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Deploying digital health data to optimize influenza surveillance at national and local scales

Author(s): Lee, Elizabeth C.; Arab, Ali; Goldlust, Sandra M.; Viboud, Cécile; Grenfell, Bryan T.; et al

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Abstract: The surveillance of influenza activity is critical to early detection of epidemics and pandemics and the design of disease control strategies. Case reporting through a voluntary network of sentinel physicians is a commonly used method of passive surveillance for monitoring rates of influenza-like illness (ILI) worldwide. Despite its ubiquity, little attention has been given to the processes underlying the observation, collection, and spatial aggregation of sentinel surveillance data, and its subsequent effects on epidemiological understanding. We harnessed the high specificity of diagnosis codes in medical claims from a database that represented 2.5 billion visits from upwards of 120,000 United States healthcare providers each year. Among influenza seasons from 2002-2009 and the 2009 pandemic, we simulated limitations of sentinel surveillance systems such as low coverage and coarse spatial resolution, and performed Bayesian inference to probe the robustness of ecological inference and spatial prediction of disease burden. Our models suggest that a number of socioenvironmental factors, in addition to local population interactions, state-specific health policies, as well as sampling effort may be responsible for the spatial patterns in U.S. sentinel ILI surveillance. In addition, we find that biases related to spatial aggregation were accentuated among areas with more heterogeneous disease risk, and sentinel systems designed with fixed reporting locations across seasons provided robust inference and prediction. With the growing availability of health-associated big data worldwide, our results suggest mechanisms for optimizing digital data streams to complement traditional surveillance in developed settings and enhance surveillance opportunities in developing countries.
Publication Date: 7-Mar-2018
Electronic Publication Date: 7-Mar-2018
Citation: Lee, Elizabeth C., Arab, Ali, Goldlust, Sandra M., Viboud, Cécile, Grenfell, Bryan T., Bansal, Shweta. (2018). Deploying digital health data to optimize influenza surveillance at national and local scales. PLOS Computational Biology, 14 (3), e1006020 - e1006020. doi:10.1371/journal.pcbi.1006020
DOI: doi:10.1371/journal.pcbi.1006020
EISSN: 1553-7358
Pages: e1006020 - e1006020
Type of Material: Journal Article
Journal/Proceeding Title: PLOS Computational Biology
Version: Final published version. This is an open access article.

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