Spatial Epidemiology of Syphilis and Gonorrhea in North Carolina

描述（由申请人提供）：性传播感染（STI）在美国东南部仍然高度流行。与美国其他大部分地区不同，东南部的性传播感染在城市和农村地区都很普遍。控制性传播感染需要将持续不断的努力和疫情爆发期间的快速干预结合起来。以前，性传播感染的空间表现为监测和有针对性的干预提供了有用的信息，同时也提供了有关性传播感染流行病学的重要线索。例如，20多年前描述的地理核心区现象今天仍然是一个重要的概念。尽管性传播感染的空间表示作出了这些重要贡献，但空间统计在性传播感染流行病学中的大多数应用相对初级，而且仅限于城市地区。我们建议使用现代地质统计学方法来开发改进的STI监测方法，并调查传播的核心区域。具体而言，我们的目标是：1）开发和评估一个时空模型，以监测报告的性传播疾病，并在早期阶段识别疫情，以梅毒和淋病为例; 2）描述在一个已知的疫情期间，梅毒发病率和病例密度的空间格局，并将此格局与性网络分析相关联;和3）评估地理核心的概念，或风险空间，在农村和城市地区，并在多个空间尺度上的淋病。为了实现这些目标，我们将使用现有的和常规收集的梅毒和淋病监测数据。我们的主要策略将使用贝叶斯最大熵模型，结合空间和时间数据。我们还将评估其他方法，以确定最有效的战略，评估爆发和空间表示网络结构。我们介绍和评估一个新的空间措施，称为“传输潜力”，它结合了发病率和病例密度方面。我们开发和应用这些空间方法将改善监测程序，并提供一个建模程序，可推广到整个美国使用这些程序将有助于有针对性的干预措施，以减少这些重要疾病的负担。此外，我们将获得有关美国东南部STI流行病学的重要新信息，这是一个这些感染负担不成比例的地区。

DESCRIPTION (provided by applicant): Sexually transmitted infections (STI) remain highly endemic in the southeast United States. Unlike most of the rest of the US, STIs in the southeast are prevalent in both urban and rural areas. Controlling STIs requires a combination of ongoing sustained efforts and rapid intervention during outbreaks. Previously, spatial representations of STI have provided useful information for surveillance and targeted intervention, while simultaneously providing important clues regarding STI epidemiology. For example, geographical core areas, a phenomenon described over 20 years ago, remains an important construct today. Despite these important contributions of spatial representations of STIs, most applications of spatial statistics in STI epidemiology have been relatively rudimentary and based solely in urban areas. We propose to use modern geostatistical methods to develop improved methods of STI surveillance and investigate core areas of transmission. Specifically, our aims are 1 )To develop and evaluate a spatiotemporal model to monitor reported STIs and identify outbreaks at an early stage, using syphilis and gonorrhea as examples; 2) To characterize the spatial pattern of syphilis incidence rates and case densities during a known outbreak extending across two rural counties and to relate this pattern to a sexual network analysis; and 3) To evaluate the concept of geographical core, or risk space, for gonorrhea in rural and urban areas and at multiple spatial scales. To address these aims, we will use existing and routinely collected surveillance data for syphilis and gonorrhea. Our primary strategy will use Bayesian Maximum Entropy models, incorporating both spatial and temporal data. We will also assess other methods to determine the most efficient strategies for evaluating outbreaks and representing network structure spatially. We introduce and evaluate a new spatial measure, termed the "transmission potential", which combines aspects of incidence rate and case density. Our development and application of these spatial methods will improve surveillance procedures and provide a modeling procedure generalizable throughout the U.S. Use of these procedures will facilitate targeted interventions to reduce the burden of these important diseases. Furthermore, we will obtain critical, new information regarding STI epidemiology in southeastern U.S., a region with disproportionate burden of these infections.