Linking syndromic surveillance with virological self-sampling

Calls to a UK national telephone health helpline (NHS Direct) have been used for syndromic surveillance, aiming to provide early warning of rises in community morbidity. We investigated whether self-sampling by NHS Direct callers could provide viable samples for influenza culture. We recruited 294 NHS Direct callers and sent them self-sampling kits. Callers were asked to take a swab from each nostril and post them to the laboratory. Forty-two per cent of the samples were returned, 16.2% were positive on PCR for influenza (16 influenza A(H3N2), three influenza A (H1N1), four influenza B) and eight for RSV (5.6%). The mean time between the NHS Direct call and laboratory analysis was 7.4 days. These samples provided amongst the earliest influenza reports of the season, detected multiple influenza strains, and augmented a national syndromic surveillance system. Self-sampling is a feasible method of enhancing community-based surveillance programmes for detection of influenza.