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Open Access Research article

Evaluation of alternative respiratory syndromes for specific syndromic surveillance of influenza and respiratory syncytial virus: a time series analysis

Suzanne K Schindeler1, David J Muscatello1*, Mark J Ferson23, Kris D Rogers1, Paul Grant1 and Tim Churches1

Author Affiliations

1 Centre for Epidemiology and Research, New South Wales Department of Health, North Sydney, Australia

2 South Eastern Sydney and Illawarra Public Health Unit, Randwick, New South Wales, Australia

3 School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia

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BMC Infectious Diseases 2009, 9:190  doi:10.1186/1471-2334-9-190

Published: 29 November 2009



Syndromic surveillance is increasingly being evaluated for its potential for early warning of increased disease activity in the population. However, interpretation is hampered by the difficulty of attributing a causative pathogen. We described the temporal relationship between laboratory counts of influenza and respiratory syncytial virus (RSV) detection and alternative groupings of Emergency Department (ED) respiratory diagnoses.


ED and laboratory data were obtained for the south-eastern area of Sydney, NSW for the period 1 June 2001 - 1 December 2006. Counts of ED visits and laboratory confirmed positive RSV and influenza cases were aggregated by week. Semi-parametric generalized additive models (GAM) were used to determine the association between the incidence of RSV and influenza and the incidence of respiratory syndrome ED presentations while controlling for temporal confounders.


For every additional RSV laboratory count, ED diagnoses of bronchiolitis increased by 3.1% (95%CI: 2.7%-3.5%) in the same week. For every additional influenza laboratory count, ED diagnoses of influenza-like illness increased by 4.7% (95%CI: 4.2%-5.2%) one week earlier.


In this study, large increases in ED diagnoses of bronchiolitis and influenza-like illness were independent and proxy indicators for RSV and influenza activity, respectively.