Estimating influenza transmission parameters: Comparing two study designs, 2023–2024

Household studies play a critical role in estimating influenza transmission parameters, which are essential for real-time modeling of epidemic and pandemic dynamics to inform influenza control strategies. We compared two approaches for estimating household influenza transmission parameters from multisite studies conducted in the United States during the 2023-2024 influenza season: interviewing index cases about illnesses among household contacts (n = 1537 contacts) and prospective enrollment of index cases and their household contacts with systematic, daily symptom assessment and testing (n = 857 contacts). We compared the detection of symptomatic illness, influenza-like illness (ILI; fever and either cough or sore throat), influenza virus infection, and estimated serial illness onset intervals among household contacts across studies. Symptomatic illness episodes among household contacts were identified in 40 % of contacts by index case interview compared to 59 % of contacts from individual daily follow-up. Reports of ILI were more comparable between platforms (20 % vs. 26 % respectively). Index case interviews identified 12 % of household contacts with positive influenza tests while systematic, daily testing in the individual daily follow-up platform identified influenza infection among 44 % of household contacts. Both platforms yielded a median serial interval of 4 days. While index case interviews offer rapid, resource-efficient data collection and can inform epidemiological outcomes such as age-related risks and serial intervals, they substantially underestimate laboratory-confirmed influenza cases compared to systematic daily follow-up. These findings highlight the importance of study design in accurately capturing transmission dynamics and underscore the need for systematic laboratory testing to inform public health responses.

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Publication Details

Journal
Epidemics
Published
2026-01-12
DOI
https://doi.org/10.1016/j.epidem.2026.100888
Primary Topic
Influenza Virus Research Studies
Type
article
Field-Weighted Citation Impact
0.00

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article

Estimating influenza transmission parameters: Comparing two study designs, 2023–2024

Elie Saade, R. Presti, Olivia R. Maras, Theresa A Scott et al.
Epidemics
Influenza Virus Research Studies
article

Estimating influenza transmission parameters: Comparing two study designs, 2023–2024

Elie Saade, R. Presti, Olivia R. Maras, Theresa A Scott, Tracey D. Conti, Tara Curley, Sydney A. Cornelison, Erica Joan Pruett Anderson, Alaina Schneider, Onika Abrams, Kiran A. Faryar, David H. Canaday, Rebecca Goodridge, Louise Taylor, Brianna Wickersham, Jessie Chung, Vel Murugan, Son H. McLaren, Jennie Kwon, Ellen Sano, Melissa S. Stockwell, Dandan Liu, Karen Aguilar, Sara Hubert, Spencer Rose, Melissa A. Rolfes, Mary G. Boyle, Richard K. Zimmerman, Elizabeth Capasso-Gulve, Natalie A.B. Bontrager, Liqun Wang, Michael E. Smith, Brianna Schibley-Laird, Manjusha Gaglani, Caroline A. O’Neil, Zainab Albar, Jonathan Schmitz, Jessica E. Biddle, H. Keipp Talbot, Amanda McKillop, Ashley M. Price, Jean A. Lava, Matthew Nguyen, Francesca Yerbic, Carlos G. Grijalva, C. Hallie Phillips, Kim T. Vu, Alexandra M. Mellis, Donny Hearn, Mengesha Teshome, Krissy Moehling Geffel, Lisa M. Richardson, Rick A. Cruz, Yuwei Zhu, Lydia Bristol, Kempapura Murthy, Judy A. King, Gia Gibson, Alexandra Astarita, Emily T. Martin, Emmanuel B. Walter, Stephanie A. Fritz, Alexandra Weissman, Joe Choe
article en

Abstract

Household studies play a critical role in estimating influenza transmission parameters, which are essential for real-time modeling of epidemic and pandemic dynamics to inform influenza control strategies. We compared two approaches for estimating household influenza transmission parameters from multisite studies conducted in the United States during the 2023-2024 influenza season: interviewing index cases about illnesses among household contacts (n = 1537 contacts) and prospective enrollment of index cases and their household contacts with systematic, daily symptom assessment and testing (n = 857 contacts). We compared the detection of symptomatic illness, influenza-like illness (ILI; fever and either cough or sore throat), influenza virus infection, and estimated serial illness onset intervals among household contacts across studies. Symptomatic illness episodes among household contacts were identified in 40 % of contacts by index case interview compared to 59 % of contacts from individual daily follow-up. Reports of ILI were more comparable between platforms (20 % vs. 26 % respectively). Index case interviews identified 12 % of household contacts with positive influenza tests while systematic, daily testing in the individual daily follow-up platform identified influenza infection among 44 % of household contacts. Both platforms yielded a median serial interval of 4 days. While index case interviews offer rapid, resource-efficient data collection and can inform epidemiological outcomes such as age-related risks and serial intervals, they substantially underestimate laboratory-confirmed influenza cases compared to systematic daily follow-up. These findings highlight the importance of study design in accurately capturing transmission dynamics and underscore the need for systematic laboratory testing to inform public health responses.

EpidemicsVol. 54
Centers for Disease Control and Prevention (US), Kaiser Permanente (US), Henry Ford Health System (US), University of Pittsburgh (US), Duke University (US), Washington University in St. Louis (US), University of Michigan (US), University Hospitals of Cleveland (US), Kaiser Permanente Washington Health Research Institute (US), Clinical Research Institute (US), Baylor Scott & White Medical Center - Temple (US), Centers for Disease Control and Prevention (KE), University School (US), Baylor Scott & White Health (US), Arizona State University (US), Case Western Reserve University (US), Columbia University (US), Vanderbilt University Medical Center (US)
University of Pittsburgh, National Institutes of Health, Centers for Disease Control and Prevention
Good health and well-being
Openalex Percentile: Top 90%
Influenza Virus Research Studies
DOIOpen Access PDFOpenAlex
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