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American Journal of Epidemiology Advance Access originally published online on October 12, 2009
American Journal of Epidemiology 2009 170(10):1300-1306; doi:10.1093/aje/kwp270
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American Journal of Epidemiology © The Author 2009. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Optimizing Influenza Sentinel Surveillance at the State Level

Philip M. Polgreen*, Zunqui Chen, Alberto M. Segre, Meghan L. Harris, Michael A. Pentella and Gerard Rushton

* Correspondence to Dr. Philip M. Polgreen, Division of Infectious Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242 (e-mail: philip-polgreen{at}uiowa.edu).

Received for publication December 23, 2008. Accepted for publication August 5, 2009.

Influenza-like illness data are collected via an Influenza Sentinel Provider Surveillance Network at the state level. Because participation is voluntary, locations of the sentinel providers may not reflect optimal geographic placement. The purpose of this study was to determine the "best" locations for sentinel providers in Iowa by using a maximal coverage model (MCM) and to compare the population coverage obtained with that of the current sentinel network. The authors used an MCM to maximize the Iowa population located within 20 miles (32.2 km) of 1–143 candidate sites and calculated the coverage provided by each additional site. The first MCM location covered 15% of the population; adding a second increased coverage to 25%. Additional locations provided more coverage but with diminishing marginal returns. In contrast, the existing 22 Iowa sentinel locations covered 56% of the population, the same coverage achieved with just 10 MCM sites. Using 22 MCM sites covered more than 75% of the population, an improvement over the current site placement, adding nearly 600,000 Iowa residents. Given scarce public health resources, MCMs can help surveillance efforts by prioritizing recruitment of sentinel locations.

geographic locations; influenza, human; models, statistical; population surveillance; sentinel surveillance

Abbreviations: IDPH, Iowa Department of Public Health; ZCTA, zip code tabulation area


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