Early warning CUSUM plans for surveillance of negative binomial daily disease counts

Automated public health surveillance of disease counts for rapid outbreak, epidemic or bioterrorism detection using conventional control chart methods can be hampered by over-dispersion and background ('in-control') mean counts that vary over time. An adaptive cumulative sum (CUSUM) plan is developed for signalling unusually high incidence in prospectively monitored time series of over-dispersed daily disease counts with a non-homogeneous mean. Negative binomial transitional regression is used to prospectively model background counts and provide 'one-step-ahead' forecasts of the next day's count. A CUSUM plan then accumulates departures of observed counts from an offset (reference value) that is dynamically updated using the modelled forecasts. The CUSUM signals whenever the accumulated departures exceed a threshold. The amount of memory of past observations retained by the CUSUM plan is determined by the offset value; a smaller offset retains more memory and is efficient at detecting smaller shifts. Our approach optimises early outbreak detection by dynamically adjusting the offset value. We demonstrate the practical application of the 'optimal' CUSUM plans to daily counts of laboratory-notified influenza and Ross River virus diagnoses, with particular emphasis on the steady-state situation (i.e. changes that occur after the CUSUM statistic has run through several in-control counts).