gp in hours measles no trend similar to baseline levels ......gp in hours syndromic surveillance...

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GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This Issue: Key messages. Diagnostic indicators at a glance. GP practices and denominator population. National syndromic indicators. Notes and further information. Diagnostic indicators at a glance: GP practices and denominator population: **based on the average number of practices and denominator population in the reporting working week. A Heat-Health Watch system operates in England from 1 June to 15 September each year. As part of the Heatwave Plan for England, the PHE Real-time Syndromic Surveillance team will be routinely monitoring the public health impact of hot weather using syndromic surveillance data during this period. Heat-health watch level (current reporting week): Level 1 Summer preparedness http://www.metoffice.gov.uk/weather/uk/heathealth/ Year: 2019 Week: 32 Data to: 11 August 2019 * Moving Epidemic Method (MEM) influenza activity threshold (see notes) Indicator Trend Level Upper respiratory tract infection no trend below baseline levels Influenza-like illness no trend pre-epidemic threshold* Pharyngitis no trend below baseline levels Scarlet fever decreasing similar to baseline levels Lower respiratory tract infection no trend below baseline levels Pneumonia no trend below baseline levels Gastroenteritis no trend below baseline levels Vomiting no trend below baseline levels Diarrhoea no trend below baseline levels Asthma decreasing above baseline levels Conjunctivitis no trend below baseline levels Mumps decreasing above baseline levels Measles no trend similar to baseline levels Rubella no trend Pertussis increasing Chickenpox decreasing Herpes zoster no trend Cellulitis no trend Impetigo decreasing below baseline levels similar to basleine levels similar to baseline levels below baseline levels below baseline levels below baseline levels Allergic rhinitis decreasing below baseline levels Heat/sunstroke decreasing similar to baseline levels Insect Bites decreasing above baseline levels Year Week GP Practices Reporting** Population size** 2019 32 2,578 22.6 million

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Page 1: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

GP In Hours Syndromic Surveillance System:

England

13 August 2019

Key messages

Nothing new to report on week 32.

In This Issue:

Key messages.

Diagnostic indicators at a glance.

GP practices and denominator population.

National syndromic indicators.

Notes and further information.

Diagnostic indicators at a glance:

GP practices and denominator population:

**based on the average number of practices and denominator population in the reporting working week.

A Heat-Health Watch system operates in England from 1 June to 15 September each year. As part of the Heatwave Plan for England, the PHE Real-time Syndromic Surveillance team will be routinely monitoring the public health impact of hot weather using syndromic surveillance data during this period. Heat-health watch level (current reporting week): Level 1 Summer preparedness

http://www.metoffice.gov.uk/weather/uk/heathealth/

Year: 2019 Week: 32

Data to: 11 August 2019

* Moving Epidemic Method (MEM) influenza activity threshold (see notes)

Indicator Trend Level

Upper respiratory tract infection no trend below baseline levels

Influenza-like illness no trend pre-epidemic threshold*

Pharyngitis no trend below baseline levels

Scarlet fever decreasing similar to baseline levels

Lower respiratory tract infection no trend below baseline levels

Pneumonia no trend below baseline levels

Gastroenteritis no trend below baseline levels

Vomiting no trend below baseline levels

Diarrhoea no trend below baseline levels

Asthma decreasing above baseline levels

Conjunctivitis no trend below baseline levels

Mumps decreasing above baseline levels

Measles no trend similar to baseline levels

Rubella no trend

Pertussis increasing

Chickenpox decreasingHerpes zoster no trend

Cellulitis no trend

Impetigo decreasing

below baseline levels similar to basleine levels similar to baseline levels below baseline levels below baseline levels below baseline levels

Allergic rhinitis decreasing below baseline levels

Heat/sunstroke decreasing similar to baseline levels

Insect Bites decreasing above baseline levels

Year Week GP Practices Reporting** Population size**

2019 32 2,578 22.6 million

Page 2: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

GP In Hours

13 August 2019.

Page 2.

1: Upper respiratory

tract infection.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

* 7-day moving average adjusted for bank holidays.

0

20

40

60

80

100

120

140

160

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline URTI

Year: 2019 Week: 32

2: Influenza-like illness

(ILI).

