Accuracy of epidemiological inferences based on publicly available information: Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China

Eric H Y Lau, Jiandong Zheng, Tim K. Tsang, Qiaohong Liao, Bryan Lewis, John S. Brownstein, Sharon Sanders, Jessica Y. Wong, Sumiko R. Mekaru, Caitlin Rivers, Peng Wu, Hui Jiang, Yu Li, Jianxing Yu, Qian Zhang, Zhaorui Chang, Fengfeng Liu, Zhibin Peng, Gabriel M. Leung, Luzhao Feng & 2 others Benjamin J. Cowling, Hongjie Yu

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Abstract

Background: Appropriate public health responses to infectious disease threats should be based on best-available evidence, which requires timely reliable data for appropriate analysis. During the early stages of epidemics, analysis of 'line lists' with detailed information on laboratory-confirmed cases can provide important insights into the epidemiology of a specific disease. The objective of the present study was to investigate the extent to which reliable epidemiologic inferences could be made from publicly-available epidemiologic data of human infection with influenza A(H7N9) virus.Methods: We collated and compared six different line lists of laboratory-confirmed human cases of influenza A(H7N9) virus infection in the 2013 outbreak in China, including the official line list constructed by the Chinese Center for Disease Control and Prevention plus five other line lists by HealthMap, Virginia Tech, Bloomberg News, the University of Hong Kong and FluTrackers, based on publicly-available information. We characterized clinical severity and transmissibility of the outbreak, using line lists available at specific dates to estimate epidemiologic parameters, to replicate real-time inferences on the hospitalization fatality risk, and the impact of live poultry market closure.Results: Demographic information was mostly complete (less than 10% missing for all variables) in different line lists, but there were more missing data on dates of hospitalization, discharge and health status (more than 10% missing for each variable). The estimated onset to hospitalization distributions were similar (median ranged from 4.6 to 5.6 days) for all line lists. Hospital fatality risk was consistently around 20% in the early phase of the epidemic for all line lists and approached the final estimate of 35% afterwards for the official line list only. Most of the line lists estimated >90% reduction in incidence rates after live poultry market closures in Shanghai, Nanjing and Hangzhou.Conclusions: We demonstrated that analysis of publicly-available data on H7N9 permitted reliable assessment of transmissibility and geographical dispersion, while assessment of clinical severity was less straightforward. Our results highlight the potential value in constructing a minimum dataset with standardized format and definition, and regular updates of patient status. Such an approach could be particularly useful for diseases that spread across multiple countries.

Original languageEnglish
Article number88
JournalBMC Medicine
Volume12
Issue number1
DOIs
Publication statusPublished - 28 May 2014
Externally publishedYes

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H7N9 Subtype Influenza A Virus
Human Influenza
China
Hospitalization
Influenza A virus
Poultry
Disease Outbreaks
Hong Kong
Virus Diseases
Centers for Disease Control and Prevention (U.S.)
Health Status
Communicable Diseases
Epidemiology
Public Health
Demography
Incidence
Infection

