TRACKING FLU OUTBREAKS TO IMPROVE PUBLIC HEALTH

How a simple idea inspired a University of Newcastle researcher and public health clinician to create one of the largest crowd-sourced public health surveillance systems in the world - and use it in the fight against COVID-19

Every year in Australia, influenza leads to over 300,000 visits to our GPs, more than 13,000 hospitalisations and roughly 3,000 deaths.

Dr Craig Dalton – a public health clinician, researcher and lecturer with the University of Newcastle – developed the award-winning FluTracking program which collects data from members of the public during Australia’s annual flu season (usually May to October).

This data helps health officials determine the onset of influenza and better understand the burden and severity of the disease.

FluTracking started with 400 participants in 2006 and now has more than 150,000 participants across Australia and New Zealand – making it one of the largest crowd-sourced public health.

When coronavirus emerged in Australia, Dr Dalton’s team deployed its FluTracking surveys four months early to monitor COVID-19.

The team saw a spike in participation as people rallied to help contain the virus. In fact, more than 23,000 new ‘flutrackers’ signed up in April 2020 alone, and that number is expected to grow as new clusters emerge.

However, since the onset of coronavirus in Australia, the FluTracking team found that just over 25 percent of people with mild illness do not present for COVID-19 testing, which highlights the challenge of controlling the virus.

The opportunity

FluTracking was inspired by a 2005 article entitled ‘Did you have the Flu last week?’ It described a telephone survey of 1,500 people in Sweden designed to establish a snapshot of flu rates in that country.

Intrigued by the concept, Dr Dalton set his sights on finding a better way to get this important information from more people, more frequently and more efficiently.

At the time, there were basic, one-off online survey platforms but nothing that allowed health professionals to follow an entire cohort of people week to week and year to year.

With FluTracking, Dr Dalton has found a way to harness the power of the internet to collect public health information on a scale never seen before.

How FluTracking works

FluTracking uses a weekly web-based survey to collect data from people in the community during Australia’s annual flu season (usually May to October).

The survey captures symptoms, time taken off work, vaccination status, laboratory results and much more.

The data helps health professionals detect seasonal influenza, pandemic influenza and other diseases so they can protect the community from epidemics.

FluTracking also enables year-to-year comparisons of the timing, attack rates and severity of the virus in specific communities.

Data and reports are posted weekly during the flu season on the FluTracking website for participants and members of the general public.

Data is shared with public health departments on a monthly basis, so emergency departments, public health units and other services can monitor flu in their local region.

FluTracking data is also fed into the National Influenza Surveillance Scheme, which monitors the virus, its severity, transmission and virology across the country.

Involving end-users

Determined to make the web-based survey as simple and intuitive as possible, the FluTracking team made the strategic decision to collect minimal demographic information from participants.

It also designed the weekly survey to take no more than 10 seconds to complete.

The development team by-passed user names and passwords for participants and instead designed the system to ensure each user had their own unique link which captured their weekly responses over time.

The team involves new and existing participants in design and user testing with every feature change it introduces.

It has also experimented with various recruitment strategies to grow participation, which is essential for crowd-sourced research and enables richer data.

Evidence of impact

FluTracking started in the NSW Hunter region with 400 participants.  Today, it collects data from more than 150,000 people across Australia and New Zealand.

To help monitor the spread of COVID-19 in Australia, the country’s Deputy Chief Health Officer used some of his media briefings to encourage Australian’s to join FluTracking.(Canberra Times, April 2020)

In April 2020, FluTracking insights showed historically low reports of flu and cold-like symptoms in Australia, indicating the social distancing measures put in place were decreasing the transmission of different types of respiratory viruses in the community. (Newcastle Herald, April 2020)

In March 2020, health authorities in the United States (including the National Institute of Allergy and Infection Diseases director Dr Anthony Fauci) issued guidelines for American homes, schools and workplaces based on a paper Dr Dalton had written with colleagues from Sydney University and Australian National University. (Science, March 2020)

Dr Dalton and his team are working to expand FluTracking to South East Asia.  They’re also working to adapt the tool to monitor and support other acute events, including thunderstorm asthma outbreaks and water contamination events.

Dr Craig Dalton

FluTracking is turning big data into highly valuable medical intelligence.