TY - JOUR
T1 - Non-annual seasonality of influenza-like illness in a tropical urban setting.
AU - Lam, Ha Minh
AU - Wesolowski, Amy
AU - Hung, Nguyen Thanh
AU - Nguyen, Tran Dang
AU - Nhat, Nguyen Thi Duy
AU - Todd, Stacy
AU - Vinh, Dao Nguyen
AU - Vy, Nguyen Ha Thao
AU - Thao, Tran Thi Nhu
AU - Thanh, Nguyen Thi Le
AU - Tin, Phan Tri
AU - Minh, Ngo Ngoc Quang
AU - Bryant, Juliet E
AU - Buckee, Caroline O
AU - Ngoc, Tran Van
AU - Chau, Nguyen Van Vinh
AU - Thwaites, Guy E
AU - Farrar, Jeremy
AU - Tam, Dong Thi Hoai
AU - Vinh, Ha
AU - Boni, Maciej F
PY - 2018/11/1
Y1 - 2018/11/1
N2 - BACKGROUNDIn temperate and sub-tropical climates, respiratory diseases exhibit seasonal peaks in winter. In the tropics, with no winter, peak timings are irregular.METHODSTo obtain a detailed picture of influenza-like illness (ILI) patterns in the tropics, we established an mHealth study in community clinics in Ho Chi Minh City (HCMC). During 2009-2015, clinics reported daily case numbers via SMS, with a subset performing molecular diagnostics for influenza virus. This real-time epidemiology network absorbs 6,000 ILI reports annually, one or two orders of magnitude more than typical surveillance systems. A real-time online ILI indicator was developed to inform clinicians of the daily ILI activity in HCMC.RESULTSFrom August 2009 to December 2015, 63 clinics were enrolled and 37,676 SMS reports were received, covering approximately 1.8M outpatient visits. Approximately 10.6% of outpatients met the ILI case definition. ILI activity in HCMC exhibited strong non-annual dynamics with a dominant periodicity of 206 days. This was confirmed by time-series decomposition, step-wise regression, and a forecasting exercise showing that median forecasting errors are 30%-40% lower when using a 206-day cycle. In ILI patients from whom naso-pharyngeal swabs were taken, 31.2% were positive for influenza. There was no correlation between the ILI time series and the time series of influenza, influenza A, or influenza B (all p > 0.15).CONCLUSIONThis suggests, for the first-time, that a non-annual cycle may be an essential driver of respiratory disease dynamics in the tropics. An immunological interference hypothesis is discussed as a potential underlying mechanism. This article is protected by copyright. All rights reserved.
AB - BACKGROUNDIn temperate and sub-tropical climates, respiratory diseases exhibit seasonal peaks in winter. In the tropics, with no winter, peak timings are irregular.METHODSTo obtain a detailed picture of influenza-like illness (ILI) patterns in the tropics, we established an mHealth study in community clinics in Ho Chi Minh City (HCMC). During 2009-2015, clinics reported daily case numbers via SMS, with a subset performing molecular diagnostics for influenza virus. This real-time epidemiology network absorbs 6,000 ILI reports annually, one or two orders of magnitude more than typical surveillance systems. A real-time online ILI indicator was developed to inform clinicians of the daily ILI activity in HCMC.RESULTSFrom August 2009 to December 2015, 63 clinics were enrolled and 37,676 SMS reports were received, covering approximately 1.8M outpatient visits. Approximately 10.6% of outpatients met the ILI case definition. ILI activity in HCMC exhibited strong non-annual dynamics with a dominant periodicity of 206 days. This was confirmed by time-series decomposition, step-wise regression, and a forecasting exercise showing that median forecasting errors are 30%-40% lower when using a 206-day cycle. In ILI patients from whom naso-pharyngeal swabs were taken, 31.2% were positive for influenza. There was no correlation between the ILI time series and the time series of influenza, influenza A, or influenza B (all p > 0.15).CONCLUSIONThis suggests, for the first-time, that a non-annual cycle may be an essential driver of respiratory disease dynamics in the tropics. An immunological interference hypothesis is discussed as a potential underlying mechanism. This article is protected by copyright. All rights reserved.
U2 - 10.1111/irv.12595
DO - 10.1111/irv.12595
M3 - Article
SN - 1750-2640
VL - 12
SP - 742
EP - 754
JO - Influenza and other Respiratory Viruses
JF - Influenza and other Respiratory Viruses
IS - 6
ER -