Investigating the efficacy of telephone health helpline mediated self-swabbing for the detection of influenza viruses: a viable tool for community based surveillance in Ontario.

Abstract

Self-swabbing mediated by a telephone health helpline (THHL) was explored as a community based surveillance tool for the detection of influenza viruses in Ontario. This surveillance system was designed to complement other surveillance systems and clinical based testing for influenza viruses by extending the reach of surveillance, through self-swabbing, to persons outside of the traditional health care setting. The “self-swabbing study” population, in terms of age and gender, residential environment, and marginalization, were explored and compared to influenza data captured by Public Health Ontario Laboratories (PHOL) during the same influenza year. Although these two populations were similar in many ways, the evaluation highlighted an increased use of the self-swabbing system among young children (age two to four years) and adults (age 20 to 39 years), and those from an area of greater ethnic concentration. Also, a larger portion of participants from rural or small population centres completed all steps of the study, as compared to those who agreed to participate initially but did not follow through. Further, this study was evaluated as a tool for early detection of influenza A and influenza B viruses relative to Public Health Agency of Canada’s FluWatch data, PHOL data, and Ontario’s Acute Care Enhanced Surveillance system. The self-swabbing study detected a rise in influenza B cases at the same time as the earliest corresponding surveillance sources using the peak comparison method; however, no sooner than any system. Lastly, the efficacy of using self-swabbing to sample influenza A and influenza B viruses was evaluated by comparing molecular test results from two different platforms: real-time reverse- transcription polymerase chain reaction (PCR) and multiplex PCR. In conclusion, self-swabbing is an appropriate method for obtaining and testing samples for influenza A and influenza B viruses based on a moderate and strong level of agreement between the results for the two viruses, respectively. Moreover, self-swabbing proved to be a successful sampling method for respiratory viruses broadly, given the detection of 13 additional respiratory viruses using this method. As such, the THHL mediated self- swabbing surveillance system has significant potential for use as a tool for laboratory-confirmed community based viral surveillance in Ontario.