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CDC recently endorsed the use of simulated outbreaks to address the dearth of outbreak data (11 ), but existing simulation studies have not compared detection through clinical case finding with syndromic surveillance (12 – 12 ).
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The number of simulated outbreaks used to evaluate the algorithms for the four scenarios was then 64, 62, 95 and 93 for the small less clustered, small more clustered, large less clustered and large more clustered scenarios respectively.
Third, as only using two-year test datasets, we inserted a limited number of simulated outbreaks, which, to some extent, may affect the stability of the evaluation.
The fitted autoregressive model was used to simulate synthetic dengue outbreaks over multiple decades, and incidence of simulated outbreaks was compared with observed incidence.
By varying independent parameters of simulated outbreaks, we have demonstrated empirically the limits of detection of different types of outbreaks.
Since the historical dataset used here was devoid of any known outbreaks and there is a paucity of data available on actual germ warfare attacks [ 11], we introduced a set of simulated outbreaks into the historical visit data by adding a certain number of simulated visits to specified days.
Syndromic surveillance detected an inhalation anthrax outbreak before the first clinical case was diagnosed in as many as half of simulated outbreaks.
While previous studies inserted the actual counts with fixed outbreak case numbers, our study inserted the actual counts with outbreak case numbers based on the proportion of case distribution of simulated outbreaks.
To optimize a surveillance system's ability to catch outbreaks, a study design that tests the in silico surveillance system against a variety of simulated outbreaks and outbreak detection algorithms could be conducted.
We demonstrate the efficacy of the design approach on simulated outbreaks of pandemic influenza with different levels of virus transmissibility.
We used simulated outbreaks to describe and compare algorithm performance.
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