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. 2024 Jun 14;229(6):1823-1829.
doi: 10.1093/infdis/jiad417.

Estimating the Burden of Influenza Hospitalizations Across Multiple Seasons Using Capture-Recapture

Amanda C Howa  1 , Yuwei Zhu  2 , Dayna Wyatt  1 , Tiffanie Markus  1 , James D Chappell  3 , Natasha Halasa  3 , Christopher H Trabue  4 , Samantha M Olson  5 , Jill Ferdinands  5 , Shikha Garg  5 , William Schaffner  1   6 , Carlos G Grijalva  1   7 , H Keipp Talbot  1   6
Affiliations

Estimating the Burden of Influenza Hospitalizations Across Multiple Seasons Using Capture-Recapture

Amanda C Howa et al. J Infect Dis. .

Abstract

Background: Influenza remains an important cause of hospitalizations in the United States. Estimating the number of influenza hospitalizations is vital for public health decision making. Combining existing surveillance systems through capture-recapture methods allows for more comprehensive burden estimations.

Methods: Data from independent surveillance systems were combined using capture-recapture methods to estimate influenza hospitalization rates for children and adults in Middle Tennessee during consecutive influenza seasons from 2016-2017 through 2019-2020. The Emerging Infections Program (EIP) identified cases through surveillance of laboratory results for hospitalized children and adults. The Hospitalized Adult Influenza Vaccine Effectiveness Network (HAIVEN) and New Vaccine Surveillance Network (NVSN) recruited hospitalized patients with respiratory symptoms or fever. Population-based influenza rates and the proportion of cases detected by each surveillance system were calculated.

Results: Estimated overall influenza hospitalization rates ranged from 23 influenza-related hospitalizations per 10 000 persons in 2016-2017 to 40 per 10 000 persons in 2017-2018. Adults aged ≥65 years had the highest hospitalization rates across seasons and experienced a rate of 170 hospitalizations per 10 000 persons during the 2017-2018 season. EIP consistently identified a higher proportion of influenza cases for adults and children compared with HAIVEN and NVSN, respectively.

Conclusions: Current surveillance systems underestimate the influenza burden. Capture-recapture provides an alternative approach to use data from independent surveillance systems and complement population-based burden estimates.

Keywords: capture-recapture; hospitalizations; influenza.

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Conflict of interest statement

Potential conflicts of interest. C. G. G. reports grants from Campbell Alliance/Syneos Health, the National Institutes of Health, the US Food and Drug Administration, the Agency for Healthcare Research and Quality, and Sanofi Pasteur, as well as consultation fees from Merck. All other authors report no potential conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Capture-recapture estimation using data from 2 independent surveillance sources using the Chapman method. Abbreviations: EIP, Emerging Infections Program; HAIVEN, Hospitalized Adult Influenza Vaccine Effectiveness Network; NVSN, New Vaccine Surveillance Network.
Figure 2.
Figure 2.
Influenza hospitalizations by capture-recapture estimates and surveillance systems for pediatric (A) and adult (B) cases in Middle Tennessee across 4 influenza seasons. Abbreviations: EIP, Emerging Infections Program; HAIVEN, Hospitalized Adult Influenza Vaccine Effectiveness Network; NVSN, New Vaccine Surveillance Network. Transformed logit confidence intervals were used for capture-recapture; Poisson confidence intervals were used for EIP and HAIVEN/NVSN.
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