Impact of seasonal influenza on polyclinic attendances for upper respiratory tract infections in Singapore

Authors

  • Annabel Chien Ying Soh University of New South Wales, Kensington, New South Wales, Australia
  • Anurag Sharma University of New South Wales, Kensington, New South Wales, Australia
  • David John Muscatello University of New South Wales, Kensington, New South Wales, Australia

DOI:

https://doi.org/10.5365/wpsar.2019.10.4.001

Abstract

Purpose: The burden of influenza on primary health-care services is not well established in tropical countries, where there are no clearly defined influenza seasons. We aimed to estimate the association between influenza infection activity and polyclinic attendance rates for upper respiratory tract infections (URTIs) in the Singapore population.

Methods: We used generalized additive time series models to estimate the association between the proportion of respiratory tests positive for influenza infection in Singapore reported to the World Health Organization every week, and the population rate of polyclinic attendances in Singapore for physician-diagnosed URTI, which includes influenza-like illness (ILI), for six years from 2012 through 2017. Where data were available, we controlled for other infections that can cause fever or respiratory symptoms.

Results: Influenza, dengue fever and chickenpox (varicella) were positively associated with acute URTI polyclinic attendances. The estimated URTI polyclinic attendance rates attributable to influenza, dengue fever and chickenpox were 618.9 (95% confidence interval [CI]: 501.6–736.3), 153.3 (95% CI: 16.5–290.2) and 1751.5 (95% CI: 1246.3–2256.8) per 100 000 population per year, respectively.

Conclusion: Influenza poses a considerable burden on primary health-care services in Singapore. However, a substantial number of polyclinic attendances due to febrile infections such as dengue fever and chickenpox appear to be recorded as URTI in the polyclinic database. These associations require further investigation.

Author Biographies

Anurag Sharma, University of New South Wales, Kensington, New South Wales, Australia

Senior Lecturer (Health Economics), Co -Director Public Health Programs, School of Public Health & Community Medicine

David John Muscatello, University of New South Wales, Kensington, New South Wales, Australia

Senior Lecturer, School of Public Health and Community Medicine

References

Iuliano AD, Roguski KM, Chang HH, Muscatello DJ, Palekar R, Tempia S, Cohen C, Gran JM, Schanzer D, Cowling BJ (2017) Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. The Lancet

Gordon A, Reingold A (2018) The Burden of Influenza: a Complex Problem. Current Epidemiology Reports 5 (1):1-9

Shubin M, Virtanen M, Toikkanen S, Lyytikäinen O, Auranen K (2014) Estimating the burden of A (H1N1) pdm09 influenza in Finland during two seasons. Epidemiology & Infection 142 (5):964-974

Ministry of Health Singapore (2017) Primary Healthcare Services. https://www.moh.gov.sg/content/moh_web/home/our_healthcare_system/Healthcare_Services/Primary_Care.html. Accessed 6 August 2018

SingHealth Group (2014) Services. https://polyclinic.singhealth.com.sg/Pages/Services.aspx. Accessed 24 September 2018

Serfling RE (1963) Methods for current statistical analysis of excess pneumonia-influenza deaths. Public health reports 78 (6):494

Muscatello DJ, Newall AT, Dwyer DE, MacIntyre CR (2013) Mortality attributable to seasonal and pandemic influenza, Australia, 2003 to 2009, using a novel time series smoothing approach. PloS one 8 (6):e64734

Thompson WW, Ridenhour BL, Barile JP, Shay DK (2012) Commentary: Time-Series Analyses of Count Data to Estimate the Burden of Seasonal Infectious Diseases. Epidemiology 23 (6):839-842

Viboud C, Alonso WJ, Simonsen L (2006) Influenza in tropical regions. PLoS medicine 3 (4):e89

Muscatello DJ (2019) Redefining influenza seasonality at a global scale and aligning it to the influenza vaccine manufacturing cycle: A descriptive time series analysis. Journal of Infection 78 (2):140-149

