title: Influenza-like illness-related emergency department visits: Christmas and New Year holiday peaks and relationships with laboratory-confirmed respiratory virus detections, Edmonton, Alberta, 2004-2014.
abstract: Emergency department (ED) visit volumes can be especially high during the Christmas-New Year holidays, a period occurring during the influenza season in Canada.
  
  
  
  Using daily data, we examined the relationship between ED visits for the chief complaint "cough" (for Edmonton, Alberta residents) and laboratory detections for influenza A and respiratory syncytial virus (RSV) (for Edmonton and surrounding areas), lagged 0-5 days ahead, for non-pandemic years (2004-2008 and 2010-2014) using multivariable linear regression adjusting for temporal variables. We defined these cough-related visits as influenza-like illness (ILI)-related ED visits and, for 2004-2014, compared Christmas-New Year holiday (December 24-January 3) and non-holiday volumes during the influenza season (October-April).
  
  
  
  Adjusting for temporal variables, ILI-related ED visits were significantly associated with laboratory detections for influenza A and RSV. During non-pandemic years, the highest peak in ILI-related visit volumes always occurred during the holidays. The median number of holiday ILI-related visits/day (42.5) was almost twice the non-holiday median (24) and was even higher in 2012-2013 (80) and 2013-2014 (86). Holiday ILI-related ED visit volumes/100 000 population ranged from 56.0 (2010-2011) to 117.4 (2012-2013). In contrast, lower visit volumes occurred during the holidays of pandemic-affected years (2008-2010).
  
  
  
  During non-pandemic years, ILI-related ED visit volumes were associated with variations in detections for influenza A and RSV and always peaked during the Christmas-New Year holidays. This predictability should be used to prepare for, and possibly prevent, this increase in healthcare use; however, interventions beyond disease prevention strategies are likely needed.
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Leah J
authors.initials: LJ
authors.lastname: Martin
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Im
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.
authors.forename: Huiru
authors.initials: H
authors.lastname: Dong
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
authors.forename: Bonita E
authors.initials: BE
authors.lastname: Lee
authors.affiliation: Office of the Chief Medical Officer of Health, Alberta Health, Edmonton, AB, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Talbot
authors.affiliation: Alberta Health Services, Edmonton, AB, Canada.
authors.forename: David P
authors.initials: DP
authors.lastname: Meurer
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.|Canadian Network for Public Health Intelligence, National Microbiology Laboratory, Winnipeg, MB, Canada.
authors.forename: Shamir N
authors.initials: SN
authors.lastname: Mukhi
authors.affiliation: Provincial Laboratory for Public Health (ProvLab) Alberta, Alberta Health Services, Edmonton, AB, Canada.|Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Drews
authors.affiliation: School of Public Health, University of Alberta, Edmonton, AB, Canada.|Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
mesh_terms: D000293:Adolescent; D000328:Adult; D000416:Alberta / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D008297:Male; D008875:Middle Aged; D058873:Pandemics / Q000517:prevention & control; D011159:Population Surveillance; D018357:Respiratory Syncytial Virus Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D018113:Respiratory Syncytial Virus, Human / Q000302:isolation & purification; D012141:Respiratory Tract Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D012621:Seasons; D055815:Young Adult
keywords: Emergency Medical Services; influenza; respiratory syncytial viruses; respiratory tract infections; surveillance