Liane Ramac-Thomas

This paper describes the problem of public health monitoring for waterborne disease outbreaks using disparate evidence from health surveillance data streams and environmental sensors. We present a combined monitoring approach along with examples from a recent project at the Johns Hopkins University Applied Physics Laboratory in collaboration with the U.S. Environmental Protection Agency. The project objective was to build a module for the Electronic Surveillance System for the Early Notification of Community-based Epidemics (ESSENCE) to include water quality data with health indicator data for the early detection of waterborne disease outbreaks. The basic question in the fused surveillance application is 'What is the likelihood of the public health threat of interest given recent information from available sources of evidence?' For a scientific perspective, we formulate this question in terms of the estimation of positive predictive value customary in classical epidemiology, and we present a solution framework using Bayesian Networks (BN). An overview of the BN approach presents advantages, disadvantages, and required adaptations needed for a fused surveillance capability that is scalable and robust relative to the practical data environment. In the BN project, we built a top-level health/water-quality fusion BN informed by separate waterborne-disease-related networks for the detection of water contamination and human health effects. Elements of the art of developing networks appropriate to this environment are discussed with examples. Results of applying these networks to a simulated contamination scenario are presented.