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Lance A. Waller

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Department of Biostatistics and Bioinformatics Rollins School of Public Health Emory University
27 April 2017 from 4:00 PM to 5:00 PM
201 Thomas Building
Contact Name
Lorey Burghard
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We explore a Netherlands outbreak of Q fever in 2009 by combining a human

dose–response model with geostatistics to predict local probability of infection,

associated probability of illness, and local effective exposures to Coxiella burnetii. We

begin with the spatial distribution of 220 notified cases in the at–risk population. Next,

we use the dose-response relationship (established via historical experiments) to

convert the observed risk map into an estimated smooth spatial field of local dose.

Based on the observed symptomatic cases, the dose–response model predicts a

median of 611 asymptomatic infections (95% range 410 to 1,084), i.e., 2.78 (95% range

1.86 to 4.93) asymptomatic infections for each reported case. The estimated peak levels

of exposure extend to the north–east from the point source with an increasing proportion

of asymptomatic infections further from the source. Our work combines established

methodology from model-based geostatistics and dose-response modeling providing a

novel approach to study outbreaks. Such predictions (and associated uncertainties) are

important for targeting interventions during an outbreak, estimating future disease

burden, and planning public health response.


Joint work with R. John Brooke, St. Jude Children’s Research Hospital, Memphis TN


Peter FM Teunis, Centre for Infectious Disease Control, RIVM

Bilthoven, the Netherlands


Mirjam EE Kretzschmar

Julius Center for Health Sciences and Primary Care

University Medical Center Utrecht

Utrecht, the Netherlands


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