Wood SN (2006) Generalized additive models: an introduction with R. Chapman and Hall/CRC,

Government Technology Agency of Singapore (2017) Average Daily Polyclinic Attendances for Selected Diseases. https://data.gov.sg/dataset/average-daily-polyclinic-attendances-selected-diseases. Accessed 10 July 2018

World Health Organization (2018) Influenza Laboratory Surveillance Information. http://apps.who.int/flumart/Default?ReportNo=12. Accessed 10 July 2018

Gul D, Cohen C, Tempia S, Newall AT, Muscatello DJ (2018) Influenza‐associated mortality in South Africa, 2009‐2013: the importance of choices related to influenza infection proxies. Influenza and other respiratory viruses 12 (1):54-64

Ministry of Health Singapore (2017) Weekly Infectious Diseases Bulletin. https://www.moh.gov.sg/resources-statistics/infectious-disease-statistics/2017/weekly-infectious-diseases-bulletin. Accessed 10 July 2018

Ministry of Manpower Singapore Press Releases. https://www.mom.gov.sg/newsroom/press-releases?keywords=Singapore+public+holidays. Accessed 29 March 2018

Ministry of Education Singapore Press Releases. https://www.moe.gov.sg/news/press-releases. Accessed 30 March 2018

Yang L, Ma S, Chen PY, He JF, Chan KP, Chow A, Ou CQ, Deng AP, Hedley AJ, Wong CM (2011) Influenza associated mortality in the subtropics and tropics: results from three Asian cities. Vaccine 29 (48):8909-8914

Muscatello DJ, Bein KJ, Dinh MM (2017) Emergency Department demand associated with seasonal influenza, 2010 through 2014, New South Wales, Australia. Western Pacific surveillance and response journal: WPSAR 8 (3):11

Department of Statistics Singapore Population Trends 2017. https://www.singstat.gov.sg/-/media/files/publications/population/population2017.pdf. Accessed 29 March 2018

Khoo HS, Lim YW, Vrijhoef HJM (2014) Primary healthcare system and practice characteristics in Singapore. Asia Pacific family medicine 13 (1):8

Cromer D, van Hoek AJ, Jit M, Edmunds WJ, Fleming D, Miller E (2014) The burden of influenza in England by age and clinical risk group: a statistical analysis to inform vaccine policy. Journal of Infection 68 (4):363-371

Chow A, Ma S, Ling AE, Chew SK (2006) Influenza-associated deaths in tropical Singapore. Emerging infectious diseases 12 (1):114

Matias G, Taylor R, Haguinet F, Schuck-Paim C, Lustig R, Shinde V (2017) Estimates of hospitalization attributable to influenza and RSV in the US during 1997–2009, by age and risk status. BMC public health 17 (1):271

Newall AT, Scuffham PA (2008) Influenza-related disease: the cost to the Australian healthcare system. Vaccine 26 (52):6818-6823

Kotwani M (2016) Increase in number of flu cases at polyclinics: MOH.

Chua A (2017) Doctors suggest free flu vaccines to boost adult immunisation rates.

Belongia EA, Simpson MD, King JP, Sundaram ME, Kelley NS, Osterholm MT, McLean HQ (2016) Variable influenza vaccine effectiveness by subtype: a systematic review and meta-analysis of test-negative design studies. The Lancet Infectious Diseases 16 (8):942-951

Osterholm MT, Kelley NS, Sommer A, Belongia EA (2012) Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis. The Lancet infectious diseases 12 (1):36-44

World Health Organization (2017) Dengue control. http://www.who.int/denguecontrol/faq/en/index2.html. Accessed 4 September 2018

The Department of Health and Wellbeing (2017) Chickenpox and shingles. https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/chickenpox+and+shingles. Accessed 4 September 2018

