title: Has estimation of numbers of cases of pandemic influenza H1N1 in England in 2009 provided a useful measure of the occurrence of disease?
abstract: BACKGROUND
  Surveillance indicators of influenza activity have generally provided robust comparative trend data for England. These indicators became less reliable, however, for monitoring trends in activity, or comparisons with previous years, during the influenza pandemic in 2009 because of changes in the perception of risk and changes in the systems of healthcare delivery. An approach was developed to estimate the number of cases of influenza-like illness (ILI) occurring because of infection with pandemic influenza virus.
  
  
  RESULTS
  The number of cases was estimated each week in England on the basis of total number of patients consulting healthcare services with ILI; estimates of the proportion of individuals in the community experiencing an ILI-seeking health care; and the proportion of these positive on laboratory testing. Almost 800,000 cases (range 375,000-1·6 million) of symptomatic ILI cases were estimated to have occurred over the course of the two waves of pandemic activity in England. More cases were estimated to have occurred in the second wave than in the first.
  
  
  CONCLUSIONS
  These results underestimate the total number of infections as they do not include asymptomatic infections nor those with mild illness not meeting the definition of a case of ILI. Nevertheless, the case number estimates provide a useful indicator of the trend in influenza activity and weekly data were extensively used in media reports. Although surveillance methods differ between countries, the approach of synthesising available data sources to produce an overall estimate of case numbers could be applied more widely to provide comparative data.
authors.affiliation: Health Protection Agency, Centre for Infections, London, UK. barry.evans@hpa.org.uk
authors.forename: Barry
authors.initials: B
authors.lastname: Evans
authors.forename: Andre
authors.initials: A
authors.lastname: Charlett
authors.forename: Cassandra
authors.initials: C
authors.lastname: Powers
authors.forename: Estelle
authors.initials: E
authors.lastname: McLean
authors.forename: Hongxin
authors.initials: H
authors.lastname: Zhao
authors.forename: Alison
authors.initials: A
authors.lastname: Bermingham
authors.forename: Gillian
authors.initials: G
authors.lastname: Smith
authors.forename: Tim
authors.initials: T
authors.lastname: Wreghitt
authors.forename: Nick
authors.initials: N
authors.lastname: Andrews
authors.forename: Richard
authors.initials: R
authors.lastname: Pebody
authors.forename: John M
authors.initials: JM
authors.lastname: Watson
mesh_terms: D000553:Ambulatory Care; D004739:England / Q000453:epidemiology; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification / Q000502:physiology*; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology; D058873:Pandemics; D011159:Population Surveillance / Q000379:methods*