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Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.


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  1. Centers for Disease Control and Prevention (CDC). Mission, role and pledge. Atlanta; CDC. [Accessed: 25 Sep 2014]. Available from: http://www.cdc.gov/about/organization/mission.htm
  2. Goodman RA, Buehler JW, Koplan JP. The epidemiologic field investigation: science and judgment in public health practice. Am J Epidemiol. 1990;132(1):9-16. PMID: 2356818 
  3. Snow J. On the Mode of Communication of Cholera. London: John Churchill; 1855.
  4. World Health Organization (WHO). Foodborne disease outbreaks: guidelines for investigation and control. Geneva: WHO; 2008. Available from: http://www.who.int/foodsafety/publications/foodborne_disease/outbreak_guidelines.pdf
  5. Public Health England (PHE). Communicable disease outbreak management: operational guidance. London: PHE; 2014. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/343723/12_8_2014_CD_Outbreak_Guidance_REandCT_2__2_.pdf
  6. European Centre for Disease Prevention and Control (ECDC). Toolkit for investigation and response to food and waterborne disease outbreaks with an EU dimension. Stockholm: ECDC. [Accessed: 30 Sep 2014]. Available from: http://www.ecdc.europa.eu/en/healthtopics/food_and_waterborne_disease/toolkit/Pages/index.aspx
  7. Centers for Disease Control and Prevention (CDC). Multistate and nationwide foodborne outbreak investigations: a step-by-step guide: Atlanta: CDC. [Accessed: 30 Sep 2014]. Available from: http://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/investigations/index.html
  8. Moore DA, Carpenter TE. Spatial analytical methods and geographic information systems: use in health research and epidemiology. Epidemiol Rev. 1999;21(2):143-61.  https://doi.org/10.1093/oxfordjournals.epirev.a017993  PMID: 10682254 
  9. Pfeiffer DU, Robinson T, Stevenson M, Stevens KB, Rogers D, Clements AC. Spatial analysis in epidemiology. Oxford: Oxford University Press; 2008.
  10. Bull M, Hall IM, Leach S, Robesyn E. The application of geographic information systems and spatial data during Legionnaires disease outbreak responses. Euro Surveill. 2012;17(49):pii=20331.
  11. Hackert VH, van der Hoek W, Dukers-Muijrers N, de Bruin A, Al Dahouk S, Neubauer H, et al. Q fever: single-point source outbreak with high attack rates and massive numbers of undetected infections across an entire region. Clin Infect Dis. 2012;55(12):1591-9.  https://doi.org/10.1093/cid/cis734  PMID: 22918992 
  12. Guidelines for Investigating Clusters of Health Events. MMWR Recomm Rep. 1990;39(RR-11):1-23. PMID:2117247
  13. Cuzick J, Edwards R. Spatial clustering for inhomogeneous populations. J R Stat Soc.1990;52:73-104.
  14. Kulldorff M. A spatial scan statistic. Commun Stat Theory Methods. 1997;26(6):1481-96.  https://doi.org/10.1080/03610929708831995 
  15. Kulldorff M, Heffernan R, Hartman J, Assunção RM, Mostashari F. A space-time permutation scan statistic for the early detection of disease outbreaks. PLoS Med. 2005;2(3):e59.  https://doi.org/10.1371/journal.pmed.0020059 
  16. Jacquez GM. Disease cluster statistics for space-time interaction. Stat Med. 1996;15(7-9):873-85.  https://doi.org/10.1002/(SICI)1097-0258(19960415)15:7/9<873::AID-SIM256>3.0.CO;2-U  PMID: 8861156 
  17. European Centre for Disease Prevention and Control (ECDC). Outbreak investigations. Stockholm: ECDC. [Accessed: 15 Oct 2014]. Available from: https://wiki.ecdc.europa.eu/fem/w/wiki/outbreak-investigations.aspx
  18. Ulugtekin N, Alkoy S, Seker DZ. Use of a geographic information system in an epidemiological study of measles in Istanbul. J Int Med Res. 2007;35(1):150-4.  https://doi.org/10.1177/147323000703500117  PMID: 17408067 
  19. Barreto ML. The dot map as an epidemiological tool: a case study of Schistosoma mansoni infection in an urban setting. Int J Epidemiol. 1993;22(4):731-41.  https://doi.org/10.1093/ije/22.4.731  PMID: 8225750 
  20. Roquet D, Diallo A, Kodio B, Daff BM, Fenech C, Etard JF. [Cholera epidemic in Senegal in 1995-1996: an example of geographic approach to health]. Sante. 1998;8(6):421-8. French.
