High added value of a population-based participatory surveillance system for community acute gastrointestinal, respiratory and influenza-like illnesses in Sweden, 2013-2014 using the web

In 2013-2014, the Public Health Agency of Sweden developed a web-based participatory surveillance system, Halsorapport, based on a random sample of individuals reporting symptoms weekly online, to estimate the community incidence of self-reported acute gastrointestinal (AGI), acute respiratory (ARI) and influenza-like (ILI) illnesses and their severity. We evaluated Halsorapport's acceptability, completeness, representativeness and its data correlation with other surveillance data. We calculated response proportions and Spearman correlation coefficients (r) between (i) incidence of illnesses in Halsorapport and (ii) proportions of specific search terms to medical-advice website and reasons for calling a medical advice hotline. Of 34 748 invitees, 3245 (9.3%) joined the cohort. Participants answered 81% (139 013) of the weekly questionnaires and 90% (16 351) of follow-up questionnaires. AGI incidence correlated with searches on winter-vomiting disease [r = 0.81, 95% confidence interval (CI) 0.69-0.89], and ARI incidence correlated with searches on cough (r = 0.77, 95% CI 0.62-0.86). ILI incidence correlated with the web query-based estimated incidence of ILI patients consulting physicians (r = 0.63, 95% CI 0.420-0.77). The high response to different questionnaires and the correlation with other syndromic surveillance systems suggest that Halsorapport offers a reasonable representation of AGI, ARI and ILI patterns in the community and can complement traditional and syndromic surveillance systems to estimate their burden in the community.