Linking syndromic surveillance with virological self-sampling

Abstract

Calls to a UK national telephone health helpline (NHS Direct) have been used for syndromic surveillance, aiming to provide early warning of rises in community morbidity. We investigated whether self-sampling by NHS Direct callers could provide viable samples for influenza culture. We recruited 294 NHS Direct callers and sent them self-sampling kits. Callers were asked to take a swab from each nostril and post them to the laboratory. Forty-two per cent of the samples were returned, 16.2% were positive on PCR for influenza (16 influenza A(H3N2), three influenza A (H1N1), four influenza B) and eight for RSV (5.6%). The mean time between the NHS Direct call and laboratory analysis was 7.4 days. These samples provided amongst the earliest influenza reports of the season, detected multiple influenza strains, and augmented a national syndromic surveillance system. Self-sampling is a feasible method of enhancing community-based surveillance programmes for detection of influenza.

Monitoring the emergence of community transmission of influenza A/H1N1 2009 in England: a cross sectional opportunistic survey of self sampled telephone callers to NHS Direct

“…14 The packaging fulfilled packaging instruction PI 650 in conformity with the UN 3373 regulation. Returned nasal swabs were tested for influenza A/H1N1 2009 virus, seasonal influenza virus (influenza A/H1N1, influenza A/H3N2, and influenza B/ H1N1), human respiratory syncytial virus, and human metapneumovirus.…”

“…Daily numbers of calls recording cold or flu symptoms, or both (aggregated across all ages), and fever (in patients aged 5-14 years) provide early warning of the beginning of community influenza transmission in winter. 13 During the swine flu epidemic, the existing NHS Direct and HPA syndromic surveillance system was augmented on 28 May 2009 with a scheme of self sampling and virological testing of telephone callers that 14 The clinical assessment algorithm used by NHS Direct for callers concerned about swine flu distinguished a subset of patients with generally uncomplicated illness who had no travel associated risk, no contact with other suspected or confirmed influenza A/H1N1 2009 cases, and had a "self care" call outcome.…”

“…14 The clinical assessment algorithm used by NHS Direct for callers concerned about swine flu distinguished a subset of patients with generally uncomplicated illness who had no travel associated risk, no contact with other suspected or confirmed influenza A/H1N1 2009 cases, and had a "self care" call outcome.…”

Prescription Surveillance and Polymerase Chain Reaction Testing to Identify Pathogens during Outbreaks of Infection

“…Thus far, syndromic surveillance with pathogenic testing has been conducted by collecting samples from patients receiving telephone consultations [18] and those receiving emergency department consultations [19]. Syndromic surveillance using electronic medical records has been combined with testing for the influenza virus [20].…”

Effectiveness of 2012–2013 influenza vaccine against influenza-like illness in general population

“…fr participants who declare ILI symptoms, similarly to what has been done in the United Kingdom, where 42% of 294 callers to the influenza telephone hotline (NHS direct) who were sent a self-sampling kit sent back the swabs within a delay allowing for analyses. 40 While the use of such non-specific outcomes for IVE estimation is problematic, there are methods to estimate the contribution of influenza to the incidence of non-specific outcomes. It is well known that influenza epidemics are associated with increases in pneumonia/influenza hospitalizations and deaths above expected, smoothed seasonal baselines.…”