P. Quenel et W. Dab, INFLUENZA-A AND INFLUENZA-B EPIDEMIC CRITERIA-BASED ON TIME-SERIES ANALYSIS OF HEALTH-SERVICES SURVEILLANCE DATA, European journal of epidemiology, 14(3), 1998, pp. 275-285
Many countries now have epidemiological surveillance systems using hea
lth services-based indicators that allow detection of influenza epidem
ics. However, there is no accepted criterion for defining an influenza
epidemic. An epidemic criterion has been developed, based on a time-s
eries analysis of health services-based indicators collected on a week
ly basis by a surveillance network implemented in the Paris region sin
ce 1984: the Groupe Regional d'Observation de la Grippe (GROG). For ea
ch new season, an epidemic threshold is independently defined for each
health services-based indicator as the upper limit of the one-sided c
onfidence interval of the expected value calculated from the weekly di
fferences between the observed number of events and those predicted by
a SARIMA model fitted on the non-epidemic.data of previous seasons. E
pidemic criteria for influenza A and B are then defined from the combi
nation of both viral indicators and epidemic thresholds of individual
health services-based indicators. Among health indicators, sick-leave
data collected from GP's or the Health Insurance system, emergency hom
e medical visits, and influenza-like-illness reported by GP's are the
most sensitive indicators for the early recognition of epidemics. The
exceeding of the above mentioned thresholds combined with virological
data allows the specific detection of influenza A or B epidemics. This
time-series method of analysing surveillance data provides early and
reliable recognition of these epidemics.