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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

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
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
OBJECTIVE: To evaluate ascertainment of the onset of community transmission of influenza A/H1N1 2009 (swine flu) in England during the earliest phase of the epidemic through comparing data from two surveillance systems. DESIGN: Cross sectional opportunistic survey. STUDY SAMPLES: Results from self samples by consenting patients who had called the NHS Direct telephone health line with cold or flu symptoms, or both, and results from Health Protection Agency (HPA) regional microbiology laboratories on patients tested according to the clinical algorithm for the management of suspected cases of swine flu. SETTING: Six regions of England between 24 May and 30 June 2009. MAIN OUTCOME MEASURE: Proportion of specimens with laboratory evidence of influenza A/H1N1 2009. RESULTS: Influenza A/H1N1 2009 infections were detected in 91 (7%) of the 1385 self sampled specimens tested. In addition, eight instances of influenza A/H3 infection and two cases of influenza B infection were detected. The weekly rate of change in the proportions of infected individuals according to self obtained samples closely matched the rate of increase in the proportions of infected people reported by HPA regional laboratories. Comparing the data from both systems showed that local community transmission was occurring in London and the West Midlands once HPA regional laboratories began detecting 100 or more influenza A/H1N1 2009 infections, or a proportion positive of over 20% of those tested, each week. CONCLUSIONS: Trends in the proportion of patients with influenza A/H1N1 2009 across regions detected through clinical management were mirrored by the proportion of NHS Direct callers with laboratory confirmed infection. The initial concern that information from HPA regional laboratory reports would be too limited because it was based on testing patients with either travel associated risk or who were contacts of other influenza cases was unfounded. Reports from HPA regional laboratories could be used to recognise the extent to which local community transmission was occurring.
0959-8138
Elliot, Alex J.
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Powers, Cassandra
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Thornton, Alicia
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Obi, Chinelo
cdd799ee-f6ee-43cc-bf31-a621929f65ad
Hill, Caterina
e3490c23-a6bd-4a20-aab7-6cae77557960
Simms, Ian
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Waight, Pauline
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Maguire, Helen
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Foord, David
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Povey, Enid
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Wreghitt, Tim
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Goddard, Nichola
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Ellis, Joanna
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Bermingham, Alison
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Sebastianpillai, Praveen
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Lackenby, Angie
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Zambon, Maria
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Brown, David
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Smith, Gillian E.
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Gill, O. Noel
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Elliot, Alex J.
370f4f48-0914-4f89-ac9d-0e258a61dfbd
Powers, Cassandra
b8f0a12a-d192-469a-b95c-7ddd164dc8ea
Thornton, Alicia
5146951d-9c97-4186-a18d-e9a0e0fd427f
Obi, Chinelo
cdd799ee-f6ee-43cc-bf31-a621929f65ad
Hill, Caterina
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Simms, Ian
8ed59245-4d3d-4d52-bb31-55240c853423
Waight, Pauline
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Maguire, Helen
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Foord, David
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Povey, Enid
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Wreghitt, Tim
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Goddard, Nichola
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Ellis, Joanna
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Bermingham, Alison
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Sebastianpillai, Praveen
8051de05-7fa1-4b0f-9fec-a4484113283e
Lackenby, Angie
2941dec0-37b0-4f4e-955c-8117b436687e
Zambon, Maria
7537de23-07fa-4404-9f95-9627ce13b3f3
Brown, David
68e8f8ee-6aaf-45e4-9aee-7f76e39ddefe
Smith, Gillian E.
451665ee-2ab0-4e6e-ae8b-ab210e7a1124
Gill, O. Noel
5e232009-3a1d-4de7-a7e6-c0df09f9110c

Elliot, Alex J., Powers, Cassandra, Thornton, Alicia, Obi, Chinelo, Hill, Caterina, Simms, Ian, Waight, Pauline, Maguire, Helen, Foord, David, Povey, Enid, Wreghitt, Tim, Goddard, Nichola, Ellis, Joanna, Bermingham, Alison, Sebastianpillai, Praveen, Lackenby, Angie, Zambon, Maria, Brown, David, Smith, Gillian E. and Gill, O. Noel (2009) 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. British Medical Journal. (doi:10.1136/bmj.b3403). (PMID:19713236)

Record type: Article

Abstract

OBJECTIVE: To evaluate ascertainment of the onset of community transmission of influenza A/H1N1 2009 (swine flu) in England during the earliest phase of the epidemic through comparing data from two surveillance systems. DESIGN: Cross sectional opportunistic survey. STUDY SAMPLES: Results from self samples by consenting patients who had called the NHS Direct telephone health line with cold or flu symptoms, or both, and results from Health Protection Agency (HPA) regional microbiology laboratories on patients tested according to the clinical algorithm for the management of suspected cases of swine flu. SETTING: Six regions of England between 24 May and 30 June 2009. MAIN OUTCOME MEASURE: Proportion of specimens with laboratory evidence of influenza A/H1N1 2009. RESULTS: Influenza A/H1N1 2009 infections were detected in 91 (7%) of the 1385 self sampled specimens tested. In addition, eight instances of influenza A/H3 infection and two cases of influenza B infection were detected. The weekly rate of change in the proportions of infected individuals according to self obtained samples closely matched the rate of increase in the proportions of infected people reported by HPA regional laboratories. Comparing the data from both systems showed that local community transmission was occurring in London and the West Midlands once HPA regional laboratories began detecting 100 or more influenza A/H1N1 2009 infections, or a proportion positive of over 20% of those tested, each week. CONCLUSIONS: Trends in the proportion of patients with influenza A/H1N1 2009 across regions detected through clinical management were mirrored by the proportion of NHS Direct callers with laboratory confirmed infection. The initial concern that information from HPA regional laboratory reports would be too limited because it was based on testing patients with either travel associated risk or who were contacts of other influenza cases was unfounded. Reports from HPA regional laboratories could be used to recognise the extent to which local community transmission was occurring.

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Published date: 27 August 2009
Organisations: Faculty of Health Sciences

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Local EPrints ID: 350999
URI: http://eprints.soton.ac.uk/id/eprint/350999
ISSN: 0959-8138
PURE UUID: 72a23717-4d09-4f15-a04f-dee01fd3fa7e

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Date deposited: 12 Apr 2013 11:37
Last modified: 14 Mar 2024 13:34

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Contributors

Author: Alex J. Elliot
Author: Cassandra Powers
Author: Alicia Thornton
Author: Chinelo Obi
Author: Caterina Hill
Author: Ian Simms
Author: Pauline Waight
Author: Helen Maguire
Author: David Foord
Author: Enid Povey
Author: Tim Wreghitt
Author: Nichola Goddard
Author: Joanna Ellis
Author: Alison Bermingham
Author: Praveen Sebastianpillai
Author: Angie Lackenby
Author: Maria Zambon
Author: David Brown
Author: Gillian E. Smith
Author: O. Noel Gill

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