Predicting the Unpredictable: Monitoring Meningitis Using GIS
by Everleigh Stokes
“FR:PSUTXT SUB:Upark alert MSG: Direct evacuation now in effect. Imminent threat of
meningitis. For more info visit live.psu.edu” It’s a frigid winter day and over 35,000 cell phones
simultaneously vibrate with the above message. What would campus be like if all undergraduate students,
graduate students, and employees stayed at home? How would such a large, research focused University
function with all classes and all exams administered online? Happy Valley would become Ghost Valley
as the dining halls remained empty, the classrooms dark, the dormitories silent, and the offices closed.
While this scenario may be hard for some to imagine it is not entirely impossible. After analyzing and
synthesizing multiple documents related to crisis management for Penn State, such as the University
Comprehensive Emergency Management Plan and The Office of Environmental Health and Safety
Emergency Management Templates, it is feasible that if an outbreak of meningitis ever occurred the
entire campus could be shut down and evacuated.
Is there a way to prevent such a crisis? I found my answer through a trip around the world this
past summer as a member of The Center for Advancement of Undergraduate Studies and Experience
(CAUSE) class. The overall goal of the course was to explore the initiatives of different national mapping
agencies while at the same time conduct individual research projects on topics such as gecko habitat
rehabilitation, renewable energy, efficient urban planning, and animal conservation across borders. With a
personal interest in medical geography, I wanted to more specifically research ways in which geographic
information systems (GIS) can be used for disease tracking in an effort to minimize the deadly impact of
epidemics. I found an example of such software at the University of Wurzburg in Germany. After a day of
lectures, lab tours, and personal interviews with the developers and designers of
the program, I saw how GIS could be used as a tool to visualize, synthesize, and spatially analyze disease
data in an effort to prevent an outbreak of meningitis.
According to the Center for Disease Control (CDC) Health Alert Update published in December
of 2012, 620 individuals were diagnosed with symptoms of meningitis last year in the United States and
39 individuals died from the disease. Below is a graph from the CDC, which illustrates the incidence of
meningitis per 100,000 people from 1979- 2009:
www.cdc.gov
As supported by the graph, the disease is known for its sporadic but intense outbreaks. The number of
cases of meningitis fluctuates dramatically over time thanks to variance in the genetics of the disease,
social networks and travel, and climate changes. Fortunately, there has been a steady decrease in
incidence number since 2004 when a new vaccine was introduced to the market.
However, our communities should not grow complacent or be fooled by this recent trend.
According to the CDC meningitis “continues to cause substantial morbidity and mortality in the United
States.” Meningitis remains a constant threat because of its inherent characteristics of adaptability and
variation; the disease can incorporate new DNA sequences once inside a host or simply recombine its
original DNA, making it difficult to design treatment procedures or vaccinations. During my experience
abroad I spoke with Johannes Elias, the head microbiologist at the University of Wurzburg, who
explained the intricacies of the disease. As the bacteria flourish inside our warm bodies they cause
infection and inflammation within the tissue surrounding the spinal cord and brain, prompting severe
stiffness, headache, and fever. The bacteria also damage the walls of our blood vessels, causing excessive
bleeding into the skin and organs. Death can occur within hours. He explained that meningitis bacteria
already live in the throat of 10% of the world’s population and therefore commonly spread through mouth
droplets or kissing. The infection is most common in infants and college student populations, which is
why trends and clusters tend to be located within schools and families. Based on these characteristics,
University Park, and all commonwealth campuses, present ideal breeding grounds.
Recognizing the intense risk and sporadic nature of meningitis, Dr. Johannes Elias and graduate
student Markus Reindhart designed a GIS based tracking system called EpiScanGIS, which was launched
in 2006. The main purpose of this system was twofold. First, it was created to increase public
accessibility, providing a way for everyone, not just medical professionals, to become aware of case
occurrences. The system is based on data contributions from over 80 registered medical professionals in
the country and serves as the main database or collection station for every single case of meningitis
reported across the 400 counties in Germany. As of December 2011 more than 4,000 cases of invasive
meningitis disease were stored in the database. The second purpose of the program was to provide
warning. With timely information on meningitis occurrences health officials can detect and identify
possible risk areas and therefore implement more targeted preventative measures.
Germany is on the cutting edge of disease tracking because they have harnessed the power of
GIS. According to epidemiologists at the United States Federal Institute for Virus Disease of Animals
“EpiScanGIS serves as a model for future GIS applications in infectious disease control.” By using GIS,
the EpiScanGIS online interface allows for more complex levels of visualization. The disease data can be
combined with other layers of interest such as location of major city, state and county boundaries, and
population density. GIS allows the user to pan and zoom around areas of interest, ultimately creating a
map they could print and use for specific goals. By combining different layers hidden relationships can be
revealed and trends are better communicated. Instead of just placing a dot on a map for each case, the dot
becomes more relevant and part of a larger story. Is there a county that continuously has high rates of
infection surrounded by counties with low infection rates? Is there a densely populated area around a
major city that has a high number of reported cases? The ability to visualize the disease data with multiple
layers reveals trends and insights that cannot be gathered through mere interpretation of a data table.
The use of GIS technology also allows for more thorough data integration and spatial analysis.
Where are the cases happening? What strand is causing each case? How do the case locations change over
time? Through the use of GIS the online interface allows the data to be displayed using animation through
time, which can help demonstrate answers to these questions. In addition, using GIS allows each case to
remain connected to unique non-spatial attributes of the individual such as age, gender, and date of
infection. This allows the doctors to go beyond simple geographic queries and the screen the data for nonspatial similarities. The doctors set parameters or rules for the system to test based on predetermined
thresholds for outbreaks. For example, one rule might direct the system to flag any cases within a certain
age group that occur within three miles of each other. When the other rules are added, it is possible to
detect severe or high threat cases. This helps the doctors differentiate between potential outbreak areas
and random cases.
The system was first developed in 2006 and continues to screen incoming data every week. From
the EpiScan system doctors at the University of Wurzburg now make more informed decisions about
where to distribute vaccinations. They have also been able to design new vaccinations. Markus Reindhart
and Dr. Elias both agreed that these improvements in meningitis care and prevention could not have been
made without a GIS tracking system. The way the system streamlines and maintains countrywide data
while at the same time displaying it in a simple, efficient way has helped to keep Germany protected from
a meningitis epidemic.
Germany is combining disease data and analytical mapping and it’s working. Their efforts
illustrate that by using GIS technology as a tool we can more efficiently study the spread of disease,
investigate the factors that support or prevent an outbreak, and design potential preventive strategies.
While washing our hands or receiving vaccinations may seem like the only available preventative
strategies, Penn State University should learn from the University of Wurzburg and implement campus
specific, GIS based disease tracking programs that visualize, synthesize, and spatially analyze data from
University Health Services and the local hospitals. Adding this type of system would create more
proactive, not reactive, strategies for the
Emergency Management Plan while at the same time arming our community against the threat of
widespread infection. Hopefully, through the continued development of systems such as EpiScanGIS and
parallel programs, medical geographers can work to predict the unpredictable, silence our cell phones,
and ultimately keep the ghosts out of Happy Valley.