Validity of clinical case definitions for influenza surveillance among hospitalized patients: results from a rural community in North India

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• Alternative Title:
  Influenza Other Respir Viruses
• Personal Author:
  Gupta, Vivek ; Dawood, Fatimah S. ; Rai, Sanjay K. ; Broor, Shobha ; Wigh, Rajan ; Mishra, Akhilesh C. ; Lafond, Kathryn ; Mott, Joshua A. ; Widdowson, Marc‐Alain ; Lal, Renu B. ; Krishnan, Anand
• Description:
  Clinical case definitions used for influenza surveillance among hospitalized patients vary and need systematic evaluation. DESIGN, SETTING AND SAMPLE: During July 2009-August 2011, we collected clinical data and specimens (nasal and throat swabs) from rural patients hospitalized for acute medical illnesses. Specimens were tested by rRT-PCR for influenza viruses.|Case definitions evaluated the following: influenza-like illness (ILI: measured fever plus cough or sore throat); severe acute respiratory illness (SARI: ILI with difficulty breathing in ≥5 years, Integrated Management of Childhood Illness-defined pneumonia or severe pneumonia, or physician diagnosed lower respiratory infection in <5 years); acute respiratory infection (ARI: ≥1 of cough, nasal discharge, difficulty breathing or sore throat); febrile acute respiratory illness (FARI: fever plus either cough, sore throat, runny nose, difficulty breathing, or earache). Variants that included "reported fever" and additional sign-symptom combinations were also evaluated.|We enrolled 1043 hospitalized patients, including 257 children <5 years of age (range 1 day-86 years). Seventy-four patients tested influenza virus positive (including 28 A(H1N1)pdm09). Sensitivity(95% CI) and specificity (95% CI) for influenza infection were 78% (67-87) and 60% (57-63) for ILI (measured/reported fever); 37% (26-49) and 78% (75-80) for SARI (measured/reported fever); 82% (72-90) and 57% (54-60) for FARI (measured/reported fever); 88% (78-94) and 45% (42-49) for ARI; and 74% (63-84) and 61% (58-64) for measured/reported fever plus cough. Case definitions including only measured fever had lower sensitivity.|ILI and FARI with measured/reported fever provided good balance between sensitivity and specificity among hospitalized patients. The simpler case definition of measured/reported fever plus cough is suited for field surveillance.
• Subjects:
  Adolescent Adult Aged Aged, 80 And Over Child Child, Preschool Female Hospitalization Humans Infant Influenza, Human Male Middle Aged Orthomyxoviridae Part 1 Rural Population Sentinel Surveillance Young Adult

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• Source:
  Influenza Other Respir Viruses. 7(3):321-329.
• Pubmed ID:
  22804843
• Pubmed Central ID:
  PMC5779832
• Document Type:
  Journal Article
• Funding:
  U01 IP000206/IP/NCIRD CDC HHS/United States
• Place as Subject:
  India
• Volume:
  7
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:66f5a5202b7f3fae4a31cb56689d74b01a8fd73ac8e6349219c35cf9895f792c
• Download URL:
  https://stacks.cdc.gov/view/cdc/51620/cdc_51620_DS1.pdf
• File Type:
  [PDF - 94.61 KB ]