A distribution-free control charting technique based on change-point analysis for detection of epidemics

Worldwide, the detection of epidemics has been recognized as a continuing problem of crucial importance to public health surveillance. Various approaches for detecting and quantifying epidemics of infectious diseases in the recent literature are directly influenced by methods of Statistical Process Control (SPC). However, implementing SPC quality tools directly to the general health care monitoring problem, in a similar manner as in industrial quality control, is not feasible since many assumptions such as stationarity, known asymptotic distribution etc. are not met. Toward this end, in this paper, some of the open statistical research issues involved in this field are discussed, and a distribution-free control charting technique based on change-point analysis is applied and evaluated for detection of epidemics. The main tool in this methodology is the detection of unusual trends, in the sense that the beginning of an unusual trend marks a switch from a control state to an epidemic state. The in-control and out-of-control performance of the adapted control scheme from SPC is thoroughly investigated using Monte Carlo simulations, and the applied scheme is found to outperform its parametric and nonparametric competitors in many cases. Moreover, the empirical comparative study provides evidence that the adapted change-point detection scheme has several appealing properties compared to the current practice for detection of epidemics.