Population-level susceptibility, severity and spread of pandemic influenza: design of, and initial results from, a pre-pandemic and hibernating pandemic phase study using cross-sectional data from the Health Survey for England (HSE)
Background Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response. It requires community-level studies to estimate the burden of infection and disease. Rapidly initiating such studies in a pandemic is diffic...
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Published in | Public health research (Southampton, England) Vol. 3; no. 6; pp. 1 - 24 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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NIHR Journals Library
01.06.2015
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Abstract | Background
Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response. It requires community-level studies to estimate the burden of infection and disease. Rapidly initiating such studies in a pandemic is difficult. The study aims to establish an efficient system allowing real-time assessment of population susceptibility, spread of infection and clinical attack rates in the event of a pandemic.
Methods
We developed and appended additional survey questions and specimen collection to the Health Survey for England (HSE) – a large, annual, rolling nationally representative general population survey recruiting throughout the year – to enable rapid population-based surveys of influenza infection and disease during a pandemic. Using these surveys we can assess the spread of the virus geographically, by age and through time. The data generated can also provide denominators for national estimates of case fatality and hospitalisation rates.
Phase 1
: we compared retrospectively collected HSE illness rates during the first two infection waves of the 2009 pandemic with the Flu Watch study (a prospective community cohort). Monthly and seasonal age-specific rates of illness and proportion vaccinated were compared.
Phase 2
: we piloted blood specimen and data collection alongside the 2012–13 HSE. We are developing laboratory methods and protocols for real-time serological assays of a novel pandemic influenza virus using these specimens, and automated programmes for analysing and reporting illness and infection rates.
Phase 3
: during inter-pandemic years, the study enters a holding phase, where it is included in the yearly HSE ethics application and planning procedures, allowing rapid triggering in a pandemic.
Phase 4
: once retriggered, the study will utilise the methods developed in phase 2 to monitor the severity and spread of the pandemic in real time.
Results
Phase 1
: the rates of reported illness during the first two waves in the HSE underestimated the community burden as measured by Flu Watch, but the patterns of illness by age and time were broadly comparable. The extent of underestimation was greatest for HSE participants interviewed later in the year compared with those interviewed closer to the pandemic. Vaccine uptake in the HSE study was comparable to independent national estimates and the Flu Watch study.
Phases 2 and 3
: illness data and serological samples from 2018 participants were collected in the 2012–13 HSE and transferred to the University College London Hospital. In the 2013 HSE and onwards, this project was included in the annual HSE ethics and planning rounds.
Conclusions
The HSE’s underestimation of illness rates during the first two waves of the pandemic is probably due to recall bias and the limitation of being able to report only one illness when multiple illnesses per season can occur. Changes to the illness questions (reporting only recent illnesses) should help minimise these issues. Additional prospective follow-up could improve measurement of disease incidence. The representative nature of the HSE allows accurate measurements of vaccine uptake.
Study registration
This study is registered as ISRCTN80214280.
Funding
This project was funded by the NIHR Public Health Research programme and will be published in full in
Public Health Research
; Vol. 3, No. 6. See the NIHR Journals Library website for further project information. |
---|---|
AbstractList | Background
Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response. It requires community-level studies to estimate the burden of infection and disease. Rapidly initiating such studies in a pandemic is difficult. The study aims to establish an efficient system allowing real-time assessment of population susceptibility, spread of infection and clinical attack rates in the event of a pandemic.
Methods
We developed and appended additional survey questions and specimen collection to the Health Survey for England (HSE) – a large, annual, rolling nationally representative general population survey recruiting throughout the year – to enable rapid population-based surveys of influenza infection and disease during a pandemic. Using these surveys we can assess the spread of the virus geographically, by age and through time. The data generated can also provide denominators for national estimates of case fatality and hospitalisation rates.
Phase 1
: we compared retrospectively collected HSE illness rates during the first two infection waves of the 2009 pandemic with the Flu Watch study (a prospective community cohort). Monthly and seasonal age-specific rates of illness and proportion vaccinated were compared.
