Comparison of outpatient medically attended and community‐level influenza‐like illness—New York City, 2013‐2015

Russell, Kate E.; Fowlkes, Ashley; Stockwell, Melissa S.; Vargas, Celibell Y.; Saiman, Lisa; Larson, Elaine L.; LaRussa, Philip; Di Lonardo, Steve; Popowich, Michael; St. George, Kirsten; Steffens, Andrea; Reed, Carrie

BACKGROUND: Surveillance of influenza‐like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non‐medically attended ILI. OBJECTIVES: To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza‐Like Illness in the Community (MoSAIC) Study. METHODS: The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community‐based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. RESULTS: Five‐hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. CONCLUSIONS: Outpatient and community‐based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly.