Influenza surveillance in Europe: establishing epidemic thresholds by the moving epidemic method.
BACKGROUND
Timely influenza surveillance is important to monitor influenza epidemics.


OBJECTIVE
(i) To calculate the epidemic threshold for influenza-like illness (ILI) and acute respiratory infections (ARI) in 19 countries, as well as the thresholds for different levels of intensity. (ii) To evaluate the performance of these thresholds.


METHODS
The moving epidemic method (MEM) has been developed to determine the baseline influenza activity and an epidemic threshold. False alerts, detection lags and timeliness of the detection of epidemics were calculated. The performance was evaluated using a cross-validation procedure.


RESULTS
The overall sensitivity of the MEM threshold was 71·8% and the specificity was 95·5%. The median of the timeliness was 1 week (range: 0-4·5).


CONCLUSIONS
The method produced a robust and specific signal to detect influenza epidemics. The good balance between the sensitivity and specificity of the epidemic threshold to detect seasonal epidemics and avoid false alerts has advantages for public health purposes. This method may serve as standard to define the start of the annual influenza epidemic in countries in Europe.
Dirección General de Salud Pública, Consejería de Sanidad, Valladolid, Spain. vegaloto@jcyl.es
Tomás
T
Vega
Jose Eugenio
JE
Lozano
Tamara
T
Meerhoff
René
R
Snacken
Joshua
J
Mott
Raul
R
Ortiz de Lejarazu
Baltazar
B
Nunes
D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D006801:Humans; D007251:Influenza, Human / Q000453:epidemiology*; D012680:Sensitivity and Specificity; D013997:Time Factors