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. 2020 Nov 20;20(1):1748.
doi: 10.1186/s12889-020-09790-3.

Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018)

Simon de Lusignan  1   2   3 , Julian Sherlock  4   5 , Oluwafunmi Akinyemi  4   5 , Richard Pebody  6 , Alex Elliot  6 , Rachel Byford  4   5 , Ivelina Yonova  4   5 , Maria Zambon  6 , Mark Joy  4   5
Affiliations

Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013-2018)

Simon de Lusignan et al. BMC Public Health. .

Abstract

Background: Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases' incidence.

Methods: We conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality.

Results: The IRR where there was a child < 5 years were 1·62 (1·38-1·89, p < 0·0001), 2·40 (2.04-2.83, p < 0·0001) and 4·46 (3.79-5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness. The HR where there was a child < 5 years were 2·34 (95%CI 1·88-2·90, p < 0·0001), 2·97 (95%CI 2·76-3·2, p < 0·0001) and 10·32 (95%CI 10.04-10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size.

Conclusions: Patterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy.

Keywords: Computerized; Disease incidence; Family characteristics; Infectious; Medical record systems; Population characteristics.

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Conflict of interest statement

SdeL is the Director of RCGP RSC, principally funded by PHE. He has received funding from GSK and Seqirus through the University of Surrey to study the monitoring of vaccine adverse events and attitudes to flu vaccination, respectively. He has attended advisory Boards for Sanofi and Seqirus.

Figures

Fig. 1
Fig. 1
Standardised rates of household incidence cases for ILI, LRTI, URTI by age band, gender and year. There is most variation between years in ILI, though LRTI and URTI follow a similar pattern. Other than for some years in ILI and in LRTI and URTI in the 0-4 year age-band, females generally present more than males. Change in incidence rate of ILI, LRTI and URTI with household size, socioeconomic status and presence of children under 5-years in the household: Registered Population of the RCGP RSC Surveillance Network of primary care practices in UK. 2013/14 Season to 2017/18 Season
Fig. 2
Fig. 2
Association of household size, socioeconomic status and a child under 5-years old in the household on household incidence rates of ILI, LRTI and URTI. Registered Population of the RCGP RSC Surveillance Network of primary care practices in UK. 2013/14 Season to 2017/18 Season
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