Evidence map›Paper›PMID 24717637›Full record

ArticleThe Lancet. Respiratory medicine2014

Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study.

Andrew C Hayward, Ellen B Fragaszy, Alison Bermingham, Lili Wang, Andrew Copas, W John Edmunds, Neil Ferguson, Nilu Goonetilleke, Gabrielle Harvey, Jana Kovar and 12 more

Open access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in The Lancet. Respiratory medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 245 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
245citing papers in PubMed, 7 pooled it
30.5field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

245 citing papers in PubMed, 7 syntheses or guidelines pooled it, 431 citations in OpenAlex.

  1. Pooled it
  2. Spotlight influenza: Laboratory-confirmed seasonal influenza in people with acute respiratory illness: a literature review and meta-analysis, WHO European Region, 2004 to 2017.Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2021
    Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Trial
  9. Trial
  10. Trial
  11. Trial
  12. Article
  13. Article
  14. Influenza.Nature reviews. Disease primers · 2026
    Review
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Observational

185 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

22 authors at 8 institutions in 3 countries.

Andrew C HaywardUCL Research Department of Infection and Population Health, University College London, London, UK. Electronic address: a.hayward@ucl.ac.uk.
Ellen B FragaszyUCL Research Department of Infection and Population Health, University College London, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Alison BerminghamRespiratory Virus Unit, Public Health England, Colindale, UK.
Lili WangWeatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
Andrew CopasUCL Research Department of Infection and Population Health, University College London, London, UK.
W John EdmundsDepartment of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Neil FergusonDepartment of Infectious Disease Epidemiology, Imperial College London, London, UK.
Nilu GoonetillekeWeatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Gabrielle HarveyUCL Research Department of Infection and Population Health, University College London, London, UK.
Jana KovarUCL Research Department of Infection and Population Health, University College London, London, UK.
Megan S C LimUCL Research Department of Infection and Population Health, University College London, London, UK; Centre for Population Health, Burnet Institute, Melbourne, VIC, Australia.
Andrew McMichaelWeatherall Institute of Molecular Medicine, University of Oxford, Oxford, UK.
Elizabeth R C MillettUCL Research Department of Infection and Population Health, University College London, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
Jonathan S Nguyen-Van-TamHealth Protection and Influenza Research Group, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
Irwin NazarethUCL Department of Primary Care and Population Health, University College London, London, UK.
Richard PebodyRespiratory Diseases Department, Public Health England, Colindale, UK.
Faiza TabassumUCL Research Department of Infection and Population Health, University College London, London, UK.
John M WatsonRespiratory Diseases Department, Public Health England, Colindale, UK.
Fatima B WurieUCL Research Department of Infection and Population Health, University College London, London, UK.
Anne M JohnsonUCL Research Department of Infection and Population Health, University College London, London, UK.
Maria ZambonRespiratory Virus Unit, Public Health England, Colindale, UK.
Flu Watch Group
University College London · GBPublic Health England · GBLondon School of Hygiene & Tropical Medicine · GBUniversity of Oxford · GBBurnet Institute · AUImperial College London · GBMRC Weatherall Institute of Molecular Medicine · GBUniversity of Nottingham · GB

Funding

Medical Research Council G0600511Medical Research Council G0800767Medical Research Council MC_U122785833Medical Research Council MR/K006584/1Medical Research Council MR/K010174/1Wellcome Trust
6 · The paper itself

Abstract

backgroundAssessment of the effect of influenza on populations, including risk of infection, illness if infected, illness severity, and consultation rates, is essential to inform future control and prevention. We aimed to compare the community burden and severity of seasonal and pandemic influenza across different age groups and study years and gain insight into the extent to which traditional surveillance underestimates this burden.

methodsUsing preseason and postseason serology, weekly illness reporting, and RT-PCR identification of influenza from nasal swabs, we tracked the course of seasonal and pandemic influenza over five successive cohorts (England 2006-11; 5448 person-seasons' follow-up). We compared burden and severity of seasonal and pandemic strains. We weighted analyses to the age and regional structure of England to give nationally representative estimates. We compared symptom profiles over the first week of illness for different strains of PCR-confirmed influenza and non-influenza viruses using ordinal logistic regression with symptom severity grade as the outcome variable.

findingsBased on four-fold titre rises in strain-specific serology, on average influenza infected 18% (95% CI 16-22) of unvaccinated people each winter. Of those infected there were 69 respiratory illnesses per 100 person-influenza-seasons compared with 44 per 100 in those not infected with influenza. The age-adjusted attributable rate of illness if infected was 23 illnesses per 100 person-seasons (13-34), suggesting most influenza infections are asymptomatic. 25% (18-35) of all people with serologically confirmed infections had PCR-confirmed disease. 17% (10-26) of people with PCR-confirmed influenza had medically attended illness. These figures did not differ significantly when comparing pandemic with seasonal influenza. Of PCR-confirmed cases, people infected with the 2009 pandemic strain had markedly less severe symptoms than those infected with seasonal H3N2.

interpretationSeasonal influenza and the 2009 pandemic strain were characterised by similar high rates of mainly asymptomatic infection with most symptomatic cases self-managing without medical consultation. In the community the 2009 pandemic strain caused milder symptoms than seasonal H3N2.

fundingMedical Research Council and the Wellcome Trust.

Indexed as

PandemicsSeasonsAdolescentAdultAgedChildChild, PreschoolDNA, ViralEnglandFemaleFollow-Up StudiesHumansInfantInfant, NewbornInfluenza A Virus, H3N2 SubtypeInfluenza, HumanDNA, Viral

Identifiers

PMID24717637
PMCPMC7164821
OpenAlexW2052385416

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.