Evaluation of self-swabbing coupled with a telephone health helpline as an adjunct tool for surveillance of influenza viruses in Ontario.
BACKGROUND
Calls to a telephone health helpline (THHL) have been previously evaluated for the ability to monitor specific syndromes, such as fever and influenza-like-illness or gastrointestinal illness. This method of surveillance has been shown to be highly correlated with traditional surveillance methods, and to have potential for early detection of community-based illness. Self-sampling, or having a person take his/her own nasal swab, has also proven successful as a useful method for obtaining a specimen, which may be used for respiratory virus detection.


METHODS
This study describes a self-swabbing surveillance system mediated by a nurse-led THHL in Ontario whereby syndromic surveillance concepts are used to recruit and monitor participants with influenza-like illness. Once recruited, participants collect a nasal specimen obtained by self-swabbing and submit for testing and laboratory confirmation. Enumeration of weekly case counts was used to evaluate the timeliness of the self-swabbing surveillance system through comparison to other respiratory virus and influenza surveillance systems in Ontario. The operational efficiency of the system was also evaluated.


RESULTS
The mean and median number of days between the day that a participant called the THHL, to the day a package was received at the laboratory for testing were approximately 10.4 and 8.6 days, respectively. The time between self-swab collection and package reception was 4.9 days on average, with a median of 4 days. The self-swabbing surveillance system adequately captured the 2014 influenza B season in a timely manner when compared to other Ontario-based sources of influenza surveillance data from the same year; however, the emergence of influenza B was not detected any earlier than with these other surveillance systems. Influenza A surveillance was also evaluated. Using the THHL self-swabbing system, a peak in the number of cases for influenza A was observed approximately one week after or during the same week as that reported by the other surveillance systems.


CONCLUSIONS
This one-year pilot study suggests that the THHL self-swabbing surveillance system has significant potential as an adjunct tool for the surveillance of influenza viruses in Ontario. Recommendations for improving system efficacy are discussed.
Queen's University, Kingston, Ontario, Canada.
D
D
McGolrick
Queen's University, Kingston, Ontario, Canada.|Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada.
P
P
Belanger
Queen's University, Kingston, Ontario, Canada.
H
H
Richardson
Queen's University, Kingston, Ontario, Canada.|Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada.
K
K
Moore
Kingston, Frontenac, and Lennox & Addington Public Health, Kingston, Ontario, Canada.
A
A
Maier
Queen's University, Kingston, Ontario, Canada. anna.majury@oahpp.ca.|Public Health Ontario, Kingston, Ontario, Canada. anna.majury@oahpp.ca.
A
http://orcid.org/0000-0001-7975-8401
A
Majury
Community-based; Influenza viruses; Ontario; Respiratory viruses; Self-swabbing; Surveillance
Can J Infect Dis Med Microbiol. 2013 Fall;24(3):150-4
24421826
MMWR Suppl. 2004 Sep 24;53:179-83
15717389
Annu Rev Pathol. 2008;3:499-522
18039138
Euro Surveill. 2015 Mar 12;20(10):21058
25788252
Int J Infect Dis. 2011 Nov;15(11):e799-803
21852171
Int J Infect Dis. 2011 Sep;15(9):e589-93
21641847
BMJ. 2009 Aug 27;339:b3403
19713236
Healthc Policy. 2007 Aug;3(1):e160-81
19305749
J Antimicrob Chemother. 1999 Nov;44 Suppl B:3-9
10877456
J Public Health Med. 2003 Dec;25(4):362-8
14747597
Crit Care Med. 2008 Sep;36(9):2660-6
18679129
J Am Med Inform Assoc. 2007 Sep-Oct;14(5):626-31
17600101
Vaccine. 2008 Sep 12;26 Suppl 4:D45-8
19230159
Can Fam Physician. 2011 Jan;57(1):42-4
21252129
Epidemiol Infect. 2008 Feb;136(2):222-4
17394678
Influenza Other Respir Viruses. 2008 Jan;2(1):1-8
19453488
Euro Surveill. 2015 Mar 19;20(11):null
25811646
CJEM. 2008 Jan;10(1):18-24
18226314
Pediatr Infect Dis J. 2006 Sep;25(9):795-800
16940836
PLoS One. 2012;7(11):e48508
23155387