Navarro-Marí JM, Pérez-Ruiz M, Cantudo-Muñoz P, Petit-Gancedo C, Jiménez-Valera M, Rosa-Fraile M (2005) Influenza-like illness criteria were poorly related to laboratory-confirmed influenza in a sentinel surveillance study. Journal of clinical epidemiology 58 (3):275-279

Van Elden LJ, Van Essen GA, Boucher CA, Van Loon AM, Nijhuis M, Schipper P, Verheij TJ, Hoepelman IM (2001) Clinical diagnosis of influenza virus infection: evaluation of diagnostic tools in general practice. Br J Gen Pract 51 (469):630-634

Huang S-Y, Lee K, Wang L, Liu J-W, Hung S-C, Chen C-C, Chang T-Y, Huang W-C (2014) Use of simple clinical and laboratory predictors to differentiate influenza from dengue and other febrile illnesses in the emergency room. BMC infectious diseases 14 (1):623

Chan DYW, Edmunds WJ, Chan HL, Chan V, Lam YCK, Thomas SL, van Hoek AJ, Flasche S (2018) The changing epidemiology of varicella and herpes zoster in Hong Kong before universal varicella vaccination in 2014. Epidemiology & Infection 146 (6):723-734

Finger R, Hughes JP, Meade BJ, Pelletier AR, Palmer CT (1994) Age-specific incidence of chickenpox. Public health reports 109 (6):750

Goh AEN, Choi EH, Chokephaibulkit K, Choudhury J, Kuter B, Lee P-I, Marshall H, Kim JO, Wolfson LJ (2019) Burden of varicella in the Asia-Pacific region: a systematic literature review. Expert review of vaccines 18 (5):475-493

Health Promotion Board (2016) National Childhood Immunisation Schedule. https://www.nir.hpb.gov.sg/nirp/eservices/immunisationSchedule. Accessed 4 September 2018

Ministry of Health Singapore (2017) MOH Establishes National Adult Immunisation Schedule; Extends Use of Medisave for Vaccines Under the Schedule. https://www.moh.gov.sg/news-highlights/details/moh-establishes-national-adult-immunisation-schedule-extends-use-of-medisave-for-vaccines-under-the-schedule. Accessed 18 September 2019

Ministry of Health Singapore (2013) A 20-year epidemiological review of the seroprevalence of varicella- zoster virus infection among children and adolescents in Singapore. http://libapps2.nus.edu.sg/nus/mlb/smcpub/b11955806/v39n1Jan-Mar2013.pdf. Accessed 18 September 2019

Centres for Disease Control and Prevention (2016) Chickenpox (Varicella). https://www.cdc.gov/chickenpox/about/bam-villain-for-kids-fs.html. Accessed 5 September 2018

Ang LW, Koh BKW, Chan KP, Chua LT, James L, Goh KT (2009) Epidemiology and control of hand, foot and mouth disease in Singapore. Ann Acad Med Singapore 38 (2):106-112

Mossong J, Hens N, Jit M, Beutels P, Auranen K, Mikolajczyk R, Massari M, Salmaso S, Tomba GS, Wallinga J (2008) Social contacts and mixing patterns relevant to the spread of infectious diseases. PLoS medicine 5 (3):e74

Abubakar I, Gautret P, Brunette GW, Blumberg L, Johnson D, Poumerol G, Memish ZA, Barbeschi M, Khan AS (2012) Global perspectives for prevention of infectious diseases associated with mass gatherings. The Lancet infectious diseases 12 (1):66-74

Ministry of Health Singapore (2018) Influenza. https://www.moh.gov.sg/diseases-updates/influenza. Accessed 10 April 2019

Published

30-06-2020

How to Cite

1.
Soh ACY, Sharma A, Muscatello DJ. Impact of seasonal influenza on polyclinic attendances for upper respiratory tract infections in Singapore. Western Pac Surveill Response J [Internet]. 2020 Jun. 30 [cited 2024 Nov. 22];11(2). Available from: https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/702

Issue

Section

Original Research