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ISDS 2012 Conference Abstracts

Flu Near You: An Online Self-reported Influenza
Surveillance System in the USA
Rumi Chunara*1, 2, Susan Aman2, Mark Smolinski3 and John S. Brownstein1, 2

1Harvard Medical School, Boston, MA, USA; 2Boston Children’s Hospital, Boston, MA, USA; 3Skoll Global Threats Fund, San
Francisco, CA, USA

Objective
To develop a participatory system for monitoring the activity of

influenza-like-illness among the United States general population.

Introduction
The emergence of new influenza strains including H1N1, H5N1,

H3N2v as well as other respiratory pathogens such as SARS, along
with generally weak information about household and community
transmission of influenza, enforce the need for augmented influenza
surveillance. At the same time, Internet penetration and access has
grown, with 82% of American adults using the Internet [1], enabling
transfer and communication of information that can be collected and
aggregated in near real-time. Surveillance targeted towards influenza
in other countries, and towards malaria in India, has previously been
executed with good user engagement [2,3]. In this study, we created
an online participatory influenza surveillance tool in the United
States, called Flu Near You.

Methods
Volunteer users were primarily solicited via collaboration with the

American Public Health Association and their members’ networks
starting Oct. 24, 2011. Upon registration, each user is sent a weekly
email, taking them to the Flu Near You website. On the website they
fill in a short survey asking if they had any of 10 symptoms: fever,
cough, sore throat, shortness of breath, chills/night sweats, fatigue,
nausea or vomiting, diarrhea, body aches and headache, in the last
week. Users can also enroll their household members and enter in-
formation in for them weekly. A map of influenza activity is made
available to users, and anyone accessing the website [Figure 1]. On
the map, the number of individuals reporting with no symptoms,
some symptoms, or Influenza-like illness are visualized, aggregated
to the zip code level. Users can also compare the contributed data
with other surveillance systems: the Centers for Disease Control and
Prevention, and Google Flu Trends for the same time period [Figure
1]. We also obtained user feedback through a survey in early July
2012.

Results
As of August 21, 2012, there are over 9300 Flu Near You users,

from all 50 states. 94.0% of users are between 20 and 70 years, al-
though 37.2% of household members are < 20 years old. Overall
62.0% of members (users and household) were female. We found that
46.4% of users answered 3 or more surveys. Qualitatively from sur-
vey responses, we learned that simple feedback and an emphasis on
public health education are important in this type of system.

Conclusions
We found that it is possible to engage users in a symptom self-re-

porting system and augment information about influenza for the na-

tion. Increased uptake would increase the value of the system for the
public and public health professionals. Flu Near You is expanding in
its second season, working to increase user participation. Other con-
nected projects are also examining the expansion into other diseases
with high prevalence and in need of augmented surveillance. With a
larger user base and through a longer period of execution, systems
like Flu Near You will help to improve our understanding of influenza
epidemiology as well as guide implementation of relevant and timely
public health interventions, for example in estimating vaccination
rates and efficacy among different demographic groups. Information
reported by individuals can augment traditional public health sur-
veillance methods for more timely detection of disease outbreaks,
monitoring disease activity and increasing the public’s engagement in
their own and population’s health.

Keywords
influenza; surveillance; crowdsourcing

Acknowledgments

All of the Flu Near You users who have contributed information.

References

[1] Pew Internet & Aerican Life Project. Available at: pewinternet.org.
Accessed Aug. 22, 2012.

[2] Marquet RL, et al. Internet-based monitoring of influenza-like illness
(ILI) in the general population of the Netherlands during the 2003-
2004 influenza season. BMC Public Health. 2006; 6: 242.

[3] Chunara R, et al. (2012) Online reporting for malaria surveillance
using micro-monetary incentives, in urban India 2010-2011. Malaria
J 11: 43.

*Rumi Chunara
E-mail: rumi@alum.mit.edu

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * 5(1):e133, 2013