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Open AccessArticle

Usefulness of Clinical Definitions of Influenza for Public Health Surveillance Purposes

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Departament de Medicina, Universitat de Barcelona, 08036 Barcelona, Spain
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CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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Agència de Salut Pública de Catalunya, Generalitat de Catalunya, 08005 Barcelona, Spain
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Institut de Recerca Biomèdica de Lleida, Universitat de Lleida, 25198 Lleida, Spain
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Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain
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Author to whom correspondence should be addressed.
Viruses 2020, 12(1), 95; https://doi.org/10.3390/v12010095
Received: 29 November 2019 / Revised: 10 January 2020 / Accepted: 12 January 2020 / Published: 14 January 2020
(This article belongs to the Section Animal Viruses)
This study investigated the performance of various case definitions and influenza symptoms in a primary healthcare sentinel surveillance system. A retrospective study of the clinical and epidemiological characteristics of the cases reported by a primary healthcare sentinel surveillance network for eleven years in Catalonia was conducted. Crude and adjusted diagnostic odds ratios (aDORs) and 95% confidence intervals (CIs) of the case definitions and symptoms for all weeks and epidemic weeks were estimated. The most predictive case definition for laboratory-confirmed influenza was the World Health Organization (WHO) case definition for ILI in all weeks (aDOR 2.69; 95% CI 2.42–2.99) and epidemic weeks (aDOR 2.20; 95% CI 1.90–2.54). The symptoms that were significant positive predictors for confirmed influenza were fever, cough, myalgia, headache, malaise, and sudden onset. Fever had the highest aDOR in all weeks (4.03; 95% CI 3.38–4.80) and epidemic weeks (2.78; 95% CI 2.21–3.50). All of the case definitions assessed performed better in patients with comorbidities than in those without. The performance of symptoms varied by age groups, with fever being of high value in older people, and cough being of high value in children. In patients with comorbidities, the performance of fever was the highest (aDOR 5.45; 95% CI 3.43–8.66). No differences in the performance of the case definition or symptoms in influenza cases according to virus type were found. View Full-Text
Keywords: influenza; sentinel surveillance system; performance assessment; case definition; symptoms; primary healthcare physician influenza; sentinel surveillance system; performance assessment; case definition; symptoms; primary healthcare physician
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Domínguez, À.; Soldevila, N.; Torner, N.; Martínez, A.; Godoy, P.; Rius, C.; Jané, M.; the PIDIRAC Sentinel Surveillance Program of Catalonia. Usefulness of Clinical Definitions of Influenza for Public Health Surveillance Purposes. Viruses 2020, 12, 95.

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