“We are still trying to think through how do we get [Flu Near You] into the general consciousness” of more Americans, said Dr. Brownstein. While participants, not all of whom are active every week, provide enough data to show good correlation with the CDC’s routine surveillance on a national scale, if Flu Near You “had enough numbers we could drill down into subpopulations,” he noted. For now, the volume of participation makes subgroups too scanty in size for meaningful analysis, Dr. Brownstein conceded.
Mass gathering surveillance in Brazil
The Brazilian surveillance program at the World Cup was modeled on Flu Near You, but Dr. Libel, Dr. Smolinski, and their collaborators produced the app in about 8 weeks after receiving very short notice of the Brazilians’ interest. The weekly, symptom surveillance questions posed by the app replicated seven symptoms from Flu Near You – fever, cough, sore throat, shortness of breath, nausea and vomiting, diarrhea, and headache – and added three new symptoms to the survey: joint pain, bleeding, and red spots on body. This allowed the Health Ministry to also monitor for outbreaks of other infections including measles, cholera, dengue, and chikungunya, Dr. Libel said. The Brazilian app also asked participants each week whether they had been in contact with anyone who had any of the 10 listed symptoms, and whether they had looked for health care services. No outbreaks of any type occurred in Brazil during the World Cup, but during the period it was actively used 27% of the frequent respondents reported experiencing at least one symptom.
The first Brazilian effort “was basically a pilot program,” with little advance promotion, Dr. Smolinksi said in an interview. Officials of the Brazilian Ministry of Health were “impressed” with the data collected. They also liked the ability of the system to push out information on health care access to registered users, and the potential the app offered to send out urgent public health messages. “What the Health Ministry loved the most was that if there had been an outbreak they could have immediately reached out to fans,” Dr. Smolinski said.
The Ministry has interest in expanded surveillance and outreach programs for Carnival and the 2016 Summer Olympics, and Dr. Smolinski and his associates are hopeful that the International Olympics Committee will be receptive to the program and aid in its promotion during 2016. They are also planning to expand beyond smart phones and include the capability to interact with users via text and voice messages.
“We hope we will have huge numbers at the Olympics,” to better document the role participatory surveillance can play at mass gatherings, Dr. Smolinski said.
Dr. Libel, Dr. Brownstein, Mr. Biggerstaff, Dr. Smolinski, and Dr. Madoff had no disclosures.
On Twitter @mitchelzoler