Application of kernel smoothing to estimate the spatio-temporal variation in risk of STEC O157 in England

Richard Elson*, Tilman M. Davies, Claire Jenkins, Roberto Vivancos, Sarah J. O'Brien, Iain R. Lake

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)

Abstract

Identifying geographical areas with significantly higher or lower rates of infectious diseases can provide important aetiological clues to inform the development of public health policy and interventions designed to reduce morbidity. We applied kernel smoothing to estimate the spatial and spatio-temporal variation in risk of STEC O157 infection in England between 2009 and 2015, and to explore differences between the residential locations of cases reporting travel and those not reporting travel. We provide evidence that the distribution of STEC O157 infection in England is non-uniform with respect to the distribution of the at-risk population; that the spatial distribution of the three main genetic lineages infecting humans (I, II and I/II) differs significantly and that the spatio-temporal risk is highly dynamic. Our results also indicate that cases of STEC O157 reporting travel within or outside the UK are more likely to live in the south/south-east of the country, meaning that their residential location may not reflect the location of exposure that led to their infection. We suggest that the observed variation in risk reflects exposure to sources of STEC O157 that are geographically prescribed. These differences may be related to a combination of changes in the strains circulating in the ruminant reservoir, animal movements (livestock, birds or wildlife) or the behavior of individuals prior to infection. Further work to identify the importance of behaviours and exposures reported by cases relative to residential location is needed.

Original languageEnglish
Article number100305
JournalSpatial and Spatio-temporal Epidemiology
Volume32
DOIs
Publication statusPublished - Feb 2020

Bibliographical note

Funding Information:
The authors are indebted to two anonymous reviewers who provided insightful feedback on the first draft of this manuscript, which in turn greatly improved the final presentation. We thank everyone involved in the surveillance of gastrointestinal infections in England. Thanks are due to Lisa Byrne, Bhavita Vishram, Saira Butt, Nalini Purohit and Mike Harte who lead and manage the enhanced surveillance system for STEC in England, and Jack Wardle who proof read the final manuscript. We are grateful to the microbiologists and health protection and environmental health specialists who have contributed data and reports to national surveillance systems, and the epidemiologists and information officers who have worked on the national surveillance of intestinal infectious diseases for the National Infection Service of Public Health England. ONS census information is licensed under the terms of the Open Government Licence [http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3]. Finally, thanks are due to the R community who share their knowledge, skills and intellect freely. The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Institute of Food Research. Tilman M. Davies was supported in part by the Royal Society of New Zealand, Marsden Fast-start grant 15-UOO-092. Richard Elson is based at Public Health England. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England. Richard Elson is an epidemiologist employed by Public Health England with a particular interest in the spatial and spatio-temporal distribution of gastrointestinal infections.

Funding Information:
The authors are indebted to two anonymous reviewers who provided insightful feedback on the first draft of this manuscript, which in turn greatly improved the final presentation. We thank everyone involved in the surveillance of gastrointestinal infections in England. Thanks are due to Lisa Byrne, Bhavita Vishram, Saira Butt, Nalini Purohit and Mike Harte who lead and manage the enhanced surveillance system for STEC in England, and Jack Wardle who proof read the final manuscript. We are grateful to the microbiologists and health protection and environmental health specialists who have contributed data and reports to national surveillance systems, and the epidemiologists and information officers who have worked on the national surveillance of intestinal infectious diseases for the National Infection Service of Public Health England. ONS census information is licensed under the terms of the Open Government Licence [ http://www.nationalarchives.gov.uk/doc/open-government-licence/version/3 ]. Finally, thanks are due to the R community who share their knowledge, skills and intellect freely. The research was funded by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with University of East Anglia, University of Oxford and the Institute of Food Research. Tilman M. Davies was supported in part by the Royal Society of New Zealand , Marsden Fast-start grant 15-UOO-092. Richard Elson is based at Public Health England. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, the Department of Health or Public Health England.

Publisher Copyright:
© 2019 The Authors

Keywords

  • Relative risk
  • Shiga-toxin producing E. coli
  • Spatial
  • Spatio-temporal

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