Seasonal Influenza Morbidity Estimates Obtained From Telephone Surveys, 2007

At the time of the study, Laurie Kamimoto, Lyn Finelli, and Joseph Bresee were with the Influenza Division and Gary L. Euler, Peng-Jun Lu, and James A. Singleton were with the Immunization Services Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Arthur Reingold was with the School of Public Health, University of California, Berkeley. James Hadler was with the Connecticut Department of Public Health, Hartford. Ken Gershman was with the Colorado Department of Public Health and Environment, Denver. Monica Farley was with Emory University School of Medicine and the VA Medical Center, Atlanta. Pauline Terebuh was with the Georgia Department of Human Resources, Division of Public Health, Atlanta. Patricia Ryan was with the Maryland Department of Health and Mental Hygiene, Baltimore. Ruth Lynfield was with the Minnesota Department of Health, St. Paul. Bernadette Albanese was with the New Mexico Department of Health, Santa Fe. Ann Thomas was with the Oregon Public Health Division, Portland. Allen S. Craig was with the Tennessee Department of Health, Nashville. William Schaffner was with Vanderbilt Medical Center, Nashville.
American Journal of Public Health (Impact Factor: 4.55). 12/2012; 103(4). DOI: 10.2105/AJPH.2012.300799
Source: PubMed


We assessed telephone surveys as a novel surveillance method, comparing data obtained by telephone with existing national influenza surveillance systems, and evaluated the utility of telephone surveys.

We used the 2007 Behavioral Risk Factor Surveillance System (BRFSS) and the 2007 National Immunization Survey-Adult (NIS-Adult) to estimate the incidence of influenza-like illness (ILI), medically attended ILI, provider-diagnosed influenza, influenza testing, and treatment of influenza with antiviral medications during the 2006-2007 influenza season.

With the January-May BRFSS, among persons aged 18 years and older, the cumulative incidence of seasonal ILI and provider-diagnosed influenza was 37.9 and 5.7 adults per 100 persons, respectively. Monthly medically attended ILI and provider-diagnosed influenza among adults were temporally associated with influenza activity, as documented by national surveillance. With the NIS-Adult survey data, estimated provider-diagnosed influenza, influenza testing, and antiviral treatment were 2.8%, 1.4%, and 0.6%, respectively.

Our telephone interview-based estimates of influenza morbidity were consistent with those from national influenza surveillance systems. Telephone surveys may provide an alternative method by which population-based influenza morbidity information can be gathered.

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    • "Additionally Flusurvey participants are more likely to be from London, be female, have risk factors and be vaccinated than the UK general population. Other methods such as telephone surveillance can be used to overcome these limitations [15,24], however these surveillance techniques are more expensive, time absorbing, have representativeness problems of their own, and still have the problem of self-reports of ILI. "
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    ABSTRACT: Background Influenza and Influenza-like-illness (ILI) represents a substantial public health problem, but it is difficult to measure the overall burden as many cases do not access health care. Community cohorts have the advantage of not requiring individuals to present at hospitals and surgeries and therefore can potentially monitor a wider variety of cases. This study reports on the incidence and risk factors for ILI in the UK as measured using Flusurvey, an internet-based open community cohort. Methods Upon initial online registration participants were asked background characteristics, and every week were asked to complete a symptoms survey. We compared the representativeness of our sample to the overall population. We used two case definitions of ILI, which differed in whether fever/chills was essential. We calculated ILI incidence week by week throughout the season, and investigated risk factors associated with ever reporting ILI over the course of the season. Risk factor analysis was conducted using binomial regression. Results 5943 participants joined the survey, and 4532 completed the symptoms survey at least twice. Participants who filled in symptoms surveys at least twice filled in a median of nine symptoms surveys over the course of the study. 46.1% of participants reported at least one episode of ILI, and 6.0% of all reports were positive for ILI. Females had slightly higher incidence, and individuals over 65 had the lowest incidence. Incidence peaked just before Christmas and declined dramatically during school holidays. Multivariate regression showed that, for both definitions of ILI considered, being female, unvaccinated, having underlying health issues, having contact with children, being aged between 35 and 64, and being a smoker were associated with the highest risk of reporting an ILI. The use of public transport was not associated with an increased risk of ILI. Conclusions Our results show that internet based surveillance can be used to measure ILI and understand risk factors. Vaccination is shown to be linked to a reduced risk of reporting ILI. Taking public transport does not increase the risk of reporting ILI. Flusurvey and other participatory surveillance techniques can be used to provide reliable information to policy makers in nearly real-time.
    Full-text · Article · May 2014 · BMC Infectious Diseases
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    ABSTRACT: Background: Few data exist describing healthcare-seeking behaviors among persons with influenza-like illness (ILI) or adherence to influenza antiviral treatment recommendations. Methods: We analyzed adult responses to the Behavioral Risk Factor Surveillance System in 31 states and the District of Columbia (DC) and pediatric responses in 25 states and DC for January-April 2011 by demographics and underlying health conditions. Results: Among 75 088 adult and 15 649 child respondents, 8.9% and 33.9%, respectively, reported ILI. ILI was more frequent among adults with asthma (16%), chronic obstruction pulmonary disease (COPD; 26%), diabetes (12%), heart disease (19%), kidney disease (16%), or obesity (11%). Forty-five percent of adults and 57% of children sought healthcare for ILI. Thirty-five percent of adults sought care ≤ 2 days after ILI onset. Seeking care ≤ 2 days was more frequent among adults with COPD (48%) or heart disease (55%). Among adults with a self-reported physician diagnosis of influenza, 34% received treatment with antiviral medications. The only underlying health condition with a higher rate of treatment was diabetes (46%). Conclusions: Adults with underlying health conditions were more likely to report ILI, but the majority did not seek care promptly, missing opportunities for early influenza antiviral treatment.
    Preview · Article · Apr 2014 · The Journal of Infectious Diseases