The Ohio State University News - July 25th, 2022
- Suicide prevention training for health care providers a first step in longer-term efficacy - University of Washington - July 25th, 2022
- Pharmalittle: Congress may miss deadline to pass FDA user-fee bill; ViiV is urged to lower price for its HIV prevention drug - STAT - July 25th, 2022
- Prevention of Bipolar Disorder Episodes: Is It Possible? - PsychCentral.com - July 25th, 2022
- GAO Found Gap in Dirty Bomb Prevention - Government Technology - July 25th, 2022
- Florida man in apparent medical distress crashes car through beach crowd before hitting the water - CNN - July 25th, 2022
- Study: Preventive care scarce in LGBTQ+ community - - Medical Marketing and Media - July 25th, 2022
- The rise of preventive insurance purchases in India - ETHealthWorld - July 25th, 2022
- Why Are My Feet Always Cold? Cold Feet Causes and Treatment - Prevention Magazine - July 25th, 2022
- Agency looking to open overdose prevention site in Saint John amid 'poisoned' drug supply - CBC.ca - July 25th, 2022
- UVA Expert Offers Insight on the Use of Dietary Supplements for Cancer Prevention - UVA Today - July 25th, 2022
- Alzheimer's: Targeting key protein in blood may slow progression - Medical News Today - July 25th, 2022
- NPPC, FAS focused on ASF prevention in the Philippines - MEAT+POULTRY - July 25th, 2022
- Implementation of IPT in people living with HIV | RMHP - Dove Medical Press - July 25th, 2022
- NL starts preventive vaccination against monkeypox in Amsterdam, The Hague - NL Times - July 25th, 2022
- Precautionary measures you can take against brain haemorrhage - Times of India - July 25th, 2022
- Acid Reflux and Liver Disease: Signs, Symptoms and Prevention - Healthline - July 25th, 2022
- What to do if you get an allergic reaction: symptoms, causes, and prevention - Fox News - July 25th, 2022
- How one woman took control of her rare disease and achieved her dream - Times of Oman - July 25th, 2022
- Tilman Fertitta donating $50 million to UH medical school, which will be renamed after him - Houston Chronicle - May 20th, 2022
- This new 3D screensaver collection includes a driving tour of global pylons - Rock Paper Shotgun - May 20th, 2022
- Dedication, generosity and compassion that had no limit! - The Sun Chronicle - May 20th, 2022
- Manhattan internist and cardiologist, Dr. William Priester collaborates with Castle Connolly Private Health Partners to create a new concierge medical... - May 20th, 2022
- Tips on avoiding mosquitos this summer - morethanthecurve.com - May 20th, 2022
- Nanomedicine and HIV Therapeutics - AZoNano - May 20th, 2022
- The HIV Vaccine: What We Know, And What We Don't - MadameNoire - May 20th, 2022
- What we know (and don't know) about North Korea's COVID-19 outbreak - WCVB Boston - May 20th, 2022
- Experts warn of health effects from dusty conditions as sandstorm blankets UAE - Al Arabiya English - May 20th, 2022
- Statin therapy: Does the gut microbiome affect outcomes? - Medical News Today - May 20th, 2022
- New Preventative Medicine Facility Wraps Work in NYC - Healthcare Construction and Operations News - November 7th, 2021
- MPD working with faith-based leaders to fight violent crime - FOX13 Memphis - November 7th, 2021
- Cornell grad and lecturer touts benefits of plant-based diet - ithaca.com - November 7th, 2021
- Meet the Cork-born bread activist who has Goldie Hawn buying her loaves - Irish Examiner - November 7th, 2021
- Pfizer says pill cuts risk of severe Covid by 89% - RTE.ie - November 7th, 2021
- The roots of ivermectin mania: How South America incubated a fake-medicine craze that took the US by storm - Yahoo News - November 7th, 2021