Background: Early and accurate diagnosis of influenza helps start correct treatment and
prevention strategies at individual level. Ongoing systematic collection, analysis and
dissemination of the surveillance data from aggregated diagnostic results and other early
indicators help gather the foremost disease information for all subsequent control and
mitigation strategies in the community. Disease information from surveillance results then
feed back to medical practitioners for improving diagnosis. By improving this loop of
disease information transfer in terms of accuracy and timeliness, interventions for disease
control can be applied efficiently and effectively.
Methods: Several new influenza diagnosis and surveillance methods were explored and
evaluated by comparing with laboratory reference test results. Logistic regression models
were applied to synthesize a refined clinical guideline for human influenza infections. The performance of QuickVue rapid diagnostic test was evaluated in a community setting.
Weekly positive rates from the above two diagnostic methods, together with three other
different syndromic surveillance systems, including data from school absenteeism, active
telephone survey and internet based survey were evaluated according to the US CDC
public health surveillance systems guideline in terms of their utility, correlations and
aberration detection performance. Different combinations of surveillance data streams and
aberration detection algorithms were evaluated to delineate the optimal use of multi-stream
influenza surveillance data. A framework of efficient surveillance data dissemination was
synthesized by incorporating the merits of the online national surveillance websites and the
principles of efficient data presentation and dashboard design.
Results: A refined clinical diagnostic rule for influenza infection using fever, cough runny
nose and clinic visit during high influenza activity months as predictors was scored the
highest amount all other current clinical definitions. Time series weekly positive rate from
this rule showed better correlation with reference community influenza activity than many
other current clinical influenza definitions. The QuickVue rapid diagnostic test has an
overall diagnostic sensitivity of 68% and specificity 96%, with an analytic sensitivity
threshold of 105 to106 viral copies per ml. Weekly aggregated QuickVue and school
absenteeism surveillance data was found to be highly correlated with hospital laboratory
and community sentinel surveillance data, but the telephone and internet survey was only
moderately correlated. Multiple univariate methods performed slightly better than
multivariate methods for aberration detections in general. More sophisticated outbreak
detection algorithms did not result in significant improvement of outbreak detection / published_or_final_version / Community Medicine / Doctoral / Doctor of Philosophy
| Identifer | oai:union.ndltd.org:HKU/oai:hub.hku.hk:10722/161576 |
| Date | January 2012 |
| Creators | Cheng, Ka-yeung., 鄭家揚. |
| Contributors | Cowling, BJ, Leung, GM, Ip, DKM |
| Publisher | The University of Hong Kong (Pokfulam, Hong Kong) |
| Source Sets | Hong Kong University Theses |
| Language | English |
| Detected Language | English |
| Type | PG_Thesis |
| Source | http://hub.hku.hk/bib/B48079819 |
| Rights | The author retains all proprietary rights, (such as patent rights) and the right to use in future works., Creative Commons: Attribution 3.0 Hong Kong License |
| Relation | HKU Theses Online (HKUTO) |
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