Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2011 Aug 15;174(4):468-78.
doi: 10.1093/aje/kwr113. Epub 2011 Jun 30.

Comparability of different methods for estimating influenza infection rates over a single epidemic wave

Affiliations
Comparative Study

Comparability of different methods for estimating influenza infection rates over a single epidemic wave

Vernon J Lee et al. Am J Epidemiol. .

Abstract

Estimation of influenza infection rates is important for determination of the extent of epidemic spread and for calculation of severity indicators. The authors compared estimated infection rates from paired and cross-sectional serologic surveys, rates of influenza like illness (ILI) obtained from sentinel general practitioners (GPs), and ILI samples that tested positive for influenza using data from similar periods collected during the 2009 H1N1 epidemic in Singapore. The authors performed sensitivity analyses to assess the robustness of estimates to input parameter uncertainties, and they determined sample sizes required for differing levels of precision. Estimates from paired seroconversion were 17% (95% Bayesian credible interval (BCI): 14, 20), higher than those from cross-sectional serology (12%, 95% BCI: 9, 17). Adjusted ILI estimates were 15% (95% BCI: 10, 25), and estimates computed from ILI and laboratory data were 12% (95% BCI: 8, 18). Serologic estimates were least sensitive to the risk of input parameter misspecification. ILI-based estimates were more sensitive to parameter misspecification, though this was lessened by incorporation of laboratory data. Obtaining a 5-percentage-point spread for the 95% confidence interval in infection rates would require more than 1,000 participants per serologic study, a sentinel network of 90 GPs, or 50 GPs when combined with laboratory samples. The various types of estimates will provide comparable findings if accurate input parameters can be obtained.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Sources of available data on influenza infection in Singapore from June to October 2009. A) Numbers of cases of acute respiratory illness (ARI) diagnosed in government clinics, in thousands per week; B) numbers of adult cases of influenza like illness (ILI) reported by primary-care general practitioner (GP) sentinel clinics per GP per week; C) percentage of ILI cases that tested positive for H1N1-2009 influenza per week. Lighter lines, 95% confidence interval.
Figure 2.
Figure 2.
Rates of H1N1-2009 influenza infection estimated from various methods, aggregated and by age group, Singapore, 2009. For details on methods 1–4 (M1–M4), see Table 2. ILI, influenza like illness. Whiskers, 95% Bayesian credible interval.
Figure 3.
Figure 3.
Change in the 95% confidence interval (dashed lines) for the mean estimated H1N1 influenza infection rate (solid line) with different sample sizes using 4 different estimation methods, Singapore, 2009. A) Method 1; B) method 2; C) method 3; D) method 4; E) method 4 (see Table 2). Sample sizes which resulted in a 5- and 10-percentage-point spreads in the confidence interval for the mean estimates are shown with dotted vertical lines; the actual sample size used in the Singapore studies is shown with a circle on the x-axis. The total number of general practitioners (GPs) in Singapore in 2009 was approximately 2,138.

References

    1. World Health Organization. Assessing the Severity of an Influenza Pandemic. Geneva, Switzerland: World Health Organization; 2009. ( http://www.who.int/csr/disease/swineflu/assess/disease_swineflu_assess_2...). (Accessed June 15, 2010)
    1. Lipsitch M, Hayden FG, Cowling BJ, et al. How to maintain surveillance for novel influenza A H1N1 when there are too many cases to count. Lancet. 2009;374(9696):1209–1211. - PubMed
    1. Ginsberg J, Mohebbi MH, Patel RS, et al. Detecting influenza epidemics using search engine query data. Nature. 2009;457(7232):1012–1014. - PubMed
    1. Cook AR, Chen MIC, Pin Lin RT. Internet search limitations and pandemic influenza, Singapore [letter] Emerg Inf Dis. 2010;16(10):1647–1649. (doi: 10.3201/eid1610.100840) - PMC - PubMed
    1. Flahault A, de Lamballerie X, Hanslik T, et al. Symptomatic infections less frequent with H1N1pdm than with seasonal strains. PLoS Curr. 2009;1 RRN1140. (doi: 10.1371/currents.RRN1140) - PMC - PubMed

Publication types