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Case Definitions for Influenza: Need for standardization in the Indian settings

Author Affiliations

  • 1 Department of Community Medicine, Lady Hardinge Medical College & Associated Hospitals, New Delhi, INDIA

Int. Res. J. Medical Sci., Volume 2, Issue (6), Pages 19-21, June,28 (2014)


Influenza is a major cause of ill health and fatality in India. The present study evaluates the performance of case definitions for Influenza enabling these to be used as a screening tool. The study includes patients with any acute medical illness of recent onset, including acute exacerbations of underlying chronic conditions. The authors have employed appropriate methodology and a good study design. The validity of the study is questionable since the authors have included only hospitalised patients. Though the authors have calculated relative risk to determine the symptoms which predict Influenza closely, but multivariate logistic regression would have been a better approach due to multiplicity of comparisons. Receiver operating characteristic (ROC) curves could have been plotted for all the case definitions and sign/ symptom combinations to determine their diagnostic accuracy.


  1. Aguilera JF, Paget WJ, Mosnier A, Heijnen ML, Uphoff H, Velden JV et al, Heterogeneous case definitions used for the surveillance of influenza in Europe, Eur J Epidemiol, (8), 751-754 (2003)
  2. Vashishtha V.M., Kalra A., Choudhury P., Influenza vaccination in India: position paper of Indian Academy of Pediatrics, Indian Pediatr, 50(9), 867-74 (2013)
  3. World Health Organization, WHO Interim Global Epidemiological Surveillance Standards for Influenza, WHO, (2012)
  4. Nachtnebel M, Greutelaers B, Falkenhorst G, Jorgensen P, Dehnert M, Schweiger B, et al, Lessons from a one-year hospital-based surveillance of acute respiratory infections in Berlin- comparing case definitions to monitor Influenza, BMC Public Health, 12(245), 1-9 (2012)
  5. Woolpert T, Brodine S, Lemus H, Waalen J, Blair P, Faix D., Determination of clinical and demographic predictors of laboratory-confirmed influenza with subtype analysis, BMC InfectiousDiseases, 12, 129 (2012)
  6. World Health Organization, Basic epidemiology, WHO, 4th ed., (2006)
  7. Fletcher RW, Fletcher SW, Clinical Epidemiology: The Essentials, 4th ed.,(2005)
  8. Park K., Park’s Text book of Preventive and Social Medicine, 21st ed., (2013)
  9. Monto AS, Gravenstein S, Elliott M, Colopy M, Schweinle J.,Clinical Signs and Symptoms Predicting Influenza Infection, Arch Intern Med, 160(21), 3243-47 (2000)
  10. Ong AK, Chen MI, Lin L, Tan AS, New NW, Barkham T et al., Improving the Clinical Diagnosis of Influenza- a Comparative Analysis of New Influenza A(H1N1), PLoS ONE, 4(12),(2009)
  11. Thriemer K, Ley BB, Ame SS, Deen JL, Pak GD, Chang NY, et al., Clinical and Epidemiological Features of Typhoid Fever in Pemba, Zanzibar: Assessment of the Performance of the WHO Case Definitions, PLoS ONE, 7(12), 1-7 (2012)
  12. The original study titled ‘Performance of case definitions used for influenza surveillance among hospitalized patients in a rural area of India’ has been conducted by Hirve S et al and published in the Bulletin of the World Health Organization, 90(11), 804-812 (2012)