0

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4

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8

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12

14

16

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Influenza-like illness

Intentionally left blank.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Page 3: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Scarlet Fever

0

5

10

15

20

25

30

35

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Pharyngitis or scarlet fever

GP In Hours

13 August 2019.

Page 3.

* 7-day moving average adjusted for bank holidays.

3: Pharyngitis or scarlet fever.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

4: Scarlet fever.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, based on a denominator population of approximately 5.5 million patients)

4a: Scarlet fever by age.

Year: 2019 Week: 32

Average daily incidence rate by week per 100,000 population (all England, based on a denominator population of approximately 5.5 million patients).

0

1

2

3

4

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

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Year - Week

Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

Page 4: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0

10

20

30

40

50

60

70

80

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline LRTI

GP In Hours

13 August 2019.

Page 4.

* 7-day moving average adjusted for bank holidays.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

5: Lower respiratory tract infection (LRTI).

Year: 2019 Week: 32

Intentionally left blank.

0.0

0.2

0.4

0.6

0.8

1.0

1.2

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Pneumonia

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

6: Pneumonia.

Page 5: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0

1

2

3

4

5

6

7

8

9

10

11

12

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Vomiting

8: Vomiting.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

7a: Gastroenteritis by age.

Average daily incidence rate by week per 100,000 population (all England).

GP In Hours

0

5

10

15

20

25

30

35

40

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Gastroenteritis

13 August 2019.

Page 5.

* 7-day moving average adjusted for bank holidays.

7: Gastroenteritis.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Year: 2019 Week: 32

0

20

40

60

80

100

120

140

160

180

200

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

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Year - Week

Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

Page 6: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0

2

4

6

8

10

12

14

16

18

20

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Diarrhoea

8a: Vomiting by age.

Average daily incidence rate by week per 100,000 population (all England).

9: Diarrhoea.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

GP In Hours

13 August 2019.

Page 6.

* 7-day moving average adjusted for bank holidays.

9a. Diarrhoea by age.

Year: 2019 Week: 32

Average daily incidence rate by week per 100,000 population (all England).

0

10

20

30

40

50

60

70

80

90

100

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

Av

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00

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Year - Week

Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

0

10

20

30

40

50

60

70

80

90

100

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

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Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

Page 7: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

GP In Hours

0

1

2

3

4

5

6

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Asthma

13 August 2019.

Page 7.

* 7-day moving average adjusted for bank holidays.

10a: Asthma by age.

Average daily incidence rate by week per 100,000 population (all England).

10: Asthma.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Year: 2019 Week: 32

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

0

2

4

6

8

10

12

14

16

18

20

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Conjunctivitis

11: Conjunctivitis.

0

1

2

3

4

5

6

7

8

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

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Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

Page 8: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0.00

0.05

0.10

0.15

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0.25

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12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Mumps

GP In Hours

13 August 2019.

Page 8.

12: Mumps.

* 7-day moving average adjusted for bank holidays.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Average daily incidence rate by week per 100,000 population (all England).

12a: Mumps by age.

Year: 2019 Week: 32

0

0.1

0.2

0.3

0.4

0.5

0.6

33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

2018 2019

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Under 1 Year 1 to 4 5 to 14 15 to 44 45 to 64 65 to 74 75 plus All ages

Intentionally left blank.

Page 9: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

GP In Hours

13 August 2019.

Page 9.

* 7-day moving average adjusted for bank holidays.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

13: Measles.

Year: 2019 Week: 32

0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Measles

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

14: Rubella.

0.000

0.005

0.010

0.015

0.020

0.025

0.030

0.035

0.040

0.045

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Rubella

Intentionally left blank.

Page 10: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

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0.20

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Pertussis

GP In Hours

Page 10.

13 August 2019.

* 7-day moving average

0.0

1.0

2.0

3.0

4.0

5.0

6.0

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Herpes Zoster

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

17: Herpes zoster.

15: Pertussis.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

16: Chickenpox.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Year: 2019 Week: 32

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Chickenpox

Page 11: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Impetigo

0

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12

14

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weekend bank holiday 7 day mov avg baseline Cellulitis

GP In Hours

13 August 2019.

Page 11.

18: Cellulitis.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

19: Impetigo.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

* 7-day moving average adjusted for bank holidays.

