Real-time prescription surveillance and its application to monitoring seasonal influenza activity in Japan

Abstract

Background: Real-time surveillance is fundamental for effective control of disease outbreaks, but the official sentinel surveillance in Japan collects information related to disease activity only weekly and updates it with a 1-week time lag.

Objective: To report on a prescription surveillance system using electronic records related to prescription drugs that was started in 2008 in Japan, and to evaluate the surveillance system for monitoring influenza activity during the 2009-2010 and 2010-2011 influenza seasons.

Methods: We developed an automatic surveillance system using electronic records of prescription drug purchases collected from 5275 pharmacies through the application service provider's medical claims service. We then applied the system to monitoring influenza activity during the 2009-2010 and 2010-2011 influenza seasons. The surveillance system collected information related to drugs and patients directly and automatically from the electronic prescription record system, and estimated the number of influenza cases based on the number of prescriptions of anti-influenza virus medication. Then it shared the information related to influenza activity through the Internet with the public on a daily basis.

Results: During the 2009-2010 influenza season, the number of influenza patients estimated by the prescription surveillance system between the 28th week of 2009 and the 12th week of 2010 was 9,234,289. In the 2010-2011 influenza season, the number of influenza patients between the 36th week of 2010 and the 12th week of 2011 was 7,153,437. The estimated number of influenza cases was highly correlated with that predicted by the official sentinel surveillance (r = .992, P < .001 for 2009-2010; r = .972, P < .001 for 2010-2011), indicating that the prescription surveillance system produced a good approximation of activity patterns.

Conclusions: Our prescription surveillance system presents great potential for monitoring influenza activity and for providing early detection of infectious disease outbreaks.

Figure 1

Prescription surveillance. Pharmacies A–D use the application service provider’s (ASP) medical claims service. All data are stored in a central database. The surveillance system automatically counts oseltamivir, zanamivir, and laninamivir prescriptions at the data center. The information is analyzed using multiple regression models. The results are presented as figures and tables and feedback to participating pharmacies as well as public health authorities.

Figure 2

Number of influenza cases, 2009–2011, estimated by the prescription surveillance and reported by the official sentinel surveillance. The estimated number of influenza cases by prescription surveillance was calculated based on the number of oseltamivir, zanamivir, and laninamivir prescriptions adjusted by the proportion of participating pharmacies and extramural dispensing percentage. See text for details. The reported number by the official sentinel surveillance shows the number of influenza patients per clinic or hospital, calculated with the reported number of influenza patients from 5000 sentinel clinics and hospitals.