Abstract
Introduction: Sentinel surveillance in Japan is used to estimate national influenza incidence under the assumption that Sentinel Medical Institutions (SMIs) are randomly selected. The current method might lead to overestimation when SMIs are recruited on a voluntary basis. Aims & Objectives: We aimed to improve influenza incidence estimation using auxiliary information without this assumption. Materials and Method: We used reports of influenza from SMIs in 2015, together with the number of all disease outpatients in September 2014 at all medical institutions from the Survey of Medical Institutions of Japan, as auxiliary information. The influenza incidence was estimated by the method using auxiliary information and the current method (without auxiliary information). Result and Conclusion: Influenza incidence rate per 1,000 population in 2015 estimated by using auxiliary information and by the current method was 63.7 (95% Confidence Interval (CI), 61.0-66.3) and 96.5 (95% CI, 93.0-100.0), respectively. The ratio of these estimates was 0.66. Our findings suggest that influenza incidence estimated by using the number of all disease outpatients as auxiliary information is more accurate than estimates by the current method.
Highlights
Sentinel surveillance in Japan is used to estimate national influenza incidence under the assumption that Sentinel Medical Institutions (SMIs) are randomly selected
30 The Open Infectious Diseases Journal, 2018, Volume 10 studies have indicated that if SMIs were recruited on a voluntary basis, medical institutions with more patient visits for influenza would likely be selected as SMIs [6, 8]; this method would lead to overestimation of influenza incidence
Mean numbers of all disease outpatients at each type of medical institution were higher in SMIs than in all medical institutions
Summary
Sentinel surveillance in Japan is used to estimate national influenza incidence under the assumption that Sentinel Medical Institutions (SMIs) are randomly selected. The number of influenza patients reported by Sentinel Medical Institutions (SMIs) and the coverage of SMIs for the national population are often used [3]. In Japan, based on well-designed criteria for selecting SMIs in the guidelines for surveillance, influenza incidence is estimated under the assumption that SMIs are randomly selected [6, 7]. 30 The Open Infectious Diseases Journal, 2018, Volume 10 studies have indicated that if SMIs were recruited on a voluntary basis, medical institutions with more patient visits for influenza would likely be selected as SMIs [6, 8]; this method would lead to overestimation of influenza incidence. Data on the number of outpatients with diseases and injuries treated at each medical institution (all disease outpatients), available from the Survey of Medical Institutions conducted by the Ministry of Health, Labour and Welfare, would be useful as a substitute for the population coverage of SMIs when estimating national incidence [6, 10 - 12]
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