1. How many respiratory specimens should be taken by each sentinel practitioner?
This may vary, but based on statistical power calculations and experience from several influenza seasons, it is anticipated that an average of one to two specimens per week may be submitted by each sentinel practitioner over the course of the study 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.
2. When should I start taking specimens from patients presenting with symptoms of influenza-like illness this year?
You can start submitting specimens as soon as you receive the information package and testing kits.
3. 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) (as per the FluWatch definition) within one week of ILI symptom onset.
You should collect a nasopharyngeal (preferred) or nasal swab using the test kits for influenza testing.
You will be notified if specimen collection for the purpose of this study will change. Please note that it is important that you collect respiratory specimens from patients who are residents of Ontario and who are presenting within seven days of ILI onset, whether they received the influenza vaccine or not.
For the 2016-17 season, we also ask that special emphasis is given to patients 65 years and older since this age group has been underrepresented in previous years.
4. Should I submit SPSN specimens to the laboratory where I usually send respiratory specimens?
Yes. Starting with the 2017-18 season sentinels can now submit SPSN specimens to PHO’s laboratory via their routine lab submission process. Specimens will be directed to PHO by your lab.
5. Will I be compensated for my time?
Yes. Your time, effort and participation are much appreciated. Participating sentinel practitioners will be compensated $10 for each specimen submitted with a completed SPSN-specific requisition. Reimbursement will be made at the end of each period.
6. 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. This means that separate ethics review and approval has been granted in each of British Columbia, Alberta, Ontario and Quebec (four separate reviews). For the 2018-2019 season, ethics approval will be requested in the Fall of 2018. 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.
7. Who else participates in this study?
In each participating province, a team of epidemiologists and laboratory investigators has been established. These investigators have been working collaboratively for several years and Ontario investigators and sentinel physicians will again join that team of provincial investigators this season.
8. How will vaccine effectiveness be calculated?
Vaccine effectiveness (VE) against laboratory confirmed influenza is calculated by SPSN researchers based on a case control design. Using the laboratory results (either positive or negative for influenza) and the answers to the questions accompanying the laboratory requisition (e.g., recent influenza immunization history), vaccine status is compared for those with and without influenza. The program is based on the understanding that not everyone with influenza-like illness 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.
9. 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 in calculating this combined estimate do not include any personal identifiers and 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.
10. Do I need special equipment for the study?
You will need:
11. 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.
12. 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.