  21. Barcellos C, Sabroza PC. Socio-environmental determinants of the leptospirosis outbreak of 1996 in western Rio de Janeiro: a geographical approach. Int J Environ Health Res. 2000;10(4):301-13.  https://doi.org/10.1080/0960312002001500  PMID: 11260779 
  22. Parkinson R, Rajic A, Jenson C. Investigation of an anthrax outbreak in Alberta in 1999 using a geographic information system. Can Vet J. 2003;44(4):315-8. PMID: 12715984 
  23. Rivas AL, Chowell G, Schwager SJ, Fasina FO, Hoogesteijn AL, Smith SD, et al. Lessons from Nigeria: the role of roads in the geo-temporal progression of avian influenza (H5N1) virus. Epidemiol Infect. 2010;138(2):192-8.  https://doi.org/10.1017/S0950268809990495  PMID: 19653927 
  24. Affolabi D, Faïhun F, Sanoussi N, Anyo G, Shamputa IC, Rigouts L, et al. Possible outbreak of streptomycin-resistant Mycobacterium tuberculosis Beijing in Benin. Emerg Infect Dis. 2009;15(7):1123-5.  https://doi.org/10.3201/eid1507.080697  PMID: 19624936 
  25. Roy M, Benedict K, Deak E, Kirby MA, McNiel JT, Sickler CJ, et al. A large community outbreak of blastomycosis in Wisconsin with geographic and ethnic clustering. Clin Infect Dis. 2013;57(5):655-62.  https://doi.org/10.1093/cid/cit366  PMID: 23735332 
  26. Keramarou M, Evans MR,South Wales Legionnaires Disease Outbreak Control Team. A community outbreak of Legionnaires’ disease in South Wales, August-September 2010. Euro Surveill. 2010;15(42):pii=19691. PMID: 21034723 
  27. Bali S, Kar SS, Kumar S, Ratho RK, Dhiman RK, Kumar R. Hepatitis E epidemic with bimodal peak in a town of north India. Indian J Public Health. 2008;52(4):189-93, 99.
  28. Fitzpatrick G, Ward M, Ennis O, Johnson H, Cotter S, Carr MJ, et al. Use of a geographic information system to map cases of measles in real-time during an outbreak in Dublin, Ireland, 2011. Euro Surveill. 2012;17(49):19-29. PMID: 23231894 
  29. Kistemann T, Dangendorf F, Krizek L, Sahl HG, Engelhart S, Exner M. GIS-supported investigation of a nosocomial Salmonella outbreak. Int J Hyg Environ Health. 2000;203(2):117-26.  https://doi.org/10.1078/S1438-4639(04)70016-4  PMID: 11109563 
  30. Sasaki S, Suzuki H, Igarashi K, Tambatamba B, Mulenga P. Spatial analysis of risk factor of cholera outbreak for 2003-2004 in a peri-urban area of Lusaka, Zambia. Am J Trop Med Hyg. 2008;79(3):414-21. PMID: 18784235 
  31. Norström M, Pfeiffer DU, Jarp J. A space-time cluster investigation of an outbreak of acute respiratory disease in Norwegian cattle herds. Prev Vet Med. 1999;47(1-2):107-19.  https://doi.org/10.1016/S0167-5877(00)00159-8  PMID: 11018738 
  32. Nygård K, Werner-Johansen Ø, Rønsen S, Caugant DA, Simonsen Ø, Kanestrøm A, et al. An outbreak of legionnaires disease caused by long-distance spread from an industrial air scrubber in Sarpsborg, Norway. Clin Infect Dis. 2008;46(1):61-9.  https://doi.org/10.1086/524016  PMID: 18171215 
  33. Wallensten A, Moore P, Webster H, Johnson C, van der Burgt G, Pritchard G, et al. Q fever outbreak in Cheltenham, United Kingdom, in 2007 and the use of dispersion modelling to investigate the possibility of airborne spread. Euro Surveill. 2010;15(12):pii=19521. PMID: 20350497 
  34. Le Comber SC, Rossmo DK, Hassan AN, Fuller DO, Beier JC. Geographic profiling as a novel spatial tool for targeting infectious disease control. Int J Health Geogr. 2011;10(1):35.  https://doi.org/10.1186/1476-072X-10-35  PMID: 21592339 
  35. Fèvre EM, Coleman PG, Odiit M, Magona JW, Welburn SC, Woolhouse MEJ. The origins of a new Trypanosoma brucei rhodesiense sleeping sickness outbreak in eastern Uganda. Lancet. 2001;358(9282):625-8.  https://doi.org/10.1016/S0140-6736(01)05778-6  PMID: 11530149 
  36. McKee KT Jr, Shields TM, Jenkins PR, Zenilman JM, Glass GE. Application of a geographic information system to the tracking and control of an outbreak of shigellosis. Clin Infect Dis. 2000;31(3):728-33.  https://doi.org/10.1086/314050  PMID: 11017823 