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Lau, Eric H Y ; Zheng, Jiandong ; Tsang, Tim K. ; Liao, Qiaohong ; Lewis, Bryan ; Brownstein, John S. ; Sanders, Sharon ; Wong, Jessica Y. ; Mekaru, Sumiko R. ; Rivers, Caitlin ; Wu, Peng ; Jiang, Hui ; Li, Yu ; Yu, Jianxing ; Zhang, Qian ; Chang, Zhaorui ; Liu, Fengfeng ; Peng, Zhibin ; Leung, Gabriel M. ; Feng, Luzhao ; Cowling, Benjamin J. ; Yu, Hongjie. / Accuracy of epidemiological inferences based on publicly available information : Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China. In: BMC Medicine. 2014 ; Vol. 12, No. 1.
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title = "Accuracy of epidemiological inferences based on publicly available information: Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China",
abstract = "Background: Appropriate public health responses to infectious disease threats should be based on best-available evidence, which requires timely reliable data for appropriate analysis. During the early stages of epidemics, analysis of 'line lists' with detailed information on laboratory-confirmed cases can provide important insights into the epidemiology of a specific disease. The objective of the present study was to investigate the extent to which reliable epidemiologic inferences could be made from publicly-available epidemiologic data of human infection with influenza A(H7N9) virus.Methods: We collated and compared six different line lists of laboratory-confirmed human cases of influenza A(H7N9) virus infection in the 2013 outbreak in China, including the official line list constructed by the Chinese Center for Disease Control and Prevention plus five other line lists by HealthMap, Virginia Tech, Bloomberg News, the University of Hong Kong and FluTrackers, based on publicly-available information. We characterized clinical severity and transmissibility of the outbreak, using line lists available at specific dates to estimate epidemiologic parameters, to replicate real-time inferences on the hospitalization fatality risk, and the impact of live poultry market closure.Results: Demographic information was mostly complete (less than 10{\%} missing for all variables) in different line lists, but there were more missing data on dates of hospitalization, discharge and health status (more than 10{\%} missing for each variable). The estimated onset to hospitalization distributions were similar (median ranged from 4.6 to 5.6 days) for all line lists. Hospital fatality risk was consistently around 20{\%} in the early phase of the epidemic for all line lists and approached the final estimate of 35{\%} afterwards for the official line list only. Most of the line lists estimated >90{\%} reduction in incidence rates after live poultry market closures in Shanghai, Nanjing and Hangzhou.Conclusions: We demonstrated that analysis of publicly-available data on H7N9 permitted reliable assessment of transmissibility and geographical dispersion, while assessment of clinical severity was less straightforward. Our results highlight the potential value in constructing a minimum dataset with standardized format and definition, and regular updates of patient status. Such an approach could be particularly useful for diseases that spread across multiple countries.",
author = "Lau, {Eric H Y} and Jiandong Zheng and Tsang, {Tim K.} and Qiaohong Liao and Bryan Lewis and Brownstein, {John S.} and Sharon Sanders and Wong, {Jessica Y.} and Mekaru, {Sumiko R.} and Caitlin Rivers and Peng Wu and Hui Jiang and Yu Li and Jianxing Yu and Qian Zhang and Zhaorui Chang and Fengfeng Liu and Zhibin Peng and Leung, {Gabriel M.} and Luzhao Feng and Cowling, {Benjamin J.} and Hongjie Yu",
year = "2014",
month = "5",
day = "28",
doi = "10.1186/1741-7015-12-88",
language = "English",
volume = "12",
journal = "BMC Medicine",
issn = "1741-7015",
publisher = "BMC",
number = "1",

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Lau, EHY, Zheng, J, Tsang, TK, Liao, Q, Lewis, B, Brownstein, JS, Sanders, S, Wong, JY, Mekaru, SR, Rivers, C, Wu, P, Jiang, H, Li, Y, Yu, J, Zhang, Q, Chang, Z, Liu, F, Peng, Z, Leung, GM, Feng, L, Cowling, BJ & Yu, H 2014, 'Accuracy of epidemiological inferences based on publicly available information: Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China' BMC Medicine, vol. 12, no. 1, 88. https://doi.org/10.1186/1741-7015-12-88

Accuracy of epidemiological inferences based on publicly available information : Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China. / Lau, Eric H Y; Zheng, Jiandong; Tsang, Tim K.; Liao, Qiaohong; Lewis, Bryan; Brownstein, John S.; Sanders, Sharon; Wong, Jessica Y.; Mekaru, Sumiko R.; Rivers, Caitlin; Wu, Peng; Jiang, Hui; Li, Yu; Yu, Jianxing; Zhang, Qian; Chang, Zhaorui; Liu, Fengfeng; Peng, Zhibin; Leung, Gabriel M.; Feng, Luzhao; Cowling, Benjamin J.; Yu, Hongjie.

In: BMC Medicine, Vol. 12, No. 1, 88, 28.05.2014.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Accuracy of epidemiological inferences based on publicly available information

T2 - Retrospective comparative analysis of line lists of human cases infected with influenza A(H7N9) in China

AU - Lau, Eric H Y

AU - Zheng, Jiandong

AU - Tsang, Tim K.

AU - Liao, Qiaohong

AU - Lewis, Bryan

AU - Brownstein, John S.

AU - Sanders, Sharon

AU - Wong, Jessica Y.

AU - Mekaru, Sumiko R.

AU - Rivers, Caitlin

AU - Wu, Peng

AU - Jiang, Hui

AU - Li, Yu

AU - Yu, Jianxing

AU - Zhang, Qian

AU - Chang, Zhaorui

AU - Liu, Fengfeng

AU - Peng, Zhibin

AU - Leung, Gabriel M.

