Embed Size (px)
Citation preview
Jennifer Goff1,2, Aditya Rajan1,2, Rumi Chunara1,3 1Boston Children’s Hospital, Boston, MA; 2Boston University, Boston, MA; 3Harvard Medical School, Boston, MA
Influenza
Meningi,s
Methods
Results
(Above) Symptom reports
• Internet-‐based Influenza surveillance systems have been developed and deployed na9onally for years in 10 countries in Europe as well as Australia and here in the United States through Flu Near You [1, 2] (below)
• Isolated pilot efforts to employ viral detec9on have occurred, but to-‐date a scalable method for
par9cipatory diagnos9c sample collec9on has not been developed
• Community par9cipa9on in analysis and specimen for flu collec9on is largely unexplored
ObjecCve
Background
Results Next Steps and References
At Home Flu Test Kit
Feasibility of Oral and Nasal Samples for Flu DetecCon • Nasopharyngeal wash and aspirate are generally considered the gold standard method
of specimen collec9on, however lay volunteers cannot be asked to perform these techniques at home [3]
• Oral specimen collec9on systems have been widely used to obtain gene9c material for direct-‐to-‐consumer medical tests, however the literature on oral specimens is sparse
• Nasal swabs have been demonstrated to be used by volunteers to collect samples at home [4]
Current Internet-‐Based Influenza Surveillance
• These kits along with prepaid mailing
labels were mailed to par9cipants at the beginning of the influenza season
• Each of the kits sent to par9cipants
included: (leU) A) Rapid test B) Rapid test liquid reagent C) Nasal swab tube with transport medium D) Oral Specimen collector E) Flocked nasal swabs
Average la9tude of incoming and outgoing calls (open and solid points respec9vely) via the antennas, for the en9re na9on. Average la9tude increases from the period of December 5 – 18 to March 12 – March 25, aUer which it decreases again. Maximum change in la9tude is 0.285 degrees ≈ 33 km. In reference, the en9re country is approximately 600 km from North to South.
• Rapid immunoassays performed by the users were not useful in iden9fying the specimens that were posi9ve with influenza or other pathogens.
• Results show that samples generated by the public
are viable and public is willing to par9cipate
• The BioFire and Genmark systems produced generally the same results for Influenza A, Coronavirus, and RSV (leU)
1. van Noort SP, Muehlen M, Rebelo de Andrade H, Koppeschaar C, Lima Lourenco JM, Gomes MG. Gripenet: an internet-‐based system to monitor influenza-‐like illness uniformly across Europe. Euro Surveill. 2007;12(7):E5-‐6. 2. Carlson SJ, Dalton CB, Tuyl FA, Durrheim DN, Fejsa J, Muscatello DJ, et al. Flutracking surveillance: comparing 2007 New South Wales results with laboratory confirmed influenza no9fica9ons. Commun Dis Intell. 2009;33(3):323-‐7. 3. Irving S. VM, Shay D., Belongia E. Comparison of Nasal and Nasopharygeal Swabs for Influenza Detec9on in Adults. Clinical Medicine & Research 2012;10(4):215-‐8. 4. Daley P, Castriciano S, Chernesky M, Smieja M. Comparison of flocked and rayon swabs for collec9on of respiratory epithelial cells from uninfected volunteers and symptoma9c pa9ents. Journal of clinical microbiology. 2006;44(6):2265-‐7.
Results
Modern informa9cs-‐based par9cipatory surveillance systems are one approach to obtaining disease informa9on in real-‐9me and at scale. However, none of these Internet-‐based systems employ molecular techniques to rapidly verify the intelligence data they garner. This work describes the GoViral plamorm; designed to acquire community generated diagnos9c samples and couple them with other contemporaneous informa9on such as par9cipatory syndromic reports.
Specimen CollecCon
• Customized videos and instruc9on sheets showed par9cipants how to collect their samples (right)
• Par9cipants were also registered for the Flu Near
You site and reported symptoms through weekly surveys
• Samples tested by GenMark eSensor Respiratory
Panel and BioFire FilmArray Respiratory Panel
• Number of par9cipants with posi9ve results from oral or nasal specimen (above) • Among the cohort of enrolled study par9cipants, 76 par9cipants completed the
diagnos9c samples and specimens were sent for nucleic acid analysis.
• Future studies will increase the amount of reported data which will enable evalua9on of the rela9onship between reported symptom profiles and viral e9ology as well as spa9o-‐temporal distribu9on of upper respiratory infec9on, and impact of these efforts on individual’s public health and healthcare seeking behavior.
• Pa9ent-‐centered, rapid informa9on retrieval and distribu9on will enable
individuals to take more interest and responsibility for their health, drive healthcare costs down, and above all provide beoer care for everyone.
• More real-‐9me methods for detec9on can be incorporated and related decision making examined
• There were no consistent symptom profiles by pathogen (above leU)
• Age of par9cipants who submioed kits ranged from 20 to 77. (above right) • Par9cipants submioed kits an average of 3.29 (95% CI: 2.39, 4.18) days aUer symptoms
began
First Feasibility of a Surveillance PlaUorm to Monitor Upper Respiratory InfecCons with Community-‐SubmiXed Symptoms and Specimens for Molecular DiagnosCc TesCng
Influenza A Influenza A H1 Influenza A H3 Influenza A 2009 H1N Influenza B Respiratory Syncy9al Virus (RSV) A Respiratory Syncy9al Virus (RSV) B
Parainfluenza Virus (PIV) 1 Parainfluenza Virus (PIV) 2 Parainfluenza Virus (PIV) 3 Human Metapneumovirus (hMPV) Human Rhinovirus (HRV) Adenovirus B/E Adenovirus C
Influenza A Influenza A H1 Influenza A H3 Influenza A 2009 H1N1 Influenza B Respiratory Syncy9al Virus (RSV) Coronavirus HKU1 Coronavirus NL63 Coronavirus 229E Coronavirus OC43
Parainfluenza Virus (PIV) 1 Parainfluenza Virus (PIV) 2 Parainfluenza Virus (PIV) 3 Parainfluenza Virus (PIV) 4 Human Metapneumovirus (hMPV) Human Rhinovirus/Enterovirus Adenovirus Bordetla pertussis Chlmaydophilia pneumoniae Mycoplasma pneumoniae
GenMark eSensor Respiratory Panel BioFire FilmArray Respiratory Panel
• A cohort of 281 lay volunteers in the Boston area were recruited through a variety of modern channels
• Par9cipants were instructed to perform the specimen collec9on and rapid test within
48 hours of experiencing symptoms
• Flu Near You uses weekly symptom informa9on from the public to provide real-‐9me tracking of the flu. (leU)
Why We Need Influenza Surveillance • Influenza causes substan9al burden of illness and severe outcomes in the US every year • Despite this burden, there is limited informa9on on aoack rates in different popula9on groups
and limited means for assessing the magnitude of an evolving influenza season • Mobile and Internet-‐connected tools can enable a more real-‐9me picture of disease incidence • Contribu9ng data directly from the home can poten9ally capture informa9on on seemingly
mild illness that would not be disclosed to health care professional
