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The time to outbreak peak but not the TAR was also sensitive to the number of index cases.
The time to outbreak detection through clinical case finding for a simulated outbreak was calculated for each simulated outbreak as the time between exposure to spores and the first positive blood culture.
Secondly, the expected time to outbreak in herds located in zone 3 was equivalent to that in zone 1, while herds located in zone 3 had the largest residuals and were influential points in the GAMs.
For the larger simulation scenarios, the 14 and 28-day HMMs had significantly greater time to outbreak detection than the EARS C3 and 7 and 14-day NBCs (p < 0.002).
It is unclear why some outbreaks reached clinical awareness and prompted targeted interventions and, given that numerous outbreaks did self-terminate, to what extent such interventions influenced the time to outbreak termination.
To calculate time to outbreak detection through syndromic surveillance, we superimposed the simulated records for respiratory syndrome visits onto the authentic baseline data, beginning on a randomly selected date in 2003, and then applied the outbreak detection algorithm to the combined baseline and simulated data.
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We interviewed staff at MHSs and the RIVM to assess the amount of personnel time related to outbreak response activities (Technical Appendix).
This could reduce the burden on PH departments from following up "unlikely" events and improve PH response times to outbreaks by several days.
Excess respiratory visits (actual – baseline) could be monitored as an indicator of the full influenza burden on ED visits, although this time series is sensitive at times to outbreaks due to other respiratory viruses.
Although several parameters, such as variable run conditions and times, likely preclude application to outbreak events in real time, the revised scheme presented here may be useful for retrospective epidemiologic investigations in which a more specific focus is often placed on a limited number of epidemiologically related isolates (15 ).
An analysis of the global capacity for detecting outbreaks showed improvements in the median time from outbreak start to outbreak discovery between 1996 (29.5 days) and 2009 (13.5 days) and from start to public communication (40 days in 1996 to 19 days in 2009); the WHO Western Pacific Region was the only WHO region that showed a statistically significant improvement in both areas (36 ).
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