Identifying outbreak risk factors through case-controls comparisons

Abstract Outbreaks are typically investigated using approaches that aim to identify place- and context-dependent causative factors. As the focus is on understanding the basis of a specific outbreak, the resulting narratives are rarely suitable for forecasting risk or developing generalizable predict...

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Main Authors: Nina H. Fefferman, Michael J. Blum, Lydia Bourouiba, Nathaniel L. Gibson, Qiang He, Debra L. Miller, Monica Papeș, Dana K. Pasquale, Connor Verheyen, Sadie J. Ryan
Format: Article
Language:English
Published: Nature Portfolio 2025-05-01
Series:Communications Medicine
Online Access:https://doi.org/10.1038/s43856-025-00916-5
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author Nina H. Fefferman
Michael J. Blum
Lydia Bourouiba
Nathaniel L. Gibson
Qiang He
Debra L. Miller
Monica Papeș
Dana K. Pasquale
Connor Verheyen
Sadie J. Ryan
author_facet Nina H. Fefferman
Michael J. Blum
Lydia Bourouiba
Nathaniel L. Gibson
Qiang He
Debra L. Miller
Monica Papeș
Dana K. Pasquale
Connor Verheyen
Sadie J. Ryan
author_sort Nina H. Fefferman
collection DOAJ
description Abstract Outbreaks are typically investigated using approaches that aim to identify place- and context-dependent causative factors. As the focus is on understanding the basis of a specific outbreak, the resulting narratives are rarely suitable for forecasting risk or developing generalizable predictive and preventative measures. This Perspective article proposes applying a case-control framework as an outbreak epidemiological study design to promote evidence-based decision-making for prevention and response to outbreaks. The approach involves identifying counterfactuals, with case-control comparisons drawn to test hypotheses about conditions that manifest outbreaks. First, a framework is described for iterative multidisciplinary interrogation to elucidate and identify minimally sufficient sets of factors that lead to disease outbreaks. Next, example case-control comparison frameworks are discussed, centered on pathogen(s), influential contributor(s), or landscape(s), illustrated with examples focused on pathogen transmission.
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spelling doaj-art-93c8afc44a454713a9bbe4eb3f7d1ca82025-08-20T03:16:51ZengNature PortfolioCommunications Medicine2730-664X2025-05-01511510.1038/s43856-025-00916-5Identifying outbreak risk factors through case-controls comparisonsNina H. Fefferman0Michael J. Blum1Lydia Bourouiba2Nathaniel L. Gibson3Qiang He4Debra L. Miller5Monica Papeș6Dana K. Pasquale7Connor Verheyen8Sadie J. Ryan9Department of Ecology and Evolutionary Biology, University of TennesseeDepartment of Ecology and Evolutionary Biology, University of TennesseeThe Fluid Dynamics of Disease Transmission Laboratory, Fluids and Health Network, Massachusetts Institute of TechnologyDepartment of Ecology and Evolutionary Biology, University of TennesseeDepartment of Civil and Environmental Engineering, University of TennesseeOne Health Initiative, School of Natural Resources and College of Veterinary Medicine, University of TennesseeDepartment of Ecology and Evolutionary Biology, University of TennesseeDuke Department of Population Health Sciences, Duke University School of MedicineThe Fluid Dynamics of Disease Transmission Laboratory, Fluids and Health Network, Massachusetts Institute of TechnologyDepartment of Geography, Quantitative Disease Ecology and Conservation (QDEC) Lab, University of FloridaAbstract Outbreaks are typically investigated using approaches that aim to identify place- and context-dependent causative factors. As the focus is on understanding the basis of a specific outbreak, the resulting narratives are rarely suitable for forecasting risk or developing generalizable predictive and preventative measures. This Perspective article proposes applying a case-control framework as an outbreak epidemiological study design to promote evidence-based decision-making for prevention and response to outbreaks. The approach involves identifying counterfactuals, with case-control comparisons drawn to test hypotheses about conditions that manifest outbreaks. First, a framework is described for iterative multidisciplinary interrogation to elucidate and identify minimally sufficient sets of factors that lead to disease outbreaks. Next, example case-control comparison frameworks are discussed, centered on pathogen(s), influential contributor(s), or landscape(s), illustrated with examples focused on pathogen transmission.https://doi.org/10.1038/s43856-025-00916-5
spellingShingle Nina H. Fefferman
Michael J. Blum
Lydia Bourouiba
Nathaniel L. Gibson
Qiang He
Debra L. Miller
Monica Papeș
Dana K. Pasquale
Connor Verheyen
Sadie J. Ryan
Identifying outbreak risk factors through case-controls comparisons
Communications Medicine
title Identifying outbreak risk factors through case-controls comparisons
title_full Identifying outbreak risk factors through case-controls comparisons
title_fullStr Identifying outbreak risk factors through case-controls comparisons
title_full_unstemmed Identifying outbreak risk factors through case-controls comparisons
title_short Identifying outbreak risk factors through case-controls comparisons
title_sort identifying outbreak risk factors through case controls comparisons
url https://doi.org/10.1038/s43856-025-00916-5
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