  37. Knox EG. The detection of space-time interactions. J Appl Stat. 1964;13:24-30.
  38. White PS, Graham FF, Harte DJG, Baker MG, Ambrose CD, Humphrey ARG. Epidemiological investigation of a Legionnaires’ disease outbreak in Christchurch, New Zealand: the value of spatial methods for practical public health. Epidemiol Infect. 2013;141(4):789-99.  https://doi.org/10.1017/S0950268812000994  PMID: 22697112 
  39. Wong BCK, Lee N, Li Y, Chan PKS, Qiu H, Luo Z, et al. Possible role of aerosol transmission in a hospital outbreak of influenza. Clin Infect Dis. 2010;51(10):1176-83.  https://doi.org/10.1086/656743  PMID: 20942655 
  40. Kirrage D, Reynolds G, Smith GE, Olowokure BHereford Legionnaires Outbreak Control Team. Investigation of an outbreak of Legionnaires’ disease: Hereford, UK 2003. Respir Med. 2007;101(8):1639-44.  https://doi.org/10.1016/j.rmed.2006.11.026  PMID: 17513103 
  41. Nygård K, Schimmer B, Søbstad Ø, Walde A, Tveit I, Langeland N, et al. A large community outbreak of waterborne giardiasis-delayed detection in a non-endemic urban area. BMC Public Health. 2006;6(1):141.  https://doi.org/10.1186/1471-2458-6-141  PMID: 16725025 
  42. Gubbels S-M, Kuhn KG, Larsson JT, Adelhardt M, Engberg J, Ingildsen P, et al. A waterborne outbreak with a single clone of Campylobacter jejuni in the Danish town of Køge in May 2010. Scand J Infect Dis. 2012;44(8):586-94.  https://doi.org/10.3109/00365548.2012.655773  PMID: 22385125 
  43. Nisha V, Gad SS, Selvapandian D, Suganya V, Rajagopal V, Suganti P, et al. Geographical information system (GIS) in investigation of an outbreak. J Commun Dis. 2005;37(1):39-43. PMID: 16637399 
  44. Acheson P, McGivern M, Frank P, Kunonga E, Simms I, Tayal S, et al. An ongoing outbreak of heterosexually-acquired syphilis across Teesside, UK. Int J STD AIDS. 2011;22(9):514-6.  https://doi.org/10.1258/ijsa.2011.011008  PMID: 21890548 
  45. Luque Fernández , Mason PR, Gray H, Bauernfeind A, Fesselet JF, Maes P. Descriptive spatial analysis of the cholera epidemic 2008-2009 in Harare, Zimbabwe: a secondary data analysis. Trans R Soc Trop Med Hyg. 2011;105(1):38-45.  https://doi.org/10.1016/j.trstmh.2010.10.001  PMID: 21075411 
  46. Sarkar R, Prabhakar AT, Manickam S, Selvapandian D, Raghava MV, Kang G, et al. Epidemiological investigation of an outbreak of acute diarrhoeal disease using geographic information systems. Trans R Soc Trop Med Hyg. 2007;101(6):587-93.  https://doi.org/10.1016/j.trstmh.2006.11.005  PMID: 17267000 
  47. Hyland JM, Hamlet N, Saunders C, Coppola J, Watt J. Outbreak of Legionnaires’ disease in West Fife: review of environmental guidelines needed. Public Health. 2008;122(1):79-83.  https://doi.org/10.1016/j.puhe.2007.05.005  PMID: 17663011 
  48. Rotela C, Fouque F, Lamfri M, Sabatier P, Introini V, Zaidenberg M, et al. Space-time analysis of the dengue spreading dynamics in the 2004 Tartagal outbreak, Northern Argentina. Acta Trop. 2007;103(1):1-13.  https://doi.org/10.1016/j.actatropica.2007.05.003  PMID: 17603989 
