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Chaidate Inchaisri
  Department of veterinary Medicine
    Faculty of Veterinary Science
       Chulalongkorn university
E-mail address: Chaidate@hotmail.com
Field epidemiology
• “A primary goal of field epidemiology is to
  inform, as quickly as possible, the processes of
  selecting and implementing interventions to
  lessen or prevent illness or death when such
  problems arise” (Goodman and Buehler, 2008)
• An emergic diseases
  – Require quick response diagnosis and
    managements
Disease control in endemic areas
• How to reduce and prevent the spread of infection?
• How to reduce disease loss?
• Do we need to eradicate or to live with disease?
• In long term, is it possible to eradicate that disease in
  some areas?
• If yes, How to do it?
     – Epidemiological study
        • Host, agent, environment and transmission
     – Difference locations, farms
     – Difference strategies
Epidemiological procedure
• Identify problems
• Study designs
• Explore for visualization
• Find risk factors, associations between factors,
  causes
• Evaluate the effect on production (animal
  performance)
• Evaluate the effect on economics and social
• Give priority and make decision
The epidemiological techniques
                    Multivariable
                      analysis




                    Veterinary      Tempo-spatial
      Simulation
                                     and network
        model      epidemiology        analysis




                     Economics
32.96                                                                                           18                         16.08
                                                      36                                                                                                                                         14.74




                                                                                                                              Percent of positive farms
                                                                               (n=91)                                                                                                                     (n=286)
Percent of positive farms
                                                      32                                                                                                                        16              (n=217)
                                                      28                                                                                                                        14                                                           10.76
                                                      24                                                                                                                        12                                                          (n=223)
                                                      20                                                 13.08      13.79                                                       10
                                                                                                                                                                                      6.11
                                                      16                                      11.11     (n=107)    (n=116)                                                       8
                                                                                             (n=117)                                                                                 (n=229)
                                                      12                                                                                                                         6
                                                       8              2.24                                                                                                       4                                       1.18
                                                                                                                                                                                                                                    0.49
                                                             0       (n=89)                                                                                                                                            (n=253)
                                                       4   (n=38)                                                                                                                2                                                (n=204)
                                                       0                                                                                                                         0
                                                           2549       2550      2551          2552       2553       2554                                                             2549        2550      2551         2552       2553      2554
                                                      18                                                                                                                        18




                                                                                                                              Percent of positive farms Percent of positive farms
Percent of positive farms Percent of positive farms




                                                      16                        สุพรรณบุรี                                                                                      16                          ราชบุรี
                                                      14                                                                                                                        14
                                                      12                                                                                                                        12                8.73
                                                      10                                                                                                                        10              (n=206)                                       7.14
                                                                                                                     6.45                                                                                                                   (n=224)
                                                       8                                                           (n=341)
                                                                                                                                                                                 8
                                                       6               3.1                                                                                                       6
                                                            1.67     (n=483)     1.76                                                                                            4    1.38                                          0.89
                                                       4                       (n=452)         0.31       0.3                                                                        (n=217)
                                                                                                                                                                                                            0.47         0.35
                                                       2
                                                           (n=179)                                                                                                               2                        (n=209)      (n=280)    (n=224)
                                                                                             (n=314)    (n=329)
                                                       0                                                                                                                         0
                                                      18   2549       2550      2551          2552       2553       2554                                                        18    2549       2550      2551         2552       2553      2554
                                                      16                                                                                                                        16
                                                      14                        กาญจนบุรี                                                                                       14                11.68     เพชรบุรี
                                                                                                                                                                                                 (n=77)
                                                      12                                                                                                                        12
                                                      10                                                                                                                        10                                        6.28                6.53
                                                                                                                                                                                                                                    6.04
                                                       8                                                                                                                         8                                      (n=175)   (n=149)   (n=152)
                                                       6               2.23
                                                                                                                                                                                 6
                                                                                                                      1.81                                                             1.85
                                                       4    0.36     (n=760)      0.98
                                                                                                0.32       0.13     (n=827)
                                                                                                                                                                                 4    (n=103)
                                                                                                                                                                                                             1.28
                                                                                (n=813)                                                                                                                    (n=156)
                                                       2   (n=548)                            (n=913)    (n=760)                                                                 2
                                                       0                                                                                                                         0
                                                            2549      2550       2551           2552      2553       2554                                                              2549       2550      2551         2552       2553      2554
                                                                               ประจวบคีรีขนธ์
                                                                                          ั                                                                                                                 นครปฐม (Panumas et al., 2554)
Percent of serum positive per flock
                            30

