title: The contribution of respiratory pathogens to the seasonality of NHS Direct calls.
abstract: OBJECTIVE
  Primary care is thought to bear half the cost of treating infections in the UK. We describe the seasonal variation in NHS Direct respiratory calls (a new source of primary care data) and estimate the contribution of specific respiratory pathogens to this variation.
  
  
  METHODS
  Linear regression models were used to estimate the weekly contribution of specific respiratory pathogens to the volume of NHS Direct respiratory calls (England and Wales, 2002-2004, all ages and 0-4 years).
  
  
  RESULTS
  Annual peaks in NHS Direct cough and difficulty breathing calls occurred in late December, with peaks in 'cold/flu' and fever calls occurring between November and April. The main explanatory variables were influenza (estimated to account for 72.5 calls per 100,000/year; 22% of 'cold/flu' calls; 15% of cough; and 13% of fever) and Streptococcus pneumoniae (55.5 per 100,000; 33% of 'cold/flu' calls; 20% of cough; and 15% of fever (0-4 years)).
  
  
  CONCLUSIONS
  It is estimated that respiratory viruses, notably influenza and RSV, are responsible for at least 50% of the seasonal variation in NHS Direct respiratory calls. These results provide estimates of the burden of specific respiratory diseases reported to NHS Direct, and will help interpret syndromic surveillance data used to provide early warning of rises in community morbidity.
authors.affiliation: Health Protection Agency West Midlands, Lincoln House, Birmingham, UK. duncan.cooper@hpa.org.uk <duncan.cooper@hpa.org.uk>
authors.forename: D L
authors.initials: DL
authors.lastname: Cooper
authors.forename: G E
authors.initials: GE
authors.lastname: Smith
authors.forename: W J
authors.initials: WJ
authors.lastname: Edmunds
authors.forename: C
authors.initials: C
authors.lastname: Joseph
authors.forename: E
authors.initials: E
authors.lastname: Gerard
authors.forename: R C
authors.initials: RC
authors.lastname: George
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification / Q000379:methods; D004739:England / Q000453:epidemiology; D015277:Hotlines; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007251:Influenza, Human / Q000453:epidemiology; D008875:Middle Aged; D008954:Models, Biological; D011008:Pneumococcal Infections / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D040442:Public Health Informatics / Q000379:methods*; D018357:Respiratory Syncytial Virus Infections / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000382:microbiology; D012621:Seasons; D013045:Species Specificity; D014852:Wales / Q000453:epidemiology