Insights From Flutracking: Thirteen Tips to Growing a Web-Based Participatory Surveillance System.

Flutracking is a weekly Web-based survey of influenza-like illness (ILI) in Australia that has grown from 400 participants in 2006 to over 26,000 participants every week in 2016. Flutracking monitors both the transmission and severity of ILI across Australia by documenting symptoms (cough, fever, and sore throat), time off work or normal duties, influenza vaccination status, laboratory testing for influenza, and health seeking behavior. Recruitment of Flutrackers commenced via health department and other organizational email systems, and then gradually incorporated social media promotion and invitations from existing Flutrackers to friends to enhance participation. Invitations from existing participants typically contribute to over 1000 new participants each year. The Flutracking survey link was emailed every Monday morning in winter and took less than 10 seconds to complete. To reduce the burden on respondents, we collected only a minimal amount of demographic and weekly data. Additionally, to optimize users' experiences, we maintained a strong focus on "obvious design" and repeated usability testing of naïve and current participants of the survey. In this paper, we share these and other insights on recruitment methods and user experience principles that have enabled Flutracking to become one of the largest online participatory surveillance systems in the world. There is still much that could be enhanced in Flutracking; however, we believe these principles could benefit others developing similar online surveillance systems.

Flutracking weekly online community survey of influenza-like illness: 2013 and 2014.

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI activity and field vaccine effectiveness. This article reports on the 2013 and 2014 findings from Flutracking. From 2013 to 2014 there was a 14.0% increase in participants who completed at least 1 survey to 21,021 participants. By the end of the 2013 and 2014 seasons, respectively 59.7% and 59.1% of all participants had received the seasonal influenza vaccine. The 2013 Flutracking national ILI weekly incidence peaked in late August at 4.3% in the unvaccinated group, 1 week earlier than national counts of laboratory confirmed influenza. The 2014 Flutracking national ILI weekly incidence also peaked in late August at 4.7% in the unvaccinated group, in the same week as national counts of laboratory confirmed influenza. A lower percentage of Flutracking participants took two or more days off from work or normal duties in 2013 (peak level 1.6%) compared with 2014 (peak level 2.5%) and sought health advice in 2013 (peak level of 1.1%) compared with 2014 (peak of 1.6%). Flutracking ILI surveillance suggests that 2014 was a moderately more intense season than 2013 and similar to 2012.

Flutracking weekly online community survey of influenza-like illness annual report 2011 and 2012.

Flutracking is a national online community influenza-like illness (ILI) surveillance system that monitors weekly ILI activity and field vaccine effectiveness (FVE). This article reports on the 2011 and 2012 findings from Flutracking. There was a 22% increase in participants to 16,046 who completed at least one survey in 2012, compared with 2011 (13,101). By October 2012 (the end of the 2012 season), 54.2% of participants had received the 2012 seasonal vaccine, while by the end of the 2011 season, 55.9% of participants had received the 2011 seasonal vaccine. From 2007 to 2012 the FVE calculation for New South Wales participants demonstrated that the seasonal vaccine was effective except in 2009 when a novel H1N1 virus was dominant. The 2012 Flutracking ILI weekly incidence peaked in mid-July at 4.9% in the unvaccinated group, 1 month earlier than laboratory confirmed influenza. The 2011 Flutracking ILI weekly incidence peaked in mid-August at 4.1% in the unvaccinated group, 1 week later than laboratory confirmed influenza. Similar to laboratory notifications, there was an increase in ILI activity from 2010 to 2012, with the peak weekly ILI prevalence for 2012 Flutracking data, (unstratified by vaccination status), being higher (4.7%) than the peak weekly prevalence for 2011 (3.8%) and 2010 (3.7%). The 2012 Flutracking influenza season showed moderate levels of ILI, compared with lower levels of ILI seen in 2011 and 2010, and consistent with the increase in national influenza laboratory notifications.

Online Flutracking survey of influenza-like illness during pandemic (H1N1) 2009, Australia.

We compared the accuracy of online data obtained from the Flutracking surveillance system during pandemic (H1N1) 2009 in Australia with data from other influenza surveillance systems. Flutracking accurately identified peak influenza activity timing and community influenza-like illness activity and was significantly less biased by treatment-seeking behavior and laboratory testing protocols than other systems.

Flutracking surveillance: comparing 2007 New South Wales results with laboratory confirmed influenza notifications.

General practice and hospital surveillance for influenza-like illness (ILI) and laboratory influenza surveillance provide useful but incomplete information on influenza incidence. Flutracking is an Australian pilot of an Internet-based community ILI syndromic surveillance system designed to detect inter-pandemic and, potentially, pandemic influenza. Presence of fever and/or cough and absence from normal duties are collected weekly. Influenza vaccination status of respondents is recorded. New South Wales Flutracking data for 2007 were compared with New South Wales laboratory notifications for confirmed influenza to validate it's ability to provide alerts of influenza activity. Symptom rates amongst vaccinated and unvaccinated Flutracking respondents were compared using a variety of case definitions, with New South Wales laboratory influenza notifications. Time series methods were used to estimate the degree of correlation between each Flutracking case definition and the laboratory data. For the unvaccinated group, the correlations between all Flutracking case definitions and laboratory data were statistically significant, while for the vaccinated group no case definitions were significantly correlated with laboratory data. Thus Flutracking ILI data amongst unvaccinated participants correlated well with influenza laboratory surveillance.

Flutracking: a weekly Australian community online survey of influenza-like illness in 2006, 2007 and 2008.

Surveillance for influenza is an important public health function as it allows initiation and evaluation of public health measures. Flutracking is a weekly online survey of influenza-like illness (ILI) completed by community members that has been trialled in the 2006, 2007, and 2008 winter influenza seasons. The online survey allows participants to record their past and current influenza immunisation status and they receive a weekly email prompt to answer questions on the previous week's experience of cough, fever and time absent from normal activities. The weekly survey takes participants less than 15 seconds to complete. Symptom rates of Flutracking participants were compared by influenza vaccination status to estimate the incidence and severity of influenza and the field effectiveness of influenza vaccine. Participation rates increased from 394 in 2006 to 982 in 2007 and 4,827 in 2008. In 2008, 56% of participants were from New South Wales and 26% were from Tasmania. Greater than 70% of respondents replied within 24 hours of the survey being sent in 2007 and 2008. The 2008 influenza season appeared milder than 2007 with the peak weekly rate of cough and fever among all unvaccinated participants at 7% in 2008 compared with 15% in 2007. The peak week of influenza activity detected by Flutracking in 2008 was the week ending 31 August, which was contemporaneous with the peak week in other syndromic and laboratory influenza surveillance systems. Participation in the survey continues to grow and appears sustainable. A more balanced recruitment across jurisdictions will provide a more national perspective.