Abstract
BackgroundDirect observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence.MethodsWe conducted two five-year retrospective analyses of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections using the England Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) primary care sentinel network database; a cross-sectional study reporting incident rate ratio (IRR) from a negative binomial model and a retrospective cohort study, using a shared gamma frailty survival model, reporting hazard ratios (HR). We reported the following household characteristics: children < 5 years old, each extra household member, gender, ethnicity (reference white), chronic disease, pregnancy, and rurality.ResultsThe IRR where there was a child < 5 years were 1·62 (1·38–1·89, p < 0·0001), 2·40 (2.04–2.83, p < 0·0001) and 4·46 (3.79–5.255, p < 0·0001) for ILI, LRTI and URTI respectively. IRR also increased with household size, rurality and presentations and by female gender, compared to male. Household incidence of URTI and LRTI changed little between years whereas influenza did and were greater in years with lower vaccine effectiveness.The HR where there was a child < 5 years were 2·34 (95%CI 1·88–2·90, p < 0·0001), 2·97 (95%CI 2·76–3·2, p < 0·0001) and 10·32 (95%CI 10.04–10.62, p < 0·0001) for ILI, LRTI and URTI respectively. HR were increased with female gender, rurality, and increasing household size.ConclusionsPatterns of household incidence can be measured from routine data and may provide insights for the modelling of disease transmission and public health policy.
Highlights
Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models
Description of household size in the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network We identified a total of 6,825,919 households. 17% of these were occupied by only one person, about 20% were occupied by 2, 3 or 4 people, 10% had 5 people living in the households while the rest (12%) had 6 or more people living in them. (Table 1)
Identifying cases of household incidence and their differing age-sex profile We found 1407 cases of household incidence of influenza-like illness (ILI), 12, 375 of lower respiratory infections (LRTI) and 68,503 of Upper respiratory tract infections (URTI)
Summary
Direct observation of the household spread of influenza and respiratory infections is limited; much of our understanding comes from mathematical models. The study aims to determine household incidence of influenza-like illness (ILI), lower (LRTI) and upper (URTI) respiratory infections within a primary care routine data and identify factors associated with the diseases’ incidence. Some groups are known to be more susceptible to influenza and respiratory infection and may be more susceptible to household transmission. These include several chronic conditions such as asthma and other chronic respiratory conditions, vascular conditions, immunosuppression [5, 8], obesity [9], and pregnancy [10]. Most published research focuses on specific organisms rather than on clinical conditions such as upper (URTI) and lower respiratory infections (LRTI)
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