                                            n=2-8
                            25
Percent of positive goats




                            20


                            15
                                                        n=7-9
                                                                n=52-87

                            10                                                            n=7-12                     n=25-32             n=13-17
                                                                                                       n=16-19                 n=28-39
                             5
                                 n =40-46

                             0
                                  A         B       C    D        E        F       G      H        I     J       K     L         M         N       O   P
                                                                                   Farm (n=2-112 per farm)

                                                                          เมษายน         ิ
                                                                                        สงหาคม         ธันวาคม


                                                                                                                      (Panumas et al., 2554)
DLD strategy
• Test and slaughter
  – A serum positive goat by a serial test of ELISA and
    complement fixation test (CFT) is eradicated.
  – For a positive farm, all goats are retested until no
    more positive results in the herd (a negative farm
    at level B).
  – After 6 months, a goat farm is declared to be free
    from brucellosis at the level A when all goats in
    flocks level B are negative for the sequence tests.
The structure of model for one time step
                               Kid death
       Kidding
                               Sales              •       Closed flock
                          Service per            •       Constant flock size
                           pregnancy
                                                  •       Contact transmission rate???
                          Abortion


       Flock size       •Population structure
                                                            Negative
                        •Prevalence
                                                           serum test

                             Test          •Sensitivity
                                           •Specificity

                                                              •Positive serum test
                                                Culling       •Old goat, death
                                                              •Sales




   Monte Carlo Stochastic-dynamics Approach
Parameters                    Default
   Input data used for         Flock size                    Lognorm(27,32)
  the simulation model         Prevalence                    RiskUniform(0.01,0.5)
                               Sensitivity
                               ELISA                         RiskUniform(0.87,0.89)
                               CFT                           RiskUniform(0.79,0.82)
                               Specificity
                               ELISA                         RiskUniform(0.84,0.99)
                               CFT                           RiskUniform(0.87,1)
                               Contact number per month      RiskPoisson(10,
                                                             RiskTruncate(1,30))
                               Transmission per contact      RiskUniform(0.0005,0.001)

                               Transmission per service      RiskUniform(0.4,1)

                               Ratio female per male         RiskTriang(1,1,38.2)

                               Number services per pregnancy RiskNormal(1.7, 0.9),
                                                             RiskTruncate(1,3)
                               Litter size                   RiskNormal(1.2,0.4),
                                                             RiskTruncate(1,4)
                               Kidding per year              RiskNormal(1.34,10),
                                                             RiskTruncate(1,2)
                               Abortion rate                 RiskNormal(0.03,0.03),
                                                             RiskTruncate(0,0.5)
                               Kid death rate                RiskNormal(0.13,0.03),
                                                             RiskTruncate(0.07,0.2)
Program interval 1-12 months   Adult death rate              RiskUniform(0.05,0.15)
No strategy to control disease
                                                               Stochastic default values (10,000 flocks)
                                  60




                                  50
Percent of 100% positive flocks




                                  40




                                  30




                                  20




                                  10




                                   0
                                       0   12   24   36   48   60   72   84   96   108   120   132   144   156   168   180   192   204   216   228   240
                                                                                     Months
Percent of successive flocks in eradication
     program with uncertain inputs
                                                    Stochastic default values (10,000 flocks)
                                  70


                                  60
   Percent of successive flocks
     in eradication program




                                  50


                                  40


                                  30


                                  20


                                  10


                                   0
                                       0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 192 204 216 228 240
                                                                   Months
99    99            98   98
                                                     100                                               95   95




