title: "Google flu trends" and emergency department triage data predicted the 2009 pandemic H1N1 waves in Manitoba.
abstract: OBJECTIVE
  We assessed the performance of syndromic indicators based on Google Flu Trends (GFT) and emergency department (ED) data for the early detection and monitoring of the 2009 H1N1 pandemic waves in Manitoba.
  
  
  METHODS
  Time-series curves for the weekly counts of laboratory-confirmed H1N1 cases in Manitoba during the 2009 pandemic were plotted against the three syndromic indicators: 1) GFT data, based on flu-related Internet search queries, 2) weekly count of all ED visits triaged as influenza-like illness (ED ILI volume), and 3) percentage of all ED visits that were triaged as an ILI (ED ILI percent). A linear regression model was fitted separately for each indicator and correlations with weekly virologic data were calculated for different lag periods for each pandemic wave.
  
  
  RESULTS
  All three indicators peaked 1-2 weeks earlier than the epidemic curve of laboratory-confirmed cases. For GFT data, the best-fitting model had about a 2-week lag period in relation to the epidemic curve. Similarly, the best-fitting models for both ED indicators were observed for a time lag of 1-2 weeks. All three indicators performed better as predictors of the virologic time trends during the second wave as compared to the first. There was strong congruence between the time series of the GFT and both the ED ILI volume and the ED ILI percent indicators.
  
  
  CONCLUSIONS
  During an influenza season characterized by high levels of disease activity, GFT and ED indicators provided a good indication of weekly counts of laboratory-confirmed influenza cases in Manitoba 1-2 weeks in advance.
authors.affiliation: Department of Mathematics, University of Manitoba, Winnipeg, MB.
authors.forename: Mohammad Tufail
authors.initials: MT
authors.lastname: Malik
authors.forename: Abba
authors.initials: A
authors.lastname: Gumel
authors.forename: Laura H
authors.initials: LH
authors.lastname: Thompson
authors.forename: Trevor
authors.initials: T
authors.lastname: Strome
authors.forename: Salaheddin M
authors.initials: SM
authors.lastname: Mahmud
mesh_terms: D004196:Disease Outbreaks; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000821:virology*; D020407:Internet; D016014:Linear Models; D008350:Manitoba / Q000453:epidemiology; D011159:Population Surveillance; D014218:Triage