JMIR Publications

ABSTRACT

Background:

Pre-pandemic sentinel surveillance was orientated towards improved management of winter pressures, with influenza-like illness (ILI) the key clinical indicator. Recently the World Health Organisation (WHO) has published global standards for influenza surveillance, which include monitoring acute respiratory infection (ARI) as well as ILI. The WHO’s mosaic framework recommends countries’ surveillance strategies include the virological monitoring of influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus (RSV) and other viruses with pandemic potential. The Oxford-Royal College of General Practitioner (RCGP) Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA), has provided sentinel surveillance since 1967 including virology since 1993.

Objective:

To describe the RSC’s plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework.

Methods:

Our approach, which includes patient and public involvement (PPI), contributes to surveillance objectives across all three domains of the mosaic framework. We will generate an ARI phenotype to enable reporting this indicator in addition to ILI. These data will support sentinel surveillance including vaccine effectiveness (VE) and burden of disease studies as well as UKHSA’s sentinel surveillance. The panel of virology tests analysed in UKHSA’s reference laboratory will remain unchanged, with additional plans for point-of-care testing (POCT), testing for pneumococcus and for screening asymptomatic individuals. Our new sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC with virology data including sequencing data held by UKHSA. We describe the governance framework for the RSC.

Results:

We are co-designing our communication about data sharing and sampling, contextualised by the mosaic framework, with national and general practice PPI groups. We present our ARI digital phenotype and key data we request RSC network members record in computerised medical record (CMR). We will share data with UKHSA to report VE for COVID-19 and influenza, and the disease burden of RSV, as well as for syndromic surveillance. Virological surveillance will include COVID-19, influenza, RSV and other common respiratory viruses. We plan to pilot POCT for group A Streptococcus, urine tests for pneumococcus and asymptomatic testing. We will integrate test requests and results with the laboratory-CMR systems. A biomedical resource will enable research linking clinical to virology data including viral sequencing. The legal basis for the RSC’s pseudonymised data extract is The Health Service (Control of Patient Information) Regulations 2002, all non-surveillance uses require research ethical approval.

Conclusions:

The RSC’s extended its surveillance activities to meet more, but not all the mosaic framework’s objectives. We have introduced an ARI indicator, seek to improve our responsiveness, but could do more around transmissibility, and benefit-risk of non-vaccine therapies.