Percent of successive flocks in eradiation program
                                                       90

                                                       80

                 within one year                       70

                                                       60

                                                       50

                                                       40

                                                       30

                                                       20

                                                       10

                                                        0
                                                                       1                  3                 6
                                                                      Eradication Program Interval (months)
                                                     Perfect specificity     Average specificity   Poor specificity
Increase transmission per contact




                Within 1 year


     Eradication program interval = 3 months
Network between flocks with the size of node represents the value of degree centrality with positive
flock (red circle) and negative flock (blue circle). The box node represents the flocks without knowing
disease status.
Conclusions
• The important of animal movements on spreading of
  disease and the specificity of diagnostic test in
  eradication program
• Add other strategies
   – Add other methods or technologies to control animal
     movement
   – Simultaneous test and slaughter program with animal
     movement control
   – Establish the goat farmer community to reduce
     uncontrollable movements between provinces
   – Quarantine farms
   – Improve the specificity of diagnostic test
   – When the prevalence at flock level is very low and the
     specificity of diagnostic test is poor, consider culling
     positive flocks.
Further studies
• Do more research in other areas
• Production structure, production chain, value
  chain
• Evaluate the success of other strategis
• Evaluate the economical benefit of other
  programs
GISTA (Geo-Informatics and Space Technology Development Agency)
สำนักงำนพัฒนำเทคโนโลยีอวกำศและภูมิสำรสนเทศ (องค์ กำรมหำชน)
90
เปอร์เซ๊นต์ของพืนทีทได้ร ับผลกระทบจากปัญหาอุทกภ ัย




                                                     80    อ.ชุมแสง
                                                           อ.เก ้าเลียว
                                                                     ้
                                                     70
                                                           อ.ท่าตะโก
                                                     60    อ.โกรกพระ
                                                           อ.เมืองนครสวรรค์
                                                     50
                                                                     ั
                                                           อ.บรรพตพิสย

                                                     40    อ.พยุหะคีรี
                                                           อ.ตาคลี
                                                     30
                                                           อ.หนองบัว
                ้ ่ ี่




                                                     20    อ.ลาดยาว
                                                           อ.แม่วงก์
                                                     10    อ.ไพศาลี
                                                           กิงอ.แม่เปิ น
                                                             ่
                                                      0
                                                           กิงอ.ชุมตาบง
                                                             ่
                                                     -10   อ.ตากฟ้ า
65%

38%
                         82%




                                     51%




      30%



       40%


               53%
                                     78%


             49%
                                     69%


                   73%
                               71%
Representation of location and size of significant clustered areas for poultry farming loss per square
kilometer. The degree of loss is indicated by the intensity of color (high intensity 0 high color)
Representation of location and size of significant clustered areas for swine farming loss per square kilometer. The degree
of loss is indicated by the intensity of color (high intensity 0 high color)
Conclusions
• Cluster mapping reveals the area with high
  risk in farming loss due to the flooding
• This helps planners to assess spatial risk
  factors, and to ascertain what would be the
  most suitable types of livestock farming and
  which period should be avoided for the
  livestock farming
Farm        DLD




University    Vet




  Society
ปั ญหำ???

วำงแผน ออกแบบกำรศึกษำและกำรวิเครำะห์ ปัญหำ
ร่ วมมือ ร่ วมใจ
บริกำรสังคม
เรี ยนรู้ ชุมชน
ศึกษำ วิจัยภำคสนำม
รวบรวมข้ อมูล
วิเครำะห์ ข้อมูล
นำเสนอรูปแบบกำรแก้ ปัญหำ
  ถ่ ำยทอดควำมรู้ส่ ูชุมชน
Thank you

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The use of epidemiology to support decision making

