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Title: The "timeless" use of influenza-like illness criteria for influenza detection in the tropics
Authors: Aung, Aung H.
Lye, David C.
Cui, Lin
Ooi, Chee K.
Chow, Angela Li Ping
Keywords: Science::Medicine
Issue Date: 2021
Source: Aung, A. H., Lye, D. C., Cui, L., Ooi, C. K. & Chow, A. L. P. (2021). The "timeless" use of influenza-like illness criteria for influenza detection in the tropics. International Journal of Infectious Diseases, 106, 160-168.
Journal: International Journal of Infectious Diseases 
Abstract: Objective: We assessed the performance of influenza-like illness (ILI) case definitions by the Centers for Disease Control and Prevention (CDC), European Centers for Disease Control and Prevention and World Health Organization (WHO) in the tropics where seasonal patterns of respiratory viruses in acute upper respiratory tract infections (AURTIs) are ill-defined. Methods: Clinical data and samples for respiratory multiplex polymerase chain reaction test were collected from 717 consecutive patients attending an emergency department in Singapore for uncomplicated AURTI in 2016-2018. Results: Influenza (20.6%), rhinoviruses (14.4%), and coronaviruses (3.6%) were the most common viral pathogens identified. Biannual peaks with year-round activity were identified for influenza. Although higher rhinovirus activity was observed in inter-influenza seasonal periods, rhinoviruses and coronaviruses circulated year-round without distinct seasonal patterns. During high influenza activity months, the CDC and WHO ILI case definitions had moderate-to-high positive likelihood ratio (LR+) of 3.8-6.8 and 4.5-10.7, respectively, for ruling in influenza. They had moderately-high LR + of 3.3-3.8 and 3.9-4.6 for diagnosing influenza during other months. The ILI case definitions had high specificity (77.2%- 85.4%) for rhinoviruses and coronaviruses. Conclusion: The CDC and WHO ILI case definitions can be applied to clinically diagnose influenza in the tropics, regardless of the time of the year.
ISSN: 1201-9712
DOI: 10.1016/j.ijid.2021.03.045
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Organisations: Tan Tock Seng Hospital
Rights: © 2021 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license (
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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