How many respiratory specimens should be collected by each sentinel practitioner?
This may vary, however based on statistical power calculations and experience from several influenza seasons, it is anticipated that a minimum of one to two specimens per week may be submitted by each sentinel practitioner over the course of the SPSN surveillance period for a total of 20-25 specimens per season. In the national collaboration between British Columbia, Alberta, Ontario and Quebec, we are aiming for a total of 3,000 respiratory specimens as part of this study.
When should I start collecting specimens from patients presenting with symptoms of influenza-like illness (ILI) or acute respiratory illness (ARI) this year? When do I stop?
You can start submitting specimens as soon as you receive the information package and testing kits. Please continue to submit samples until notified by the SPSN coordinator.
Which patients are eligible for inclusion?
Any patient who is a resident of Ontario, who presents in your practice with symptoms of an influenza-like illness (ILI) or acute respiratory illness (ARI) within one week of ILI symptom onset.
You should collect a nasopharyngeal or nasal swab using the test kits provided by the SPSN for testing. You will be notified if specimen collection for the purpose of the SPSN will change. Please note that it is important that you collect respiratory specimens from patients who are residents of participating provinces (British Columbia, Alberta, Ontario and Quebec) and who are presenting within seven days of ILI onset, whether or not they received the influenza vaccine.
Should I submit SPSN specimens to the laboratory where I usually send respiratory specimens?
Yes. Sentinels can submit SPSN specimens to PHO’s laboratory via their routine lab submission process. Specimens will be directed to PHO by your laboratory. Please ensure that a fully completed SPSN requisition is submitted with each specimen.
Will I be compensated for my time?
Yes. As your time, effort and participation are much appreciated, participating sentinels will be compensated $20 for each specimen submitted with a completed SPSN-specific requisition. Reimbursement will be made at the end of each period.
Has this study received ethics approval and if so, what special ethics requirements are there?
The SPSN’s methodology has been reviewed by ethics boards in each participating province every year since 2004. In more recent year separate ethics review and approval has been granted in Alberta, and Ontario while SPSN activities in British Columbia and Quebec are considered regular public health surveillance. For the 2022-2023 season, ethics approval for SPSN Ontario was granted in the fall of 2022. As part of the program, sentinel physicians and nurse practitioners are required to inform their eligible patients and elicit verbal consent to participate through specimen collection and questionnaire completion. A verbal consent script has been drafted by SPSN investigators for this purpose and is included with the study material sent to consenting sentinels
Who else is involved in this study?
In each participating province (ON, BC, AB, QC), a team of epidemiologists and laboratory investigators has been established. These investigators have been working collaboratively for several years and Ontario investigators and sentinels will again join that team of provincial investigators this season.
How will vaccine effectiveness be calculated?
Vaccine effectiveness against laboratory confirmed influenza and COVID-19 infection is calculated by SPSN researchers based on a case control design. Using the laboratory results (either positive or negative for influenza & COVID-19) and the answers to the questions accompanying the laboratory requisition (e.g., recent immunization history), vaccine status is compared for those with and without influenza & COVID-19. The program is based on the understanding that not everyone with ILI will have influenza. Those who test positive for influenza are counted as cases, whereas those who test negative for influenza become the controls. Immunization rates among these two groups are used for VE estimation.
Where will this analysis be done nationally and how will confidentiality be preserved?
Since 2004, an overall vaccine effectiveness result has been calculated for all participating provinces combined nationally through statistical analysis at the British Columbia Centre for Disease Control (BCCDC).
Data from Quebec, Ontario, and Alberta that are shared with BCCDC do not include any personal identifiers and chronic medical conditions, as specified by ethics boards. Absolutely no personal identifying information will be transmitted. Only the influenza test result and relevant epidemiologic information provided on the requisition are shared for the sole purpose of calculating an aggregate vaccine effectiveness result. At each level, all data is stored in a secure and locked facility. Dr. Danuta Skowronski, principal investigator, is located at the BCCDC.
Do I need special equipment for the study?
You will need:
- Test kits (provided by PHO’s laboratory – Toronto location PHO’s laboratory, Toronto location).
- A fridge to store specimens at 4°C until transported to lab. Specimens should be shipped as soon as they are collected, but this is not always possible.
How do I receive results for specimens I submitted?
In order to reduce the turnaround time and increase the efficiency of testing and reporting, results will be reported automatically by the Laboratory Information System using the AutoFax system. To register for AutoFax, please contact the Toronto Public Health Laboratory’s Customer Service Centre at 416-235-6556 or 1-877-604-4567.
Where can I get more information about what else is circulating in my area?
Please refer to the Ontario Respiratory Pathogen Bulletin for more information.
How can I contact the SPSN team?
By email: firstname.lastname@example.org
By phone: (647) 792-3187
Sentinel Practitioner Surveillance Network
Public Health Ontario 661 University Avenue, Suite 1701
Toronto, ON M5G 1M1
If you are interested in the SPSN, sentinel consent forms can be submitted by email to email@example.com or faxed to (416) 235-6103.