  • 1. Chaidate Inchaisri Department of veterinary Medicine Faculty of Veterinary Science Chulalongkorn university E-mail address: Chaidate@hotmail.com
  • 2. Field epidemiology • “A primary goal of field epidemiology is to inform, as quickly as possible, the processes of selecting and implementing interventions to lessen or prevent illness or death when such problems arise” (Goodman and Buehler, 2008) • An emergic diseases – Require quick response diagnosis and managements
  • 3. Disease control in endemic areas • How to reduce and prevent the spread of infection? • How to reduce disease loss? • Do we need to eradicate or to live with disease? • In long term, is it possible to eradicate that disease in some areas? • If yes, How to do it? – Epidemiological study • Host, agent, environment and transmission – Difference locations, farms – Difference strategies
  • 4. Epidemiological procedure • Identify problems • Study designs • Explore for visualization • Find risk factors, associations between factors, causes • Evaluate the effect on production (animal performance) • Evaluate the effect on economics and social • Give priority and make decision
  • 5. The epidemiological techniques Multivariable analysis Veterinary Tempo-spatial Simulation and network model epidemiology analysis Economics
  • 6.
  • 7. 32.96 18 16.08 36 14.74 Percent of positive farms (n=91) (n=286) Percent of positive farms 32 16 (n=217) 28 14 10.76 24 12 (n=223) 20 13.08 13.79 10 6.11 16 11.11 (n=107) (n=116) 8 (n=117) (n=229) 12 6 8 2.24 4 1.18 0.49 0 (n=89) (n=253) 4 (n=38) 2 (n=204) 0 0 2549 2550 2551 2552 2553 2554 2549 2550 2551 2552 2553 2554 18 18 Percent of positive farms Percent of positive farms Percent of positive farms Percent of positive farms 16 สุพรรณบุรี 16 ราชบุรี 14 14 12 12 8.73 10 10 (n=206) 7.14 6.45 (n=224) 8 (n=341) 8 6 3.1 6 1.67 (n=483) 1.76 4 1.38 0.89 4 (n=452) 0.31 0.3 (n=217) 0.47 0.35 2 (n=179) 2 (n=209) (n=280) (n=224) (n=314) (n=329) 0 0 18 2549 2550 2551 2552 2553 2554 18 2549 2550 2551 2552 2553 2554 16 16 14 กาญจนบุรี 14 11.68 เพชรบุรี (n=77) 12 12 10 10 6.28 6.53 6.04 8 8 (n=175) (n=149) (n=152) 6 2.23 6 1.81 1.85 4 0.36 (n=760) 0.98 0.32 0.13 (n=827) 4 (n=103) 1.28 (n=813) (n=156) 2 (n=548) (n=913) (n=760) 2 0 0 2549 2550 2551 2552 2553 2554 2549 2550 2551 2552 2553 2554 ประจวบคีรีขนธ์ ั นครปฐม (Panumas et al., 2554)
  • 8. Percent of serum positive per flock 30 n=2-8 25 Percent of positive goats 20 15 n=7-9 n=52-87 10 n=7-12 n=25-32 n=13-17 n=16-19 n=28-39 5 n =40-46 0 A B C D E F G H I J K L M N O P Farm (n=2-112 per farm) เมษายน ิ สงหาคม ธันวาคม (Panumas et al., 2554)
  • 9. DLD strategy • Test and slaughter – A serum positive goat by a serial test of ELISA and complement fixation test (CFT) is eradicated. – For a positive farm, all goats are retested until no more positive results in the herd (a negative farm at level B). – After 6 months, a goat farm is declared to be free from brucellosis at the level A when all goats in flocks level B are negative for the sequence tests.
  • 10. The structure of model for one time step Kid death Kidding Sales • Closed flock  Service per • Constant flock size pregnancy • Contact transmission rate???  Abortion Flock size •Population structure Negative •Prevalence serum test Test •Sensitivity •Specificity •Positive serum test Culling •Old goat, death •Sales Monte Carlo Stochastic-dynamics Approach
