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Do Family Physicians Make Good Sentinels for Influenza?
Joanna Buffington, MD;
Louisa E. Chapman, MD, MSPH;
Leone M. Schmeltz;
Alan P. Kendal, PhD
Arch Fam Med. 1993;2(8):859-864.
Abstract
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Objective
To determine whether volunteer family physician reports of the frequency of influenza—like illness (ILI) usefully supplement information from other influenza surveillance systems conducted by the Centers for Disease Control and Prevention.
Design
Evaluation of physician reports from five influenza surveillance seasons (1987-88 through 1991-92).
Setting
Family physician office practices in all regions of the United States.
Participants
An average of 140 physicians during each of five influenza seasons.
Interventions
None.
Outcome Measures
An office visit or hospitalization of a patient for ILI, defined as presence of fever (temperature  37.8°C) and cough, sore throat, or myalgia, along with the physician's clinical judgment of influenza. A subset of physicians collected specimens for confirmation of influenza virus by culture.
Results
Physicians attributed 81 408 (5%) of 1 672 542 office visits to ILI; 2754 (3%) patients with ILI were hospitalized. Persons 65 years of age and older accounted for 11% of visits for ILI and 43% of hospitalizations for ILI. In three of five seasons, physicians obtained influenza virus isolates from a greater proportion of specimens compared with those processed by World Health Organization laboratories (36% vs 12%). Influenza virus isolates from sentinel physicians peaked from 1 to 4 weeks earlier than those reported by World Health Organization laboratories. Physicians reported peak morbidity 1 to 4 weeks earlier than state and territorial health departments in four of five seasons and 2 to 5 weeks earlier than peak mortality reported by 121 cities during seasons with excess mortality associated with pneumonia and influenza.
Conclusions
Family physicians provide sensitive, timely, and accurate community influenza morbidity data that complement data from other surveillance systems. This information enables monitoring of the type, timing, and intensity of influenza activity and can help health care workers implement prevention or control measures.
Author Affiliations
From the Epidemic Intelligence Service, Epidemiology Program Office (Dr Buffington), and the Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention (Drs Chapman and Kendal and Ms Schmeltz), Atlanta, Ga. Dr Buffington is now with the Division of Training, Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga. Dr Kendal is now with the World Health Organization, European Regional Office, Copenhagen, Denmark.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Update: Influenza Activity-- United States, 1996-97 Season
JAMA 1997;277:105-106.
ABSTRACT
Editorial Comment
Konen
Arch Fam Med 1993;2:865-865.
ABSTRACT
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