Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective da
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RESEARCH ARTICLE
Open Access
Household presentation of influenza and acute respiratory illnesses to a primary care sentinel network: retrospective database studies (2013–2018) Simon de Lusignan1,2,3* , Julian Sherlock1,3, Oluwafunmi Akinyemi1,3, Richard Pebody4, Alex Elliot4, Rachel Byford1,3, Ivelina Yonova1,3, Maria Zambon4 and Mark Joy1,3
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: Disease incidence, Infectious, Family characteristics, Population characteristics, Medical record systems, Computerized
* Correspondence: [email protected] 1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Woodstock Rd, Oxford OX2 6GG, UK 2 Royal College of General Practitioners Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and
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