The Bureau of Communicable Disease (BCD) at the NYC Department of Health and Mental Hygiene performs daily automated analyses using SaTScan to detect spatio-temporal clusters for 37 reportable diseases. Initially, we analyzed one address per patient, prioritizing home address if available. On September 25, 2015, a BCD investigator noticed two legionellosis cases with similar work addresses. A third case was identified in a nearby residential facility, and an investigation was initiated to identify a common exposure source. Four days later, after additional cases living nearby were reported, the SaTScan analysis detected a corresponding cluster. In response to this signaling delay, we implemented a multiple address (MA) analysis to improve upon single address (SA) analyses by using all location data available on possible exposure sites.
To improve timeliness and sensitivity of legionellosis cluster detection in New York City (NYC) by using all addresses available for each patient in one analysis.