Validity of clinical case definitions for influenza surveillance among hospitalized patients: results from a rural community in North India
Article first published online: 16 JUL 2012
Published 2012. This article is a US Government work and is in the public domain in the USA.
Influenza and Other Respiratory Viruses
Volume 7, Issue 3, pages 321–329, May 2013
Total views since publication: 189
How to Cite
Gupta, V., Dawood, F. S., Rai, S. K., Broor, S., Wigh, R., Mishra, A. C., Lafond, K., Mott, J. A., Widdowson, M.-A., Lal, R. B. and Krishnan, A. (2013), Validity of clinical case definitions for influenza surveillance among hospitalized patients: results from a rural community in North India. Influenza and Other Respiratory Viruses, 7: 321–329. doi: 10.1111/j.1750-2659.2012.00401.x
- Issue published online: 17 APR 2013
- Article first published online: 16 JUL 2012
- Accepted 6 June 2012. Published online 16 July 2012.
- Case definitions;
Objective: 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.
Main outcome measures: 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.
Results: 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.
Conclusion: 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.