1. Using GIS as a Tool for Investigating Outbreaks Adrienne Dunne CET, HPA East Midlands 15 th May 2007

2. Outline of this mornings session Demo of ESRI ArcGIS software While focusing on work undertaken on Legionnaire’s disease by a student on placement with the HPA EM, during early 2006.

3. ESRI ArcGIS ArcGIS is an integrated collection of GIS software products that allow visualisation, management, creation and analysis of geographic data. There are 3 ArcGIS applications: ArcMap or ArcView - is used for all mapping and editing tasks as well as for map based analysis. * ArcToolbox – is used for data conversion and geoprocessing (integrated into ArcMap) ArcCatalog - is the application for designed for browsing, managing and documenting geographic data. http://www.esriuk.com

4. Overview of ArcView Switch to ArcView for demo

5. ArcView in Layout view

6. ArcView in Data View Zoom features Pan Identify feature

7. Investigating Layer properties In layer properties the transparency and symbology can be set

8. Labels can be added using default settings e.g each feature labelled in same way, although can alter fonts, size etc Or labelling can be defined using the labelling manager and SQL queries. Labels can be converted to annotation and manipulated as graphics.

9. Legionnaires Disease Legionnaires' disease, is a rare form of pneumonia. It takes its name from the first known outbreak which occurred in a hotel that was hosting a convention of the Pennsylvania Department of the American Legion in 1976. Disease is most often contracted by inhaling mist from water sources. Caused by bacteria, that is widely distributed in the environment Disease fatal in 5% to 15% of cases. Source: BBC website

10. Legionnaires Disease – Outbreak Barrow-in-Furness 2002 Multiple deaths linked to leisure centre air conditioning

11. A HPU investigation of Legionnaires in the East Midlands HPU notified of case of Legionnaires (usually via microbiology lab) Patient will be interviewed (HPA or LA) – towards identifying locations the patient had been 2 weeks prior to onset. Particular interest in any contact with water (i.e. plumbing, water features, whirlpool/ spa pools, car washes etc) Environmental Sampling (including the home) The scientific bit (?): Can a source be identified and is there a link to any other case (either current or historic)? Partnership working is important National reporting of data (national and European surveillance)

12. Student Project – Defining the Problem When investigating cases of legionnaires’ HPU staff need to: Access information on potential sources Access current/ historical case information Identify potential sources Identify potentially linked cases

13. Student Project - the Study Pilot project Partnership with one Local Authority – Ashfield DC Collected data on potential sources Collected data on cases

14. Student Project – Data Collection Collection of data- Liaison with Ashfield District Council and Health Protection Unit North Potential sources Case Data

15. Student Project – Mapping and Manipulation of the Data Back to ArcView

16. Adding data Data can be added by dragging and dropping from ArcCatalog Add data button

17. Importing tables from database and adding XY data

18. Using symbology to define data In the layer properties you can define how you want data displayed

19. Using Selection Features Select by location – select potential sources within 500m of a case location

20. Using Selection Features Select by attribute – selection of ‘cooling tower’ sources that are within 500m of a case (using selection on previous slide)

21. Buffering – Using ArcToolbox Single or multiple buffers can be drawn using the Analysis Tools (Proximity) within ArcToolbox. Once completed Arcview will ask if the data is to be added to the map.

22. Clipping and extracting data Using the Analysis Tools (Extract) within ArcToolbox, you can clip features from one layer based on another i.e. extract sources within the created buffer areas

23. Potential Benefits of Using GIS to investigate Outbreaks Stores historical data in one place in an easy to access system. Visual representation of cases and potential sources Allows you to see relationships, patterns, or trends Changes in data are reflected instantly in the GIS No local knowledge is necessary for use Can run queries on the data to aid investigation

24. Considerations in making GIS use a reality Number of cases Co-ordination within the HPA Liaison with local authorities Accuracy of data Security of Information Accessibility

25. The need for GIS Project work has identified that GIS as a useful tool No of cases in East Midlands Aug- Oct 2006

26. The need for GIS Growing interest in the practical use of GIS within HPA/ HPU However, need resources to develop fully. Especially time to keep datasets current. Understanding of what GIS can’t do – not a panacea of all problems! Better than relying on memory (?)

27. Questions? Contact details: Health Protection Agency – East Midlands 29 Bridgford Road West Bridgford Nottingham NG2 6AU T: 0115 981 5675 F: 0115 981 5500 E: cet@hpa.org.uk