  49. Luquero FJ, Banga CN, Remartínez D, Palma PP, Baron E, Grais RF. Cholera epidemic in Guinea-Bissau (2008): the importance of "place". PLoS ONE. 2011;6(5):e19005.  https://doi.org/10.1371/journal.pone.0019005  PMID: 21572530 
  50. van der Hoek W, van de Kassteele J, Bom B, de Bruin A, Dijkstra F, Schimmer B, et al. Smooth incidence maps give valuable insight into Q fever outbreaks in The Netherlands. Geospat Health. 2012;7(1):127-34.  https://doi.org/10.4081/gh.2012.111  PMID: 23242690 
  51. Davis GS, Sevdalis N, Drumright LN. Spatial and temporal analyses to investigate infectious disease transmission within healthcare settings. J Hosp Infect. 2014;86(4):227-43.  https://doi.org/10.1016/j.jhin.2014.01.010  PMID: 24650720 
  52. European Food Safety Authority (EFSA), European Centre for Disease Prevention and Control (ECDC). The European Union summary report on trends and sources of zoonoses, zoonotic agents and food-borne outbreaks in 2013. EFSA Journal. 2015;13(1):3991. Available from: http://www.efsa.europa.eu/en/efsajournal/pub/3991
  53. Centers for Disease Control and Prevention (CDC). Surveillance for foodborne disease outbreaks, United States, 2012: Annual report. Atlanta: CDC; 2014. Available from: http://www.cdc.gov/foodsafety/pdfs/foodborne-disease-outbreaks-annual-report-2012-508c.pdf
  54. Tanser FC, Le Sueur D. The application of geographical information systems to important public health problems in Africa. Int J Health Geogr. 2002;1:4.  https://doi.org/10.1186/1476-072X-1-4  PMID: 12537589 
  55. Chadee DD, Williams FLR, Kitron UD. Impact of vector control on a dengue fever outbreak in Trinidad, West Indies, in 1998. Trop Med Int Health. 2005;10(8):748-54.  https://doi.org/10.1111/j.1365-3156.2005.01449.x  PMID: 16045461 
  56. Sowmyanarayanan TV, Mukhopadhya A, Gladstone BP, Sarkar R, Kang G. Investigation of a hepatitis A outbreak in children in an urban slum in Vellore, Tamil Nadu, using geographic information systems. Indian J Med Res. 2008;128(1):32-7. PMID: 18820356 
  57. García-Fulgueiras A, Navarro C, Fenoll D, García J, González-Diego P, Jiménez-Buñuales T, et al. Legionnaires’ disease outbreak in Murcia, Spain. Emerg Infect Dis. 2003;9(8):915-21.  https://doi.org/10.3201/eid0908.030337  PMID: 12967487 
  58. Jansà JM, Caylà JA, Ferrer D, Gracia J, Pelaz C, Salvador M, et al. An outbreak of Legionnaires’ disease in an inner city district: importance of the first 24 hours in the investigation. Int J Tuberc Lung Dis. 2002;6(9):831-8. PMID: 12234140 
  59. Carr R, Warren R, Towers L, Bartholomew A, Duggal HV, Rehman Y, et al. Investigating a cluster of Legionnaires’ cases: public health implications. Public Health. 2010;124(6):326-31.  https://doi.org/10.1016/j.puhe.2010.03.001  PMID: 20483439 
  60. Brown CM, Nuorti PJ, Breiman RF, Hathcock AL, Fields BS, Lipman HB, et al. A community outbreak of Legionnaires’ disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. Int J Epidemiol. 1999;28(2):353-9.  https://doi.org/10.1093/ije/28.2.353  PMID: 10342703 
