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The Community Burden of Influenza

Fragaszy, Ellen; (2022) The Community Burden of Influenza. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Background: Influenza causes substantial morbidity and mortality. Novel strains from animals can infect humans, but such transmission is poorly understood. Serosurveillance estimates levels of influenza population immunity and infection but obtaining representative sera is challenging. Health-related quality of life (HRQoL) and absenteeism inform cost-effectiveness models of influenza interventions but these parameters are poorly understood. The National Pandemic Flu Service (NPFS) aimed to treat community cases. Little is known about the scheme’s coverage or effectiveness. / Objectives: 1) Investigate whether occupational exposure to pigs increases risk of seasonal, pandemic and zoonotic influenza infection. 2) Describe population-level patterns of influenza infection and immunity in England during 2012/13. 3) Quantify work and school absences and HRQoL from community influenza illnesses. 4) Evaluate the success of the NPFS and propose algorithm changes to improve antiviral targeting. / Methods: Flu Watch is a prospective community cohort of influenza and included recruitment of pig workers during the 2009 pandemic. The Pandemic Immunity and Population Spread study (PIPS) is a novel, population-level, cross-sectional, pandemic serosurveillance system utilizing the Health Survey for England. / Results: Pig workers had increased odds of seropositivity to seasonal, pandemic, and zoonotic influenza compared to the general population. A(H1N1)pdm09 and A(H3N2) infected 40% and 25% of the population in 2012/13. HRQoL loss and absenteeism is low for individual community-level influenza cases. NPFS consultation was low and the case definition specificity was 51%. / Conclusions: Influenza spreads readily from pigs to pig workers, posing risks for novel virus emergence and pandemics. Representative, population-level serology show that, before COVID-19, a large proportion of the population was infected each winter. Most community influenza cases take little time off work and school and this has implications for transmission. The coverage and impact of NPFS was low. Community-based surveys are needed to inform the control of seasonal and pandemic respiratory infections.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: The Community Burden of Influenza
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2022. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
Keywords: Influenza, Epidemiology, Pandemic, Community Studies, Population-based studies, Cohort studies, Seroepidemiologic Studies, Severity, Burden, Impact, Swine, Quality of life, Surveillance, Antivirals
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Health Informatics
URI: https://discovery.ucl.ac.uk/id/eprint/10151113
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