Phase 2
: we piloted blood specimen and data collection alongside the 2012–13 HSE. We are developing laboratory methods and protocols for real-time serological assays of a novel pandemic influenza virus using these specimens, and automated programmes for analysing and reporting illness and infection rates.
Phase 3
: during inter-pandemic years, the study enters a holding phase, where it is included in the yearly HSE ethics application and planning procedures, allowing rapid triggering in a pandemic.
Phase 4
: once retriggered, the study will utilise the methods developed in phase 2 to monitor the severity and spread of the pandemic in real time.
Results
Phase 1
: the rates of reported illness during the first two waves in the HSE underestimated the community burden as measured by Flu Watch, but the patterns of illness by age and time were broadly comparable. The extent of underestimation was greatest for HSE participants interviewed later in the year compared with those interviewed closer to the pandemic. Vaccine uptake in the HSE study was comparable to independent national estimates and the Flu Watch study.
Phases 2 and 3
: illness data and serological samples from 2018 participants were collected in the 2012–13 HSE and transferred to the University College London Hospital. In the 2013 HSE and onwards, this project was included in the annual HSE ethics and planning rounds.
Conclusions
The HSE’s underestimation of illness rates during the first two waves of the pandemic is probably due to recall bias and the limitation of being able to report only one illness when multiple illnesses per season can occur. Changes to the illness questions (reporting only recent illnesses) should help minimise these issues. Additional prospective follow-up could improve measurement of disease incidence. The representative nature of the HSE allows accurate measurements of vaccine uptake.
Study registration
This study is registered as ISRCTN80214280.
Funding
This project was funded by the NIHR Public Health Research programme and will be published in full in
Public Health Research
; Vol. 3, No. 6. See the NIHR Journals Library website for further project information. Background: Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response. It requires community-level studies to estimate the burden of infection and disease. Rapidly initiating such studies in a pandemic is difficult. The study aims to establish an efficient system allowing real-time assessment of population susceptibility, spread of infection and clinical attack rates in the event of a pandemic. Methods: We developed and appended additional survey questions and specimen collection to the Health Survey for England (HSE) – a large, annual, rolling nationally representative general population survey recruiting throughout the year – to enable rapid population-based surveys of influenza infection and disease during a pandemic. Using these surveys we can assess the spread of the virus geographically, by age and through time. The data generated can also provide denominators for national estimates of case fatality and hospitalisation rates. Phase 1: we compared retrospectively collected HSE illness rates during the first two infection waves of the 2009 pandemic with the Flu Watch study (a prospective community cohort). Monthly and seasonal age-specific rates of illness and proportion vaccinated were compared. Phase 2: we piloted blood specimen and data collection alongside the 2012–13 HSE. We are developing laboratory methods and protocols for real-time serological assays of a novel pandemic influenza virus using these specimens, and automated programmes for analysing and reporting illness and infection rates. Phase 3: during inter-pandemic years, the study enters a holding phase, where it is included in the yearly HSE ethics application and planning procedures, allowing rapid triggering in a pandemic. Phase 4: once retriggered, the study will utilise the methods developed in phase 2 to monitor the severity and spread of the pandemic in real time. Results: Phase 1: the rates of reported illness during the first two waves in the HSE underestimated the community burden as measured by Flu Watch, but the patterns of illness by age and time were broadly comparable. The