Adding the spatial dimension to the social network analysis of an epidemic: investigation of the 2007 outbreak of equine influenza in Australia.

Equine influenza is a highly contagious and widespread viral respiratory disease of horses and other equid species, characterised by fever and a harsh dry cough. In 2007, in the first reported outbreak in Australia, the virus spread through the horse populations of two states within 4 months. Most of the geographic spread occurred within the first 10 days and was associated with the movement of infected horses prior to the implementation of movement controls. This study applies social network analysis to describe spread of equine influenza between horse premises infected in the early outbreak period, identifying spread occurring through a contact network and secondary local spatial spread. Social networks were constructed by combining contact-tracing data on horse movements with a distance matrix between all premises holding horses infected within the first 10 days of the outbreak. These networks were analysed to provide a description of the epidemic, identify premises that were central to disease spread and to estimate the relative proportion of premises infected through infected horse movements and through local spatial spread. We then explored the effect of distance on disease spread by estimating the range of local spread (through direct contact, transmission on fomites and windborne transmission) based on the level of fragmentation in the network and also by directly estimating the shape of the outbreak's spatial transmission kernel. During the first 10 days of this epidemic, 197 horse premises were infected; 70 of these were included in the contact-traced network. Most local spread occurred within 5 km. Local spread was estimated to have occurred up to a distance of 15.3 km - based on the contact-and-proximity network - and at a very low incidence beyond this distance based on the transmission kernel estimate. Of the 70 premises in the contact network, spread to 14 premises (95% CI: 9, 20 premises) was likely to have occurred through local spatial spread from nearby infected premises, suggesting that 28.3% of spread in the early epidemic period was 'network-associated' (95% CI: 25.6, 31.0%). By constructing a 'maximal network' of contact and proximity (based on a distance cut-off of 15.3 km), 44 spatial clusters were described, and the horse movements that initiated infection in these locations were identified. Characteristics of the combined network, incorporating both spatial and underlying contact relationships between infected premises, explained the high rate of spread, the sequence of cluster formation and the widespread dispersal experienced in the early phase of this epidemic. These results can inform outbreak control planning by guiding the imposition of appropriate control zone diameters around infected premises and the targeting of surveillance and interventions.