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    This article has been cited by the following publications. This list is generated based on data provided by CrossRef.

    Kinyanjui, T.M. Pellis, L. and House, T. 2016. Information content of household-stratified epidemics. Epidemics, Vol. 16, p. 17.

    Spreco, A and Timpka, T 2016. Algorithms for detecting and predicting influenza outbreaks: metanarrative review of prospective evaluations. BMJ Open, Vol. 6, Issue. 5, p. e010683.

    Tsang, Tim K. Lau, Lincoln L.H. Cauchemez, Simon and Cowling, Benjamin J. 2016. Household Transmission of Influenza Virus. Trends in Microbiology, Vol. 24, Issue. 2, p. 123.


Optimal design of studies of influenza transmission in households. II: Comparison between cohort and case-ascertained studies

  • B. KLICK (a1), H. NISHIURA (a1) (a2), G. M. LEUNG (a1) and B. J. COWLING (a1)
  • DOI:
  • Published online: 05 July 2013

Both case-ascertained household studies, in which households are recruited after an ‘index case’ is identified, and household cohort studies, where a household is enrolled before the start of the epidemic, may be used to test and estimate the protective effect of interventions used to prevent influenza transmission. A simulation approach parameterized with empirical data from household studies was used to evaluate and compare the statistical power of four study designs: a cohort study with routine virological testing of household contacts of infected index case, a cohort study where only household contacts with acute respiratory illness (ARI) are sampled for virological testing, a case-ascertained study with routine virological testing of household contacts, and a case-ascertained study where only household contacts with ARI are sampled for virological testing. We found that a case-ascertained study with ARI-triggered testing would be the most powerful design while a cohort design only testing household contacts with ARI was the least powerful. Sensitivity analysis demonstrated that these conclusions varied by model parameters including the serial interval and the risk of influenza virus infection from outside the household.

Corresponding author
*Author for correspondence: Dr B. J. Cowling, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. (Email:
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1.AS Monto . Global burden of influenza: what we know and what we need to know. International Congress Series 2004; 1263: 311.

2.F Carrat , Influenza burden of illness: estimates from a national prospective survey of household contacts in France. Archives of Internal Medicine 2002; 162: 18421848.

3.NM Ferguson , Strategies for mitigating an influenza pandemic. Nature 2006; 442: 448452.

4.DL Chao , FluTE, a publicly available stochastic influenza epidemic simulation model. PLoS Computational Biology 2010; 6: e1000656.

5.KO Kwok , GM Leung , S Riley . Modelling the proportion of influenza infections within households during pandemic and non-pandemic years. PLoS One 2011; 6: e22089.

7.FG Hayden , Inhaled zanamivir for the prevention of influenza in families. Zanamivir Family Study Group. New England Journal of Medicine 2000; 343: 12821289.

8.AS Monto , Zanamivir prophylaxis: an effective strategy for the prevention of influenza types A and B within households. Journal of Infectious Diseases 2002; 186: 15821588.

9.FG Hayden , Management of influenza in households: a prospective, randomized comparison of oseltamivir treatment with or without postexposure prophylaxis. Journal of Infectious Diseases 2004; 189: 440449.

10.R Welliver , Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial. Journal of the American Medical Association 2001; 285: 748754.

11.M van Boven , Transmission of novel influenza A(H1N1) in households with post-exposure antiviral prophylaxis. PLoS One 2010; 5: e11442.

12.BJ Cowling , Preliminary findings of a randomized trial of non-pharmaceutical interventions to prevent influenza transmission in households. PLoS One 2008; 3: e2101.

13.BJ Cowling , Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial. Annals of Internal Medicine 2009; 151: 437446.

14.T Suess , The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009–2011. BMC Infectious Diseases 2012; 12: 26.

15.JM Simmerman , Findings from a household randomized controlled trial of hand washing and face masks to reduce influenza transmission in Bangkok, Thailand. Influenza and Other Respiratory Viruses 2011; 5: 256267.

16.CR MacIntyre , Face mask use and control of respiratory virus transmission in households. Emerging Infectious Diseases 2009; 15: 233241.

17.L Canini , Surgical mask to prevent influenza transmission in households: a cluster randomized trial. PLoS One 2010; 5: e13998.

18.C Viboud , Risk factors of influenza transmission in households. British Journal of General Practice 2004; 54: 684689.

19.S Cauchemez , Household transmission of 2009 pandemic influenza A (H1N1) virus in the United States. New England Journal of Medicine 2009; 361: 26192627.