extent of underestimation was greatest for HSE participants interviewed later in the year compared with those interviewed closer to the pandemic. Vaccine uptake in the HSE study was comparable to independent national estimates and the Flu Watch study. Phases 2 and 3: illness data and serological samples from 2018 participants were collected in the 2012–13 HSE and transferred to the University College London Hospital. In the 2013 HSE and onwards, this project was included in the annual HSE ethics and planning rounds. Conclusions: The HSE’s underestimation of illness rates during the first two waves of the pandemic is probably due to recall bias and the limitation of being able to report only one illness when multiple illnesses per season can occur. Changes to the illness questions (reporting only recent illnesses) should help minimise these issues. Additional prospective follow-up could improve measurement of disease incidence. The representative nature of the HSE allows accurate measurements of vaccine uptake. Study registration: This study is registered as ISRCTN80214280. Funding: This project was funded by the NIHR Public Health Research programme and will be published in full in Public Health Research; Vol. 3, No. 6. See the NIHR Journals Library website for further project information. |
Author | Quinlivan, Mark Breuer, Judith Hayward, Andrew C Hutchings, Stephanie Fragaszy, Ellen B Craig, Rachel Kidd, Michael Mindell, Jennifer |
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Cites_doi | 10.1136/bmj.b2840 10.1371/journal.pone.0017074 10.1093/ije/dyr199 10.1371/journal.pmed.1000275 10.1136/bmj.b5213 10.1371/journal.pone.0011677 10.1016/S2213-2600(14)70034-7 10.1128/CVI.00368-08 10.1111/1469-0691.12477 10.1371/journal.pmed.1000207 10.1186/1471-2334-11-68 10.1128/CVI.05072-11 10.1371/journal.ppat.1003061 10.3310/hta14550-03 |
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References | Craig (key20150701152716668_ref1-bib19) 2011 Garske (key20150701152716668_ref1-bib16) 2009; 339 Donaldson (key20150701152716668_ref1-bib10) 2009; 339 Monica Sethi (key20150701152716668_ref1-bib17) 2010 Baguelin (key20150701152716668_ref1-bib11) 2011; 6 Presanis (key20150701152716668_ref1-bib9) 2009; 6 Hine (key20150701152716668_ref1-bib4) 2010 key20150701152716668_ref1-bib5 Mindell (key20150701152716668_ref1-bib13) 2012; 41 Noah (key20150701152716668_ref1-bib15) 2009; 16 Brooks-Pollock (key20150701152716668_ref1-bib6) 2011; 11 Hayward (key20150701152716668_ref1-bib12) 2014; 2 Cauchemez (key20150701152716668_ref1-bib20) 2012; 8 Van Kerkhove (key20150701152716668_ref1-bib1) 2010; 7 Paolotti (key20150701152716668_ref1-bib7) 2014; 20 Hardelid (key20150701152716668_ref1-bib3) 2010; 14 Broberg (key20150701152716668_ref1-bib2) 2011; 18 Craig (key20150701152716668_ref1-bib14) 2011 Hadler (key20150701152716668_ref1-bib8) 2010; 5 Fateha Begum (key20150701152716668_ref1-bib18) 2010 |
References_xml | – ident: key20150701152716668_ref1-bib5 – volume: 339 start-page: b2840 year: 2009 ident: key20150701152716668_ref1-bib16 article-title: Assessing the severity of the novel influenza A/H1N1 pandemic publication-title: BMJ doi: 10.1136/bmj.b2840 contributor: fullname: Garske – volume: 6 start-page: e17074 year: 2011 ident: key20150701152716668_ref1-bib11 article-title: Age-specific incidence of A/H1N1 2009 influenza infection in England from sequential antibody prevalence data using likelihood-based estimation publication-title: PLOS ONE doi: 10.1371/journal.pone.0017074 contributor: fullname: Baguelin – volume: 41 start-page: 1585 year: 2012 ident: key20150701152716668_ref1-bib13 article-title: Cohort profile: the health survey for England publication-title: Int J Epidemiol doi: 10.1093/ije/dyr199 contributor: fullname: Mindell – volume-title: Health Survey for England 2010. Volume 1: Respiratory Health year: 2011 ident: key20150701152716668_ref1-bib19 contributor: fullname: Craig – volume: 7 start-page: e1000275 year: 2010 ident: key20150701152716668_ref1-bib1 article-title: Studies needed to address public health challenges of the 2009 H1N1 influenza pandemic: insights from modeling publication-title: PLOS Med doi: 10.1371/journal.pmed.1000275 contributor: fullname: Van Kerkhove – volume: 339 start-page: b5213 year: 