A clinical diagnostic model for predicting influenza among young adult military personnel with febrile respiratory illness in Singapore

Influenza infections present with wide-ranging clinical features. We aim to compare the differences in presentation between influenza and non-influenza cases among those with febrile respiratory illness (FRI) to determine predictors of influenza infection. Personnel with FRI (defined as fever ≥ 37.5...

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Bibliographic Details
Published in:	PloS one Vol. 6; no. 3; p. e17468
Main Authors:	Lee, Vernon J, Yap, Jonathan, Cook, Alex R, Tan, Chi Hsien, Loh, Jin-Phang, Koh, Wee-Hong, Lim, Elizabeth A S, Liaw, Jasper C W, Chew, Janet S W, Hossain, Iqbal, Chan, Ka Wei, Ting, Pei-Jun, Ng, Sock-Hoon, Gao, Qiuhan, Kelly, Paul M, Chen, Mark I, Tambyah, Paul A, Tan, Boon Huan
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 02-03-2011 Public Library of Science (PLoS)
Subjects:	Absenteeism Adults Antigens Biology Camps Chills Cough Demographics Demography Diagnostic equipment (Medical) Diagnostic systems Diagnostic tests Disease control Epidemiology Etiology Female Fever Fever - complications High temperature Humans Illnesses Immunology Infections Influenza Influenza A Influenza A Virus, H1N1 Subtype - genetics Influenza B Influenza, Human - complications Influenza, Human - diagnosis Influenza, Human - epidemiology Influenza, Human - virology Male Medical diagnosis Medical laboratories Medical research Medicine Military Military Personnel Models, Biological Multivariate Analysis Nausea Nose Pandemics Personnel Pharyngitis Pharynx Population Public health Regression models Reproducibility of Results Respiratory diseases Reverse Transcriptase Polymerase Chain Reaction Singapore - epidemiology Statistical analysis Swine flu Viruses Vomiting Young Adult Young adults Youth Singapore Australia Canberra Australian Capital Territory Australia
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Summary:	Influenza infections present with wide-ranging clinical features. We aim to compare the differences in presentation between influenza and non-influenza cases among those with febrile respiratory illness (FRI) to determine predictors of influenza infection. Personnel with FRI (defined as fever ≥ 37.5 °C, with cough or sore throat) were recruited from the sentinel surveillance system in the Singapore military. Nasal washes were collected, and tested using the Resplex II and additional PCR assays for etiological determination. Interviewer-administered questionnaires collected information on patient demographics and clinical features. Univariate comparison of the various parameters was conducted, with statistically significant parameters entered into a multivariate logistic regression model. The final multivariate model for influenza versus non-influenza cases was used to build a predictive probability clinical diagnostic model. 821 out of 2858 subjects recruited from 11 May 2009 to 25 Jun 2010 had influenza, of which 434 (52.9%) had 2009 influenza A (H1N1), 58 (7.1%) seasonal influenza A (H3N2) and 269 (32.8%) influenza B. Influenza-positive cases were significantly more likely to present with running nose, chills and rigors, ocular symptoms and higher temperature, and less likely with sore throat, photophobia, injected pharynx, and nausea/vomiting. Our clinical diagnostic model had a sensitivity of 65% (95% CI: 58%, 72%), specificity of 69% (95% CI: 62%, 75%), and overall accuracy of 68% (95% CI: 64%, 71%), performing significantly better than conventional influenza-like illness (ILI) criteria. Use of a clinical diagnostic model may help predict influenza better than the conventional ILI definition among young adults with FRI.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1 Conceived and designed the experiments: VJL JY JPL MIC PAT BHT. Performed the experiments: VJL JY CHT JPL WHK EASL JCWL JSWC IH. Analyzed the data: VJL JY ARC CHT JPL IH QHG PMK MIC PAT BHT. Contributed reagents/materials/analysis tools: ARC JPL WHK EASL JCWL JSWC IH KWC PJT SHN BHT. Wrote the paper: VJL JY ARC CHT JPL PMK MIC PAT BHT.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0017468