20.AM France , Household transmission of 2009 influenza A (H1N1) virus after a school-based outbreak in New York City, April–May 2009. Journal of Infectious Diseases 2010; 201: 984992.

21.C Looker , Influenza A (H1N1) in Victoria, Australia: a community case series and analysis of household transmission. PLoS One 2010; 5: e13702.

22.TJ Doyle , RS Hopkins . Low secondary transmission of 2009 pandemic influenza A (H1N1) in households following an outbreak at a summer camp: relationship to timing of exposure. Epidemiology and Infection 2010; 139: 4551.

23.J Papenburg , Household transmission of the 2009 pandemic A/H1N1 influenza virus: elevated laboratory-confirmed secondary attack rates and evidence of asymptomatic infections. Clinical Infectious Diseases 2010; 51: 10331041.

24.OW Morgan , Household transmission of pandemic (H1N1) 2009, San Antonio, Texas, USA, April–May 2009. Emerging Infectious Diseases 2010; 16: 631637.

25.BJ Cowling , Comparative epidemiology of pandemic and seasonal influenza A in households. New England Journal of Medicine 2010; 362: 21752184.

26.T Suess , Shedding and transmission of novel influenza virus A/H1N1 infection in households – Germany, 2009. American Journal of Epidemiology 2010; 171: 11571164.

29.Y Yang , IM Longini Jr., ME Halloran . Design and evaluation of prophylactic interventions using infectious disease incidence data from close contact groups. Journal of the Royal Statistical Society Series C (Applied Statistics) 2006; 55: 317330.

30.B Klick , GM Leung , BJ Cowling . Optimal design of studies of influenza transmission in households. I. Case-ascertained studies. Epidemiology and Infection 2012; 140: 106114.

31.LL Lau , Household transmission of 2009 pandemic influenza A (H1N1): a systematic review and meta-analysis. Epidemiology 2012; 23: 531542.

32.SH Vollmer , G Howard . Statistical power, the Belmont report, and the ethics of clinical trials. Science and Engineering Ethics 2010; 16: 675691.

33.AC Hurt , Performance of six influenza rapid tests in detecting human influenza in clinical specimens. Journal of Clinical Virology 2007; 39: 132135.

34.C Sikora , Transmission of pandemic influenza A (H1N1) 2009 within households: Edmonton, Canada. Journal of Clinical Virology 2010; 49: 9093.

35.ME Halloran , M-P Préziosi , H Chu . Estimating vaccine efficacy from secondary attack rates. Journal of the American Statistical Association 2003; 98: 3846.

37.R Moineddin , FI Matheson , RH Glazier . A simulation study of sample size for multilevel logistic regression models. BMC Medical Research Methodology 2007; 7: 34.

40.LF White , Estimation of the reproductive number and the serial interval in early phase of the 2009 influenza A/H1N1 pandemic in the USA. Influenza and Other Respiratory Viruses 2009; 3: 267276.

41.BJ Cowling , Estimation of the serial interval of influenza. Epidemiology 2009; 20: 344347.

42.LL Lau , Viral shedding and clinical illness in naturally acquired influenza virus infections. Journal of Infectious Diseases 2010; 201: 15091516.

43.AJ Elliot , Monitoring the emergence of community transmission of influenza A/H1N1 2009 in England: a cross sectional opportunistic survey of self sampled telephone callers to NHS Direct. British Medical Journal 2009; 339: b3403.

44.OE Larios , Self-collected mid-turbinate swabs for the detection of respiratory viruses in adults with acute respiratory illnesses. PLoS One 2011; 6: e21335.

45.N Dhiman , Effectiveness of patient-collected swabs for influenza testing. Mayo Clinic Proceedings 2012; 87: 548554.

46.DK Ip , Validation of self-swab for virologic confirmation of influenza virus infections in a community setting. Journal of Infectious Diseases 2012; 205: 631634.

47.IM Longini Jr., AS Monto . Efficacy of virucidal nasal tissues in interrupting familial transmission of respiratory agents. A field trial in Tecumseh, Michigan. American Journal of Epidemiology 1988; 128: 639644.

48.ME Halloran , Antiviral effects on influenza viral transmission and pathogenicity: observations from household-based trials. American Journal of Epidemiology 2007; 165: 212221.

50.J Lessler , Incubation periods of acute respiratory viral infections: a systematic review. Lancet Infectious Diseases 2009; 9: 291300.

51.H Nishiura , H Inaba . Estimation of the incubation period of influenza A (H1N1-2009) among imported cases: addressing censoring using outbreak data at the origin of importation. Journal of Theoretical Biology 2011; 272: 123130.

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