Surveillance and Clinical Characterization of Influenza in a University Cohort in Singapore

Tan, Aidan Lyanzhiang; Virk, Ramandeep Kaur; Tambyah, Paul Anantharajah; Inoue, Masafumi; Lim, Elizabeth Ai-Sim; Chan, Ka-Wei; Chelvi, C. Senthamarai; Ooi, Say-Tat; Chua, Catherine; Tan, Bernard C. Y.

doi:10.1371/journal.pone.0119485

Cited by 7 publications

(7 citation statements)

References 15 publications

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“…Among students and staff at the National University of Singapore presenting with ILI, 21.1% had laboratory‐confirmed influenza in 2007 and 32.8% in 2007‐09. Although the study conducted in 2007‐09 detected a higher influenza‐positivity rate, the proportion of influenza B was lower comparing to the study in 2007 (6.7% vs 16.1%) as influenza A/H1N1pdm09 became the predominant type in the second half of the 2007‐09 study …”

Section: Resultsmentioning

confidence: 61%

Literature review of the epidemiology of influenza B disease in 15 countries in the Asia‐Pacific region

Jennings

Huang

Barr

et al. 2018

Influenza Resp Viruses

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Influenza control strategies focus on the use of trivalent influenza vaccines containing two influenza A virus subtypes and one of the two circulating influenza type B lineages (Yamagata or Victoria). Mismatches between the vaccine B lineage and the circulating lineage have been regularly documented in many countries, including those in the Asia‐Pacific region. We conducted a literature review with the aim of understanding the relative circulation of influenza B viruses in Asia‐Pacific countries. PubMed and Western Pacific Region Index Medicus were searched for relevant articles on influenza type B published since 1990 in English language for 15 Asia‐Pacific countries. Gray literature was also accessed. From 4834 articles identified, 121 full‐text articles were analyzed. Influenza was reported as an important cause of morbidity in the Asia‐Pacific region, affecting all age groups. In all 15 countries, influenza B was identified and associated with between 0% and 92% of laboratory‐confirmed influenza cases in any one season/year. Influenza type B appeared to cause more illness in children aged between 1 and 10 years than in other age groups. Epidemiological data for the two circulating influenza type B lineages remain limited in several countries in the Asia‐Pacific, although the co‐circulation of both lineages was seen in countries where strain surveillance data were available. Mismatches between circulating B lineages and vaccine strains were observed in all countries with available data. The data suggest that a shift from trivalent to quadrivalent seasonal influenza vaccines could provide additional benefits by providing broader protection.

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Section: Resultsmentioning

confidence: 61%

Literature review of the epidemiology of influenza B disease in 15 countries in the Asia‐Pacific region

Jennings

Huang

Barr

et al. 2018

Influenza Resp Viruses

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“…Influenza infection was confirmed by PCR. Details of this cohort have been described previously [14]. …”

Section: Methodsmentioning

confidence: 99%

Molecular Evidence of Transmission of Influenza A/H1N1 2009 on a University Campus

et al. 2017

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BackgroundIn the recent years, the data on the molecular epidemiology of influenza viruses have expanded enormously because of the availability of cutting-edge sequencing technologies. However, much of the information is from the temperate regions with few studies from tropical regions such as South-east Asia. Despite the fact that influenza has been known to transmit rapidly within semi-closed communities, such as military camps and educational institutions, data are limited from these communities.ObjectivesTo determine the phylogeography of influenza viruses on a university campus, we examined the spatial distribution of influenza virus on the National University of Singapore (NUS) campus.MethodsConsenting students from the NUS who sought medical attention at the UHC provided two nasopharyngeal swabs and demographic data. PCR was used for detection of influenza viruses. 34 full-genomes of pH1N1/09 viruses were successfully sequenced by Sanger method and concatenated using Geneious R7. Phylogenetic analysis was conducted using these 34 sequences and 1518 global sequences. Phylogeographic analysis was done using BaTS software and Association index and Fitch parsimony scores were determined.ResultsIntegrating whole genome sequencing data with epidemiological data, we found strong evidence of influenza transmission on campus as isolates from students residing on-campus were highly similar to each other (AI, P value = 0.009; PS, P value = 0.04). There was also evidence of multiple introductions from the community.ConclusionsSuch data are useful in formulating pandemic preparedness plans which can use these communities as sentinel sites for detection and monitoring of emerging respiratory viral infections.

