The geographic structure of measles epidemics in the northeastern United States

The incidence of disease across geographic space often produces distinctive regional patterns. In this paper, a modeling approach to the identification of the factors that shape the patterns is presented, and a procedure for fitting the model to observed data is given. The methodology is illustrated by an application to the geographic structure of measles epidemics among 22 states of the northeastern United States, New York City, and Washington, D.C., from 1962 to 1988. The patterns identified are interpreted in terms of the spatial behavior of measles epidemics in the region, and the implications of the methodology for surveillance and control are considered.