{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:08:23Z","timestamp":1788926903325,"version":"build-2803163510"},"reference-count":33,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T00:00:00Z","timestamp":1539820800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T00:00:00Z","timestamp":1539820800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2019]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Legionnaires\u2019 disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014\u20132016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of \u2a7d30 and \u2a7d180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of \u2a7e20, \u2a7e100 and \u2a7e365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of \u2a7e100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.<\/jats:p>","DOI":"10.1017\/s0950268818002789","type":"journal-article","created":{"date-parts":[[2018,10,18]],"date-time":"2018-10-18T05:20:31Z","timestamp":1539840031000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Simulation of Legionnaires\u2019 disease prospective spatiotemporal cluster detection, Allegheny County, Pennsylvania, USA"],"prefix":"10.1017","volume":"147","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9049-4934","authenticated-orcid":false,"given":"L. T.","family":"Orkis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. R.","family":"Peterson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Brooks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. J.","family":"Mertz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. H.","family":"Harrison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. E.","family":"Stout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. K.","family":"Greene","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2018,10,18]]},"reference":[{"key":"S0950268818002789_ref9","doi-asserted-by":"publisher","DOI":"10.3201\/eid1005.030646"},{"key":"S0950268818002789_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60078-2"},{"key":"S0950268818002789_ref12","first-page":"144","article-title":"Benchmark data and power calculations for evaluating disease outbreak detection methods","volume":"53","author":"Kulldorff","year":"2004","journal-title":"MMWR Supplement"},{"key":"S0950268818002789_ref2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6522e1"},{"key":"S0950268818002789_ref32","doi-asserted-by":"publisher","DOI":"10.1186\/s12942-017-0118-4"},{"key":"S0950268818002789_ref28","doi-asserted-by":"publisher","DOI":"10.1177\/0033354916689612"},{"key":"S0950268818002789_ref24","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh029"},{"key":"S0950268818002789_ref20","doi-asserted-by":"publisher","DOI":"10.2807\/ese.17.28.20216-en"},{"key":"S0950268818002789_ref18","unstructured":"United States Department of Health and Human Services Centers for Disease Control and Prevention (2005) Legionellosis\/Legionnaires\u2019 Disease or Pontiac Fever (Legionella pneumophila 2005 Case Definition. October 20, 2017]; Available at https:\/\/wwwn.cdc.gov\/nndss\/conditions\/legionellosis\/case-definition\/2005\/."},{"key":"S0950268818002789_ref16","unstructured":"United States Census Bureau (2017) Allegheny County, Pennsylvania. [cited 2017 11\/10\/2017]; Available at https:\/\/factfinder.census.gov\/faces\/nav\/jsf\/pages\/community_facts.xhtml?src=bkmk."},{"key":"S0950268818002789_ref15","first-page":"1083","article-title":"Legionellosis \u2013 United States, 2000\u20132009","volume":"60","year":"2011","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S0950268818002789_ref10","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268812003135"},{"key":"S0950268818002789_ref5","doi-asserted-by":"publisher","DOI":"10.1002\/sim.5765"},{"key":"S0950268818002789_ref3","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268809990185"},{"key":"S0950268818002789_ref13","doi-asserted-by":"publisher","DOI":"10.3201\/eid0906.020794"},{"key":"S0950268818002789_ref17","unstructured":"Allegheny County Health Department (2014) Allegheny County summary of reportable disease 2004\u20132013."},{"key":"S0950268818002789_ref22","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268814001964"},{"key":"S0950268818002789_ref4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010406"},{"key":"S0950268818002789_ref31","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2015.302741"},{"key":"S0950268818002789_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2015.03.037"},{"key":"S0950268818002789_ref33","doi-asserted-by":"publisher","DOI":"10.3201\/eid2011.131872"},{"key":"S0950268818002789_ref7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0020059"},{"key":"S0950268818002789_ref6","doi-asserted-by":"publisher","DOI":"10.3201\/eid2210.160097"},{"key":"S0950268818002789_ref21","doi-asserted-by":"publisher","DOI":"10.1086\/498575"},{"key":"S0950268818002789_ref14","doi-asserted-by":"publisher","DOI":"10.1177\/0033354916689620"},{"key":"S0950268818002789_ref8","article-title":"Monitoring over-the-counter pharmacy sales for early outbreak detection in New York City","volume":"53","author":"Das","year":"2004","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S0950268818002789_ref19","article-title":"Age adjustment using the 2000 projected U.S. population","author":"Klein","journal-title":"Healthy People 2010 Statistics Notes"},{"key":"S0950268818002789_ref11","doi-asserted-by":"publisher","DOI":"10.1177\/003335490612100206"},{"key":"S0950268818002789_ref23","unstructured":"Kulldorff M (2018) SaTScan User Guide. 2018 January 2018 [cited 2018 March 9, 2018]; Available at https:\/\/www.satscan.org\/cgi-bin\/satscan\/register.pl\/SaTScan_Users_Guide.pdf?todo=process_userguide_download."},{"key":"S0950268818002789_ref30","doi-asserted-by":"publisher","DOI":"10.5210\/ojphi.v9i1.7705"},{"key":"S0950268818002789_ref29","doi-asserted-by":"publisher","DOI":"10.3201\/eid2311.161584"},{"key":"S0950268818002789_ref25","doi-asserted-by":"publisher","DOI":"10.3201\/eid2405.170764"},{"key":"S0950268818002789_ref26","doi-asserted-by":"publisher","DOI":"10.1002\/sim.6430"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268818002789","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,6,7]],"date-time":"2019-06-07T17:54:37Z","timestamp":1559930077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268818002789\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,10,18]]},"references-count":33,"alternative-id":["S0950268818002789"],"URL":"https:\/\/doi.org\/10.1017\/s0950268818002789","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,10,18]]},"assertion":[{"value":"Copyright \u00a9 Cambridge University Press 2018\u00a0","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}],"article-number":"e29"}}