Year: 2019 Week: 32

0

5

10

15

20

25

30

35

40

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg Allergic Rhinitis baseline

20: Allergic rhinitis.

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Page 12: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

21: Heat/sunstroke.

22: Insect bites.

0.00

0.02

0.04

0.06

0.08

0.10

0.12

0.14

0.16

0.18

0.20

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Heat stroke

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

Daily incidence rate (and 7-day moving average*) per 100,000 population (all England, all ages).

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0

5.5

6.0

6.5

7.0

12/08/18 09/09/18 07/10/18 04/11/18 02/12/18 30/12/18 27/01/19 24/02/19 24/03/19 21/04/19 19/05/19 16/06/19 14/07/19 11/08/19

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weekend bank holiday 7 day mov avg baseline Insect bite

GP In Hours

13 August 2019.

Page 12.

* 7-day moving average adjusted for bank holidays.

Year: 2019 Week: 32

Page 13: GP In Hours Measles no trend similar to baseline levels ......GP In Hours Syndromic Surveillance System: England 13 August 2019 Key messages Nothing new to report on week 32. In This

GP In Hours

13 August 2019.

Page 13.

Notes and further information:

• The Public Health England GP in hours surveillance system is a syndromic surveillance system monitoring community-based morbidity recorded by GP practices.

• GP consultation data are analysed on a daily basis to identify national and regional trends. A statistical algorithm underpins each system, routinely identifying activity that has increased significantly or is statistically significantly high for the time of year. Results from these daily analyses are assessed by the ReSST, along with analysis by age group, and anything deemed of public health importance is alerted by the team.

• This system captures anonymised GP morbidity data from two GP clinical software systems, EMIS, from version 1 of the QSurveillance® database, and TPP SystmOne.

• Baselines represent seasonally expected levels of activity and are constructed from historical data since April 2012. They take into account any known substantial changes in data collection, population coverage or reporting practices. Gastroenteritis, diarrhoea and vomiting baselines also account for changes since the introduction of rotavirus vaccine in July 2013. Baselines are refreshed using the latest data on a regular basis.

Acknowledgements: We thank and acknowledge the University of Nottingham, ClinRisk® and the contribution of

EMIS and EMIS practices. Data source: version 1 of the QSurveillance® database. We thank TPP, ResearchOne and the SystmOne GP practices contributing to this surveillance system.

GP In Hours Syndromic Surveillance System Bulletin.

Produced by: PHE Real-time Syndromic Surveillance Team 1

st Floor, 5 St Philips Place, Birmingham, B3 2PW Tel: 0344 225 3560 > Option 4 > Option 2

Web: https://www.gov.uk/government/collections/syndromic-surveillance-systems-and-analyses

Contact ReSST: [email protected]

• From week 40 2018 the levels of influenza-like illness (ILI) rates are illustrated in the bulletin appendix maps. The ILI intensity levels are calculated using MEM.

• The current ILI thresholds are based upon previous influenza seasons from 2012/13 onwards and therefore illustrate activity levels in relation to previous ILI activity recorded in the GPIH system. IILI thresholds presented in the maps should be interpreted with caution and reference made to other GP surveillance systems incorporating more historical data, which are available in the PHE National Influenza Report.

https://www.gov.uk/government/statistics/weekly-national-flu-reports

• The ILI thresholds have been calculated separately for each of the nine PHE Centres to allow for differences between areas e.g. background ILI rates are historically higher in London than other areas of England.

Maps:

Year: 2019 Week: 32

Moving Epidemic Method:

• During winter 2018/19 we presented Moving Epidemic Method (MEM) influenza thresholds on selected indicators.

• The moving epidemic method or MEM is a standard methodology used for setting influenza thresholds across many European nations.

1

• MEM is used for GP ILI thresholds at a national level and at PHE Centre level and stratified by age band.

• MEM thresholds should be interpreted using 7 day moving averages rather than daily data.

• MEM thresholds currently use five years of historic data (2013-2018). The thresholds are re-calculated every year.

• ‘Pre-epidemic thresholds’ are used alongside other surveillance systems to identify the start of influenza circulating in the community; 40%, 95% and 97.5% intensity thresholds are used to identify when influenza activity moves from low to medium, high or very high.

1Vega T et al. Influenza Other Respir Viruses. 2013;7(4):546-58.