  61. Bhaduri B. Encyclopedia of GIS. New York: Springer; 2008.
  62. Martin D. Directions in Population GIS. Geogr Compass. 2011;5(9):655-65.  https://doi.org/10.1111/j.1749-8198.2011.00440.x 
  63. Nguyen TM, Ilef D, Jarraud S, Rouil L, Campese C, Che D, et al. A community-wide outbreak of legionnaires disease linked to industrial cooling towers--how far can contaminated aerosols spread? J Infect Dis. 2006;193(1):102-11.  https://doi.org/10.1086/498575  PMID: 16323138 
  64. Tango T. A test for spatial disease clustering adjusted for multiple testing. Stat Med. 2000;19(2):191-204.  https://doi.org/10.1002/(SICI)1097-0258(20000130)19:2<191::AID-SIM281>3.0.CO;2-Q  PMID: 10641024 
  65. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med. 2007;45(4):247-51.  https://doi.org/10.1016/j.ypmed.2007.08.012  PMID: 17950122 
  66. Sickweather. Baltimore: Sickweather Inc. [Accessed: 15 Oct 2014]. Available from: http://www.sickweather.com/
  67. Boccia D, Oliver CI, Charlett A, Bennett S, Orr H, Sarangi J, et al. Outbreak of a new Salmonella phage type in South West England: alternative epidemiological investigations are needed. Commun Dis Public Health. 2004;7(4):339-43. PMID: 15779803 
  68. Neira-Munoz E, Okoro C, McCarthy ND. Outbreak of waterborne cryptosporidiosis associated with low oocyst concentrations. Epidemiol Infect. 2007;135(7):1159-64.  https://doi.org/10.1017/S0950268807008503  PMID: 17445321 
  69. Sanson RL, Gloster J, Burgin L. Reanalysis of the start of the UK 1967 to 1968 foot-and-mouth disease epidemic to calculate airborne transmission probabilities. Vet Rec. 2011;169(13):336.  https://doi.org/10.1136/vr.d4401  PMID: 21846685 
  70. Manfredi Selvaggi T, Rezza G, Scagnelli M, Rigoli R, Rassu M, De Lalla F, et al. Investigation of a Q-fever outbreak in northern Italy. Eur J Epidemiol. 1996;12(4):403-8.  https://doi.org/10.1007/BF00145305  PMID: 8891546 
  71. Orsi A, Alicino C, Patria AG, Parodi V, Carloni R, Turello V, et al. Epidemiological and molecular approaches for management of a measles outbreak in Liguria, Italy. J Prev Med Hyg. 2010;51(2):67-72. PMID: 21155408 
  72. Varani S, Cagarelli R, Melchionda F, Attard L, Salvadori C, Finarelli AC, et al. Ongoing outbreak of visceral leishmaniasis in Bologna Province, Italy, November 2012 to May 2013. Euro Surveill. 2013;18(29):20530.  https://doi.org/10.2807/1560-7917.ES2013.18.29.20530  PMID: 23929116 
  73. Abellán JJ, Martínez-Beneito MA, Zurriaga O, Jorques G, Ferrándiz J, López-Quílez A. [Point processes as a tool for analyzing possible sources of contamination]. Gac Sanit. 2002;16(5):445-9. Spanish. PMID: 12372192 
  74. Schimmer B, Ter Schegget R, Wegdam M, Züchner L, de Bruin A, Schneeberger PM, et al. The use of a geographic information system to identify a dairy goat farm as the most likely source of an urban Q-fever outbreak. BMC Infect Dis. 2010;10(1):69.  https://doi.org/10.1186/1471-2334-10-69  PMID: 20230650 
  75. Lai P-c, Kwong K-h. Spatial Analysis of the 2008 Influenza Outbreak of Hong Kong. Computational Science and Its Applications - Iccsa 2010, Pt 1, Proceedings. Lecture Notes in Computer Science. 60162010. p. 374-88.
