Self-Swabbing for Virological Confirmation of Influenza-Like Illness Among an Internet-Based Cohort in the UK During the 2014-2015 Flu Season: Pilot Study

Abstract

BackgroundRoutine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK’s largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza.ObjectiveWe designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory.MethodsVirological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing.ResultsA total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%).ConclusionsThis demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity.

Feasibility study for the use of self‐collected nasal swabs to identify pathogens among participants of a population‐based surveillance system for acute respiratory infections (GrippeWeb‐Plus)—Germany, 2016

“…The proportion of swabs taken after a report had been submitted was not as high (61%). In comparison with data from the literature, this proportion was lower than that reported by Wenham (77%), but higher than that reported from Goff (43%) . While no data were collected on the reasons why a swab was taken or not taken, taking a swab was not associated with symptom severity, so the simplest explanation would be just oversight; nevertheless, more detailed information would be useful in the interpretation of results.…”

“…Similar to the experience made by other researchers, self‐collection of nasal swabs was well accepted . The large majority of both adults and children would have been willing to participate in a self‐swabbing scheme for a longer period of time.…”

The potential value of crowdsourced surveillance systems in supplementing sentinel influenza networks: the case of France

“…In addition, GN could be coupled in the near future with virological confirmation from self-collected swabs from volunteering participants. With a pilot study within the United Kingdom system of Influenzanet [ 29 ], recent works confirmed indeed the feasibility and validity of self-collected swabs for respiratory virus surveillance [ 30 , 31 ]. The participatory approach would thus offer a novel solution to meet the recent recommendation by the World Health Organization prompting national sentinel networks to monitor also ARI episodes in order to describe a broader range of non-influenza viral pathogens [ 32 ].…”

Unsupervised extraction of epidemic syndromes from participatory influenza surveillance self-reported symptoms

“…However, we are aware that one of the criticisms of online participatory surveillance is the lack of virological confirmation of influenza cases that would instead help to better assess the actual circulation of influenza in the population. To this respect, a pilot study has been developed in the United Kingdom by the national Influenzanet platform, called Flusurvey, which demonstrates that self-swabbing can be applied to an online cohort to conduct virological laboratory testing [69].…”