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Open Access Research article

Epidemic features affecting the performance of outbreak detection algorithms

Jie Kuang1, Wei Zhong Yang2, Ding Lun Zhou1, Zhong Jie Li2 and Ya Jia Lan1*

Author Affiliations

1 Department of Occupational Health, West China School of Public Health, Sichuan University, 17 South Section 3 Renmin Road, Chengdu, Sichuan 610041, China

2 Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention (China CDC), 155 Changbai Road Changping District, Beijing, 102206, China

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BMC Public Health 2012, 12:418  doi:10.1186/1471-2458-12-418

Published: 8 June 2012



Outbreak detection algorithms play an important role in effective automated surveillance. Although many algorithms have been designed to improve the performance of outbreak detection, few published studies have examined how epidemic features of infectious disease impact on the detection performance of algorithms. This study compared the performance of three outbreak detection algorithms stratified by epidemic features of infectious disease and examined the relationship between epidemic features and performance of outbreak detection algorithms.


Exponentially weighted moving average (EWMA), cumulative sum (CUSUM) and moving percentile method (MPM) algorithms were applied. We inserted simulated outbreaks into notifiable infectious disease data in China Infectious Disease Automated-alert and Response System (CIDARS), and compared the performance of the three algorithms with optimized parameters at a fixed false alarm rate of 5% classified by epidemic features of infectious disease. Multiple linear regression was adopted to analyse the relationship of the algorithms’ sensitivity and timeliness with the epidemic features of infectious diseases.


The MPM had better detection performance than EWMA and CUSUM through all simulated outbreaks, with or without stratification by epidemic features (incubation period, baseline counts and outbreak magnitude). The epidemic features were associated with both sensitivity and timeliness. Compared with long incubation, short incubation had lower probability (β* = −0.13, P < 0.001) but needed shorter time to detect outbreaks (β* = −0.57, P < 0.001). Lower baseline counts were associated with higher probability (β* = −0.20, P < 0.001) and longer time (β* = 0.14, P < 0.001). The larger outbreak magnitude was correlated with higher probability (β* = 0.55, P < 0.001) and shorter time (β* = −0.23, P < 0.001).


The results of this study suggest that the MPM is a prior algorithm for outbreak detection and differences of epidemic features in detection performance should be considered in automatic surveillance practice.

Epidemic feature; Outbreak detection algorithms; Performance; Automated infectious disease surveillance