  • 11. Parameters Default Input data used for Flock size Lognorm(27,32) the simulation model Prevalence RiskUniform(0.01,0.5) Sensitivity ELISA RiskUniform(0.87,0.89) CFT RiskUniform(0.79,0.82) Specificity ELISA RiskUniform(0.84,0.99) CFT RiskUniform(0.87,1) Contact number per month RiskPoisson(10, RiskTruncate(1,30)) Transmission per contact RiskUniform(0.0005,0.001) Transmission per service RiskUniform(0.4,1) Ratio female per male RiskTriang(1,1,38.2) Number services per pregnancy RiskNormal(1.7, 0.9), RiskTruncate(1,3) Litter size RiskNormal(1.2,0.4), RiskTruncate(1,4) Kidding per year RiskNormal(1.34,10), RiskTruncate(1,2) Abortion rate RiskNormal(0.03,0.03), RiskTruncate(0,0.5) Kid death rate RiskNormal(0.13,0.03), RiskTruncate(0.07,0.2) Program interval 1-12 months Adult death rate RiskUniform(0.05,0.15)
  • 12. No strategy to control disease Stochastic default values (10,000 flocks) 60 50 Percent of 100% positive flocks 40 30 20 10 0 0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 192 204 216 228 240 Months
  • 13. Percent of successive flocks in eradication program with uncertain inputs Stochastic default values (10,000 flocks) 70 60 Percent of successive flocks in eradication program 50 40 30 20 10 0 0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 180 192 204 216 228 240 Months
  • 14.
  • 15. 99 99 98 98 100 95 95 Percent of successive flocks in eradiation program 90 80 within one year 70 60 50 40 30 20 10 0 1 3 6 Eradication Program Interval (months) Perfect specificity Average specificity Poor specificity
  • 16. Increase transmission per contact Within 1 year Eradication program interval = 3 months
  • 17.
  • 18.
  • 19.
  • 20. Network between flocks with the size of node represents the value of degree centrality with positive flock (red circle) and negative flock (blue circle). The box node represents the flocks without knowing disease status.
  • 21. Conclusions • The important of animal movements on spreading of disease and the specificity of diagnostic test in eradication program • Add other strategies – Add other methods or technologies to control animal movement – Simultaneous test and slaughter program with animal movement control – Establish the goat farmer community to reduce uncontrollable movements between provinces – Quarantine farms – Improve the specificity of diagnostic test – When the prevalence at flock level is very low and the specificity of diagnostic test is poor, consider culling positive flocks.
  • 22. Further studies • Do more research in other areas • Production structure, production chain, value chain • Evaluate the success of other strategis • Evaluate the economical benefit of other programs
  • 23.
  • 24. GISTA (Geo-Informatics and Space Technology Development Agency) สำนักงำนพัฒนำเทคโนโลยีอวกำศและภูมิสำรสนเทศ (องค์ กำรมหำชน)
  • 25.
  • 26.
  • 27.
  • 28. 90 เปอร์เซ๊นต์ของพืนทีทได้ร ับผลกระทบจากปัญหาอุทกภ ัย 80 อ.ชุมแสง อ.เก ้าเลียว ้ 70 อ.ท่าตะโก 60 อ.โกรกพระ อ.เมืองนครสวรรค์ 50 ั อ.บรรพตพิสย 40 อ.พยุหะคีรี อ.ตาคลี 30 อ.หนองบัว ้ ่ ี่ 20 อ.ลาดยาว อ.แม่วงก์ 10 อ.ไพศาลี กิงอ.แม่เปิ น ่ 0 กิงอ.ชุมตาบง ่ -10 อ.ตากฟ้ า
  • 29. 65% 38% 82% 51% 30% 40% 53% 78% 49% 69% 73% 71%
  • 30.
  • 31. Representation of location and size of significant clustered areas for poultry farming loss per square kilometer. The degree of loss is indicated by the intensity of color (high intensity 0 high color)
  • 32. Representation of location and size of significant clustered areas for swine farming loss per square kilometer. The degree of loss is indicated by the intensity of color (high intensity 0 high color)
  • 33. Conclusions • Cluster mapping reveals the area with high risk in farming loss due to the flooding • This helps planners to assess spatial risk factors, and to ascertain what would be the most suitable types of livestock farming and which period should be avoided for the livestock farming
  • 34. Farm DLD University Vet Society