  76. Lai PC, Wong CM, Hedley AJ, Lo SV, Leung PY, Kong J, et al. Understanding the spatial clustering of severe acute respiratory syndrome (SARS) in Hong Kong. Environ Health Perspect. 2004;112(15):1550-6.  https://doi.org/10.1289/ehp.7117  PMID: 15531441 
  77. Sze-To GN, Chao CYH. Use of risk assessment and likelihood estimation to analyze spatial distribution pattern of respiratory infection cases. Risk Anal. 2011;31(3):351-69.  https://doi.org/10.1111/j.1539-6924.2010.01525.x  PMID: 21039710 
  78. Yu ITS, Wong TW, Chiu YL, Lee N, Li Y. Temporal-spatial analysis of severe acute respiratory syndrome among hospital inpatients. Clin Infect Dis. 2005;40(9):1237-43.  https://doi.org/10.1086/428735  PMID: 15825024 
  79. Saha T, Murhekar M, Hutin YJ, Ramamurthy T. An urban, water-borne outbreak of diarrhoea and shigellosis in a district town in eastern India. Natl Med J India. 2009;22(5):237-9. PMID: 20334044 
  80. Fang L-Q, Li X-L, Liu K, Li Y-J, Yao H-W, Liang S, et al. Mapping spread and risk of avian influenza A (H7N9) in China. Sci Rep. 2013;3:2722.  https://doi.org/10.1038/srep02722  PMID: 24072008 
  81. Liang W, McLaws ML, Liu M, Mi J, Chan DKY. Hindsight: a re-analysis of the severe acute respiratory syndrome outbreak in Beijing. Public Health. 2007;121(10):725-33.  https://doi.org/10.1016/j.puhe.2007.02.023  PMID: 17555781 
  82. Ali M, Wagatsuma Y, Emch M, Breiman RF. Use of a geographic information system for defining spatial risk for dengue transmission in Bangladesh: role for Aedes albopictus in an urban outbreak. Am J Trop Med Hyg. 2003;69(6):634-40. PMID: 14740881 
  83. Tenzin SB, Sharma B, Dhand NK, Timsina N, Ward MP. Reemergence of rabies in Chhukha district, Bhutan, 2008. Emerg Infect Dis. 2010;16(12):1925-30.  https://doi.org/10.3201/eid1612.100958  PMID: 21122223 
  84. Nishiguchi A, Kobayashi S, Ouchi Y, Yamamoto T, Hayama Y, Tsutsui T. Spatial analysis of low pathogenic H5N2 avian influenza outbreaks in Japan in 2005. J Vet Med Sci. 2009;71(7):979-82.  https://doi.org/10.1292/jvms.71.979  PMID: 19652489 
  85. Siddiqui FJ, Bhutto NS, von Seidlein L, Khurram I, Rasool S, Ali M, et al. Consecutive outbreaks of Vibrio cholerae O139 and V. cholerae O1 cholera in a fishing village near Karachi, Pakistan. Trans R Soc Trop Med Hyg. 2006;100(5):476-82.  https://doi.org/10.1016/j.trstmh.2005.07.019  PMID: 16443247 
  86. Miranda ME, Yoshikawa Y, Manalo DL, Calaor AB, Miranda NL, Cho F, et al. Chronological and spatial analysis of the 1996 Ebola Reston virus outbreak in a monkey breeding facility in the Philippines. Exp Anim. 2002;51(2):173-9.
  87. Le H, Poljak Z, Deardon R, Dewey CE. Clustering of and risk factors for the porcine high fever disease in a region of Vietnam. Transbound Emerg Dis. 2012;59(1):49-61.  https://doi.org/10.1111/j.1865-1682.2011.01239.x  PMID: 21722329 
  88. Addiss DG, Davis JP, LaVenture M, Wand PJ, Hutchinson MA, McKinney RM. Community-acquired Legionnaires’ disease associated with a cooling tower: evidence for longer-distance transport of Legionella pneumophila. Am J Epidemiol. 1989;130(3):557-68. PMID: 2764000 
  89. Blondin N, Baumgardner DJ, Moore GE, Glickman LT. Blastomycosis in indoor cats: suburban Chicago, Illinois, USA. Mycopathologia. 2007;163(2):59-66.  https://doi.org/10.1007/s11046-006-0090-1  PMID: 17262169 
  90. Chung WM, Buseman CM, Joyner SN, Hughes SM, Fomby TB, Luby JP, et al. The 2012 West Nile encephalitis epidemic in Dallas, Texas. JAMA. 2013;310(3):297-307.  https://doi.org/10.1001/jama.2013.8267  PMID: 23860988 