2009 ident: key20150701152716668_ref1-bib10 article-title: Mortality from pandemic A/H1N1 2009 influenza in England: public health surveillance study publication-title: BMJ doi: 10.1136/bmj.b5213 contributor: fullname: Donaldson – volume: 5 start-page: e11677 year: 2010 ident: key20150701152716668_ref1-bib8 article-title: Case fatality rates based on population estimates of influenza-like illness due to novel H1N1 influenza: New York City, May–June 2009 publication-title: PLOS ONE doi: 10.1371/journal.pone.0011677 contributor: fullname: Hadler – volume: 2 start-page: 445 year: 2014 ident: key20150701152716668_ref1-bib12 article-title: Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study publication-title: Lancet Respir Med doi: 10.1016/S2213-2600(14)70034-7 contributor: fullname: Hayward – volume: 16 start-page: 558 year: 2009 ident: key20150701152716668_ref1-bib15 article-title: Qualification of the hemagglutination inhibition assay in support of pandemic influenza vaccine licensure publication-title: Clin Vaccine Immunol doi: 10.1128/CVI.00368-08 contributor: fullname: Noah – volume-title: The 2009 Influenza Pandemic. An Independent Review of the UK Response to the 2009 Influenza Pandemic year: 2010 ident: key20150701152716668_ref1-bib4 contributor: fullname: Hine – volume-title: Seasonal Influenza Vaccine Uptake Among the 65 years and Over and Under 65 Years at Risk in England year: 2010 ident: key20150701152716668_ref1-bib18 contributor: fullname: Fateha Begum – volume: 20 start-page: 17 year: 2014 ident: key20150701152716668_ref1-bib7 article-title: Web-based participatory surveillance of infectious diseases: the Influenzanet participatory surveillance experience publication-title: Clin Microbiol Infect doi: 10.1111/1469-0691.12477 contributor: fullname: Paolotti – volume: 6 start-page: e1000207 year: 2009 ident: key20150701152716668_ref1-bib9 article-title: The severity of pandemic H1N1 influenza in the United States, from April to July 2009: a Bayesian analysis publication-title: PLOS Med doi: 10.1371/journal.pmed.1000207 contributor: fullname: Presanis – volume: 11 start-page: 68 year: 2011 ident: key20150701152716668_ref1-bib6 article-title: Using an online survey of healthcare-seeking behaviour to estimate the magnitude and severity of the 2009 H1N1v influenza epidemic in England publication-title: BMC Infect Dis doi: 10.1186/1471-2334-11-68 contributor: fullname: Brooks-Pollock – volume: 18 start-page: 1205 year: 2011 ident: key20150701152716668_ref1-bib2 article-title: Seroprevalence to influenza A(H1N1) 2009 virus – where are we? publication-title: Clin Vaccine Immunol doi: 10.1128/CVI.05072-11 contributor: fullname: Broberg – volume-title: Pandemic H1N1 (Swine) Influenza Vaccine Uptake Amongst Patient Groups in Primary Care in England 2009/10 year: 2010 ident: key20150701152716668_ref1-bib17 contributor: fullname: Monica Sethi – volume: 8 start-page: e1003061 year: 2012 ident: key20150701152716668_ref1-bib20 article-title: Influenza infection rates, measurement errors and the interpretation of paired serology publication-title: PLOS Pathog doi: 10.1371/journal.ppat.1003061 contributor: fullname: Cauchemez – volume: 14 issue: 55 year: 2010 ident: key20150701152716668_ref1-bib3 article-title: Assessment of baseline age-specific antibody prevalence and incidence of infection to novel influenza A/H1N1 2009 publication-title: Health Technol Assess doi: 10.3310/hta14550-03 contributor: fullname: Hardelid – volume-title: Health Survey for England 2010. Volume 2: Methods and Documentation year: 2011 ident: key20150701152716668_ref1-bib14 contributor: fullname: Craig |
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Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional response.... Background: Assessing severity and spread of a novel influenza strain at the start of a pandemic is critical for informing a targeted and proportional... |
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Title | Population-level susceptibility, severity and spread of pandemic influenza: design of, and initial results from, a pre-pandemic and hibernating pandemic phase study using cross-sectional data from the Health Survey for England (HSE) |
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