AU - Feng, Luzhao

AU - Cowling, Benjamin J.

AU - Yu, Hongjie

PY - 2014/5/28

Y1 - 2014/5/28

N2 - Background: Appropriate public health responses to infectious disease threats should be based on best-available evidence, which requires timely reliable data for appropriate analysis. During the early stages of epidemics, analysis of 'line lists' with detailed information on laboratory-confirmed cases can provide important insights into the epidemiology of a specific disease. The objective of the present study was to investigate the extent to which reliable epidemiologic inferences could be made from publicly-available epidemiologic data of human infection with influenza A(H7N9) virus.Methods: We collated and compared six different line lists of laboratory-confirmed human cases of influenza A(H7N9) virus infection in the 2013 outbreak in China, including the official line list constructed by the Chinese Center for Disease Control and Prevention plus five other line lists by HealthMap, Virginia Tech, Bloomberg News, the University of Hong Kong and FluTrackers, based on publicly-available information. We characterized clinical severity and transmissibility of the outbreak, using line lists available at specific dates to estimate epidemiologic parameters, to replicate real-time inferences on the hospitalization fatality risk, and the impact of live poultry market closure.Results: Demographic information was mostly complete (less than 10% missing for all variables) in different line lists, but there were more missing data on dates of hospitalization, discharge and health status (more than 10% missing for each variable). The estimated onset to hospitalization distributions were similar (median ranged from 4.6 to 5.6 days) for all line lists. Hospital fatality risk was consistently around 20% in the early phase of the epidemic for all line lists and approached the final estimate of 35% afterwards for the official line list only. Most of the line lists estimated >90% reduction in incidence rates after live poultry market closures in Shanghai, Nanjing and Hangzhou.Conclusions: We demonstrated that analysis of publicly-available data on H7N9 permitted reliable assessment of transmissibility and geographical dispersion, while assessment of clinical severity was less straightforward. Our results highlight the potential value in constructing a minimum dataset with standardized format and definition, and regular updates of patient status. Such an approach could be particularly useful for diseases that spread across multiple countries.

AB - Background: Appropriate public health responses to infectious disease threats should be based on best-available evidence, which requires timely reliable data for appropriate analysis. During the early stages of epidemics, analysis of 'line lists' with detailed information on laboratory-confirmed cases can provide important insights into the epidemiology of a specific disease. The objective of the present study was to investigate the extent to which reliable epidemiologic inferences could be made from publicly-available epidemiologic data of human infection with influenza A(H7N9) virus.Methods: We collated and compared six different line lists of laboratory-confirmed human cases of influenza A(H7N9) virus infection in the 2013 outbreak in China, including the official line list constructed by the Chinese Center for Disease Control and Prevention plus five other line lists by HealthMap, Virginia Tech, Bloomberg News, the University of Hong Kong and FluTrackers, based on publicly-available information. We characterized clinical severity and transmissibility of the outbreak, using line lists available at specific dates to estimate epidemiologic parameters, to replicate real-time inferences on the hospitalization fatality risk, and the impact of live poultry market closure.Results: Demographic information was mostly complete (less than 10% missing for all variables) in different line lists, but there were more missing data on dates of hospitalization, discharge and health status (more than 10% missing for each variable). The estimated onset to hospitalization distributions were similar (median ranged from 4.6 to 5.6 days) for all line lists. Hospital fatality risk was consistently around 20% in the early phase of the epidemic for all line lists and approached the final estimate of 35% afterwards for the official line list only. Most of the line lists estimated >90% reduction in incidence rates after live poultry market closures in Shanghai, Nanjing and Hangzhou.Conclusions: We demonstrated that analysis of publicly-available data on H7N9 permitted reliable assessment of transmissibility and geographical dispersion, while assessment of clinical severity was less straightforward. Our results highlight the potential value in constructing a minimum dataset with standardized format and definition, and regular updates of patient status. Such an approach could be particularly useful for diseases that spread across multiple countries.

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U2 - 10.1186/1741-7015-12-88

DO - 10.1186/1741-7015-12-88

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JO - BMC Medicine

JF - BMC Medicine

SN - 1741-7015

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