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“…Recruitment via mass advertisements has also been found to underrepresent important populations who are at high risk of ILI and influenza, such as children and the elderly [ 14 ]. Recent virological studies have demonstrated that targeted disease surveillance, which is based on specific populations such as university students and military recruits, is not only cost-effective but also complementary to existing systems [ 16 , 17 ]. However, the effectiveness of internet-based surveillance systems using targeted samples has not been thoroughly explored.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of a Mobile-Based Influenza-Like Illness Surveillance System (FluMob) Among Health Care Workers: Longitudinal Study

Lwin¹,

Lu²,

Sheldenkar³

et al. 2020

JMIR Mhealth Uhealth

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Background Existing studies have suggested that internet-based participatory surveillance systems are a valid sentinel for influenza-like illness (ILI) surveillance. However, there is limited scientific knowledge on the effectiveness of mobile-based ILI surveillance systems. Previous studies also adopted a passive surveillance approach and have not fully investigated the effectiveness of the systems and their determinants. Objective The aim of this study was to assess the efficiency of a mobile-based surveillance system of ILI, termed FluMob, among health care workers using a targeted surveillance approach. Specifically, this study evaluated the effectiveness of the system for ILI surveillance pertaining to its participation engagement and surveillance power. In addition, we aimed to identify the factors that can moderate the effectiveness of the system. Methods The FluMob system was launched in two large hospitals in Singapore from April 2016 to March 2018. A total of 690 clinical and nonclinical hospital staff participated in the study for 18 months and were prompted via app notifications to submit a survey listing 18 acute respiratory symptoms (eg, fever, cough, sore throat) on a weekly basis. There was a period of study disruption due to maintenance of the system and the end of the participation incentive between May and July of 2017. Results On average, the individual submission rate was 41.4% (SD 24.3%), with a rate of 51.8% (SD 26.4%) before the study disruption and of 21.5% (SD 30.6%) after the disruption. Multivariable regression analysis showed that the adjusted individual submission rates were higher for participants who were older (<30 years, 31.4% vs 31-40 years, 40.2% [P<.001]; 41-50 years, 46.0% [P<.001]; >50 years, 39.9% [P=.01]), ethnic Chinese (Chinese, 44.4% vs non-Chinese, 34.7%; P<.001), and vaccinated against flu in the past year (vaccinated, 44.6% vs nonvaccinated, 34.4%; P<.001). In addition, the weekly ILI incidence was 1.07% on average. The Pearson correlation coefficient between ILI incidence estimated by FluMob and that reported by Singapore Ministry of Health was 0.04 (P=.75) with all data and was 0.38 (P=.006) including only data collected before the study disruption. Health care workers with higher risks of ILI and influenza such as women, non-Chinese, allied health staff, those who had children in their households, not vaccinated against influenza, and reported allergy demonstrated higher surveillance correlations. Conclusions Mobile-based ILI surveillance systems among health care workers can be effective. However, proper operation of the mobile system without major disruptions is vital for the engagement of participants and the persistence of surveillance power. Moreover, the effectiveness of the mobile surveillance system can be moderated by participants’ characteristics, which highlights the importance of targeted disease surveillance that can reduce the cost of recruitment and engagement.

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Surveillance and Clinical Characterization of Influenza in a University Cohort in Singapore

Cited by 7 publications

References 15 publications

Literature review of the epidemiology of influenza B disease in 15 countries in the Asia‐Pacific region

Literature review of the epidemiology of influenza B disease in 15 countries in the Asia‐Pacific region

Molecular Evidence of Transmission of Influenza A/H1N1 2009 on a University Campus

Effectiveness of a Mobile-Based Influenza-Like Illness Surveillance System (FluMob) Among Health Care Workers: Longitudinal Study

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