  91. Mongoh MN, Dyer NW, Stoltenow CL, Khaitsa ML. Risk factors associated with anthrax outbreak in animals in North Dakota, 2005: a retrospective case-control study. Public Health Rep. 2008;123(3):352-9. PMID: 19006977 
  92. Pfister JR, Archer JR, Hersil S, Boers T, Reed KD, Meece JK, et al. Non-rural point source blastomycosis outbreak near a yard waste collection site. Clin Med Res. 2011;9(2):57-65.  https://doi.org/10.3121/cmr.2010.958  PMID: 20974888 
  93. Bowie WR, King AS, Werker DH, Isaac-Renton JL, Bell A, Eng SB, et al. Outbreak of toxoplasmosis associated with municipal drinking water. Lancet. 1997;350(9072):173-7.  https://doi.org/10.1016/S0140-6736(96)11105-3  PMID: 9250185 
  94. Epp T, Argue C, Waldner C, Berke O. Spatial analysis of an anthrax outbreak in Saskatchewan, 2006. Can Vet J. 2010;51(7):743-8. PMID: 20885827 
  95. Pasma T. Spatial epidemiology of an H3N2 swine influenza outbreak. Can Vet J. 2008;49(2):167-76. PMID: 18309747 
  96. Morrison AC, Getis A, Santiago M, Rigau-Perez JG, Reiter P. Exploratory space-time analysis of reported dengue cases during an outbreak in Florida, Puerto Rico, 1991-1992. Am J Trop Med Hyg. 1998;58(3):287-98. PMID: 9546405 
  97. Chadee DD, Lee R, Ferdinand A, Prabhakar P, Clarke D, Jacob B. Meningococcal meningitis outbreak in Trinidad, 1998. European Journal of General Medicine.2006;3(2):49-53.
  98. Bartels SA, Greenough PG, Tamar M, VanRooyen MJ. Investigation of a cholera outbreak in Ethiopia's Oromiya Region. Disaster med. 2010;4(4):312-7.
  99. Bessong PO, Odiyo JO, Musekene JN, Tessema A. Spatial distribution of diarrhoea and microbial quality of domestic water during an outbreak of diarrhoea in the Tshikuwi community in Venda, South Africa. J Health Popul Nutr. 2009;27(5):652-9.  https://doi.org/10.3329/jhpn.v27i5.3642  PMID: 19902801 
  100. Angulo JJ, Pederneiras CA, Sakuma ME, Takiguti CK, Megale P. Contour mapping of the temporal-spatial progression of a contagious disease. Bull Soc Pathol Exot Filiales. 1979;72(4):374-85. PMID: 535118 
  101. de Moura L, Bahia-Oliveira LMG, Wada MY, Jones JL, Tuboi SH, Carmo EH, et al. Waterborne toxoplasmosis, Brazil, from field to gene. Emerg Infect Dis. 2006;12(2):326-9.  https://doi.org/10.3201/eid1202.041115  PMID: 16494765 
  102. Passos AD, Castro e Silva AA, Ferreira AH, Maria e Silva J, Monteiro ME, Santiago RC. [Rabies epizootic in the urban area of Ribeirão Preto, São Paulo, Brazil]. Cad Saude Publica. 1998;14(4):735-40. Portuguese.  https://doi.org/10.1590/S0102-311X1998000400015  PMID: 9878906 
  103. Rivas AL, Smith SD, Sullivan PJ, Gardner B, Aparicio JP, Hoogesteijn AL, et al. Identification of geographic factors associated with early spread of foot-and-mouth disease. Am J Vet Res. 2003;64(12):1519-27.  https://doi.org/10.2460/ajvr.2003.64.1519  PMID: 14672431 
  104. Firestone SM, Ward MP, Christley RM, Dhand NK. The importance of location in contact networks: Describing early epidemic spread using spatial social network analysis. Prev Vet Med. 2011;102(3):185-95.  https://doi.org/10.1016/j.prevetmed.2011.07.006  PMID: 21852007 
  105. Waldron LS, Ferrari BC, Cheung-Kwok-Sang C, Beggs PJ, Stephens N, Power ML. Molecular epidemiology and spatial distribution of a waterborne cryptosporidiosis outbreak in Australia. Appl Environ Microbiol. 2011;77(21):7766-71.  https://doi.org/10.1128/AEM.00616-11  PMID: 21908623 
  106. Turcios-Ruiz RM, Axelrod P, St John K, Bullitt E, Donahue J, Robinson N, et al. Outbreak of necrotizing enterocolitis caused by norovirus in a neonatal intensive care unit. J Pediatr. 2008;153(3):339-44.  https://doi.org/10.1016/j.jpeds.2008.04.015  PMID: 18534621 

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