Monitoring Trends in Influenza and Other Respiratory Infections and Healthcare Utilization through Community-Based Participatory Surveillance

The Influenza Division at CDC utilizes data from Outbreaks Near Me, a participatory surveillance system, which relies on individuals in the population to report on symptoms, healthcare utilization, vaccination status, and testing for respiratory infections. These data are used to inform estimation of influenza and COVID-19 disease burden. Specifically, this system is the only source of data to assess healthcare utilization among individuals who report feeling unwell. The system captures information on respiratory, digestive, and whole body symptoms, which can be summarized into syndromic case definitions for influenza-like illness or covid-like illness. These can be further summarized to determine what proportion of individuals who meet one of these syndromic case definitions also sought medical care. These data metrics to understand healthcare utilization for epidemiologic week by age group and geographic area does not exist from other sources and are critical to providing information that is used in estimation of influenza and COVID-19 disease burden. These data are used to adjust influenza or COVID-19 infection data to quantify the numbers who sought medical care. In addition to using these data for disease burden estimation, studies to examine vaccination for influenza and COVID-19, changes in symptom presentation over time for COVID-19 and/or influenza, and information about testing for influenza and COVID-19 can be explored with these data. The Outbreaks Near Me system is the only system of its kind in the United States. It enrolls participants from anywhere in the U.S. and allows them to report health status for themselves or family members. The system collects information on participant age, gender, location (e.g., zipcode), vaccination for influenza and COVID-19, and health status. If participants report feeling well, they are prompted to answer questions about being tested for COVID-19 in the past 30 days and reasons for being tested. If participants report feeling unwell, they are prompted to report symptoms experienced, health seeking behaviors, and testing for respiratory illness. Participants are able to report for themselves and household members. Information can then be summarized by syndromic case definitions by geographic area, age group and epidemiologic week. The proportion of individuals who sought medical care by age group and geographic region are used in burden models to estimate the number of individuals with a influenza-like illness or a covid-like illness who sought medical care. Not only can these estimates be used for national burden estimates, but can be used at the state and HHS Region level as well. Prior to launching Outbreaks Near Me, Boston Children's Hospital had two other systems that were used for influenza and COVID-19 burden, Flu Near You and COVID Near You. With the assistance of external partners, including representatives from CDC, these two systems were consolidated and Outbreaks Near Me was developed and launched. This advisory group still meets and evaluates relevant information to guide the future of this system. Flu Near You was established more than 10 years ago as a self-report symptom surveillance system. The vast experience from this system that the vendor obtained was critical establishing and guiding the launch of Outbreaks Near Me. This experience and the system make the vendor the only source able to provide these vital public health data services to the agency.