A hierarchical model for space–time surveillance data on meningococcal disease incidence

Summary. We describe a model-based approach to analyse space–time surveillance data on meningococcal disease. Such data typically comprise a number of time series of disease counts, each representing a specific geographical area. We propose a hierarchical formulation, where latent parameters capture temporal, seasonal and spatial trends in disease incidence. We then add—for each area—a hidden Markov model to describe potential additional (autoregressive) effects of the number of cases at the previous time point. Different specifications for the functional form of this autoregressive term are compared which involve the number of cases in the same or in neighbouring areas. The two states of the Markov chain can be interpreted as representing an 'endemic' and a 'hyperendemic' state. The methodology is applied to a data set of monthly counts of the incidence of meningococcal disease in the 94 départements of France from 1985 to 1997. Inference is carried out by using Markov chain Monte Carlo simulation techniques in a fully Bayesian framework. We emphasize that a central feature of our model is the possibility of calculating—for each region and each time point—the posterior probability of being in a hyperendemic state, adjusted for global spatial and temporal trends, which we believe is of particular public health interest.