{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,14]],"date-time":"2026-09-14T05:09:28Z","timestamp":1789362568336,"version":"build-2803163510"},"reference-count":40,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2007,11,30]],"date-time":"2007-11-30T00:00:00Z","timestamp":1196380800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2008,7]]},"abstract":"<jats:title>SUMMARY<\/jats:title>\n                  <jats:p>The influenza virus continues to pose a significant threat to public health throughout the world. Current avian influenza outbreaks in humans have heightened the need for improved surveillance and planning. Despite recent advances in the development of vaccines and antiviral drugs, seasonal epidemics of influenza continue to contribute significantly to general practitioner workloads, emergency hospital admissions, and deaths. In this paper we review data produced by the Royal College of General Practitioners Weekly Returns Service, a sentinel general practice surveillance network that has been in operation for over 40 years in England and Wales. We show a gradually decreasing trend in the incidence of respiratory illness associated with influenza virus infection (influenza-like illness; ILI) over the 40 years and speculate that there are limits to how far an existing virus can drift and yet produce substantial new epidemics. The burden of disease caused by influenza presented to general practitioners varies considerably by age in each winter. In the pandemic winter of 1969\/70 persons of working age were most severely affected; in the serious influenza epidemic of 1989\/90 children were particularly affected; in the millennium winter (in which the NHS was severely stretched) ILI was almost confined to adults, especially the elderly. Serious confounders from infections due to respiratory syncytial virus are discussed, especially in relation to assessing influenza vaccine effectiveness. Increasing pressure on hospitals during epidemic periods are shown and are attributed to changing patterns of health-care delivery.<\/jats:p>","DOI":"10.1017\/s0950268807009910","type":"journal-article","created":{"date-parts":[[2007,11,30]],"date-time":"2007-11-30T04:31:05Z","timestamp":1196397065000},"page":"866-875","source":"Crossref","is-referenced-by-count":86,"title":["Lessons from 40 years' surveillance of influenza in England and Wales"],"prefix":"10.1017","volume":"136","author":[{"given":"D.\u00a0M.","family":"FLEMING","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.\u00a0J.","family":"ELLIOT","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2007,11,30]]},"reference":[{"key":"S0950268807009910_ref030","doi-asserted-by":"publisher","DOI":"10.1086\/515616"},{"key":"S0950268807009910_ref029","volume-title":"Report on the pandemic of influenza, 1918\u201319","year":"1920"},{"key":"S0950268807009910_ref006","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp068205"},{"key":"S0950268807009910_ref039","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa043951"},{"key":"S0950268807009910_ref038","volume-title":"A Winter's Tale: coming to terms with winter respiratory illnesses","author":"Fleming","year":"2005"},{"key":"S0950268807009910_ref017","doi-asserted-by":"publisher","DOI":"10.1023\/A:1007525402861"},{"key":"S0950268807009910_ref016","unstructured":"16.\u00a0Birmingham Research Unit of the Royal College of General Practitioners. Communicable and Respiratory Disease Report for England and Wales, 2007 (http:\/\/www.rcgp.org.uk\/bru_\/bru_home\/weekly_disease_table.aspx). Accessed May 2007."},{"key":"S0950268807009910_ref020","unstructured":"20.\u00a0NICE. Flu treatment\u00a0\u2013\u00a0zanamivir, amantadine and oseltamivir: guidance. London: National Institute for Clinical Excellence, 2003."},{"key":"S0950268807009910_ref008","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0308352100"},{"key":"S0950268807009910_ref037","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268806006601"},{"key":"S0950268807009910_ref033","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2004.026450"},{"key":"S0950268807009910_ref010","first-page":"3","volume-title":"Textbook of Influenza","author":"Potter","year":"1998"},{"key":"S0950268807009910_ref009","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)03311-5"},{"key":"S0950268807009910_ref036","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2004.063461"},{"key":"S0950268807009910_ref035","first-page":"1","article-title":"Morbidity profiles of patients consulting during influenza and respiratory syncytial virus active periods","author":"Fleming","year":"2007","journal-title":"Epidemiology and Infection"},{"key":"S0950268807009910_ref022","unstructured":"22.\u00a0European Influenza Surveillance Scheme (EISS). 2007 (www.eiss.org). Accessed 19 May 2007."},{"key":"S0950268807009910_ref014","unstructured":"14.\u00a0HES Online. Hospital Episode Statistics, 2007 (http:\/\/www.hesonline.nhs.uk). Accessed August 2007."},{"key":"S0950268807009910_ref007","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa044307"},{"key":"S0950268807009910_ref015","unstructured":"15.\u00a0The Office for National Statistics. Death\/mortality rates (http:\/\/www.statistics.gov.uk). Accessed August 2007."},{"key":"S0950268807009910_ref024","first-page":"231","article-title":"Influenza and adult hospital admissions for respiratory conditions in England 1989\u20132001","volume":"6","author":"Fleming","year":"2003","journal-title":"Communicable Disease and Public Health"},{"key":"S0950268807009910_ref023","volume-title":"Options for the Control of Influenza VI","author":"Elliot","year":"2007"},{"key":"S0950268807009910_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/S0264-410X(99)00437-5"},{"key":"S0950268807009910_ref011","doi-asserted-by":"publisher","DOI":"10.3201\/eid0910.020789"},{"key":"S0950268807009910_ref019","doi-asserted-by":"crossref","first-page":"249","DOI":"10.2807\/esm.11.10.00651-en","article-title":"Surveillance of influenza-like illness in England and Wales during 1966\u20132006","volume":"11","author":"Elliot","year":"2006","journal-title":"Eurosurveillance"},{"key":"S0950268807009910_ref003","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)01182-9"},{"key":"S0950268807009910_ref040","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.38995.531701.80"},{"key":"S0950268807009910_ref012","doi-asserted-by":"publisher","DOI":"10.1016\/S0264-410X(02)00121-4"},{"key":"S0950268807009910_ref001","unstructured":"1.\u00a0World Health Organisation. Confirmed human cases of avian influenza A(H5N1), 2007 (http:\/\/www.who.int\/csr\/disease\/avian_influenza\/country\/). Accessed August 2007."},{"key":"S0950268807009910_ref005","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1056\/NEJMoa040419","article-title":"Avian influenza A (H5N1) in 10 patients in Vietnam","volume":"350","author":"Tran","year":"2004","journal-title":"New England Journal of Medicine"},{"key":"S0950268807009910_ref004","first-page":"100","article-title":"Cases of influenza A (H5N1)\u00a0\u2013\u00a0Thailand, 2004","volume":"53","author":"Chotpitayasunondh","year":"2004","journal-title":"Morbidity and Mortality Weekly Reports"},{"key":"S0950268807009910_ref028","article-title":"Can pharmacists diagnose influenza? Assessing the accuracy of influenza diagnosis in the community pharmacy setting","author":"Fleming","year":"2007","journal-title":"Pharmaceutical Journal"},{"key":"S0950268807009910_ref002","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)11212-0"},{"key":"S0950268807009910_ref025","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkg007"},{"key":"S0950268807009910_ref031","first-page":"32","article-title":"The contribution of influenza to combined acute respiratory infections, hospital admissions, and deaths in winter","volume":"3","author":"Fleming","year":"2000","journal-title":"Communicable Disease and Public Health"},{"key":"S0950268807009910_ref018","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(01)06528-X"},{"key":"S0950268807009910_ref013","unstructured":"13.\u00a0World Health Organisation. Global influenza surveillance, 2007 (http:\/\/www.who.int\/csr\/disease\/influenza\/influenzanetwork\/en\/index.html). Accessed May 2007."},{"key":"S0950268807009910_ref034","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa051721"},{"key":"S0950268807009910_ref027","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1128\/CDLI.5.5.604-608.1998","article-title":"Increased interleukin-6 levels in nasal lavage samples following experimental influenza A virus infection","volume":"5","author":"Gentile","year":"1998","journal-title":"Clinical and Diagnostic Laboratory Immunology"},{"key":"S0950268807009910_ref032","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.2.179"},{"key":"S0950268807009910_ref026","first-page":"256","article-title":"Presentation with influenza-like illness in general practice: implications for use of neuraminidase inhibitors","volume":"3","author":"Ross","year":"2000","journal-title":"Communicable Disease and Public Health"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268807009910","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,28]],"date-time":"2020-04-28T19:44:52Z","timestamp":1588103092000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268807009910\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2007,11,30]]},"references-count":40,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2008,7]]}},"alternative-id":["S0950268807009910"],"URL":"https:\/\/doi.org\/10.1017\/s0950268807009910","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2007,11,30]]}}}