{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T07:48:36Z","timestamp":1792050516544,"version":"4.4.0"},"reference-count":37,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"unspecified","delay-in-days":287,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2026]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The Moving Epidemic Method (MEM) is the ECDC\/WHO-Europe-endorsed approach for establishing influenza epidemic thresholds and intensity levels, yet no positivity-based MEM analysis exists for T\u00fcrkiye or any country in the WHO Western Asia transmission zone. Weekly influenza positivity rates from FluNet sentinel surveillance were analysed for ten of twelve seasons (2013\/2014\u20132024\/2025, excluding two COVID-19 pandemic seasons) using the mem R package with cross-validated optimized slope parameter, and T\u00fcrkiye\u2019s average epidemic curve and thresholds were compared with the Western Asia (excluding T\u00fcrkiye) and South West Europe zones using Lin\u2019s concordance correlation coefficient (CCC), root mean square deviation (RMSD) and complementary correlation metrics. The epidemic threshold was 10.59% positivity, with intensity thresholds at 42.56% (medium), 60.92% (high), and 71.38% (very high); cross-validated sensitivity was 0.77, specificity 0.88, and Matthews correlation coefficient 0.65. T\u00fcrkiye\u2019s average curve showed higher concordance with Western Asia (CCC=0.890; RMSD=4.22 percentage points) than South West Europe (CCC=0.672; RMSD=12.48) despite similar Pearson correlations (0.922 vs. 0.939), and the Western Asia epidemic threshold (11.50%) closely matched T\u00fcrkiye\u2019s. These first operational MEM thresholds for T\u00fcrkiye and the first positivity-based thresholds for the Western Asia zone confirm alignment with the current WHO transmission zone classification and support integration into routine surveillance.<\/jats:p>","DOI":"10.1017\/s095026882610209x","type":"journal-article","created":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:58:31Z","timestamp":1792047511000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Establishing influenza epidemic thresholds and intensity levels in T\u00fcrkiye using the moving epidemic method and assessing concordance with WHO transmission zones: A sentinel surveillance analysis of ten seasons, 2013\u20132025"],"prefix":"10.1017","volume":"154","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0150-0694","authenticated-orcid":false,"given":"Eray","family":"Ontas","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01wntqw50","id-type":"ROR","asserted-by":"publisher"}],"name":"Ankara University School of Medicine"},{"id":[{"id":"https:\/\/ror.org\/014weej12","id-type":"ROR","asserted-by":"publisher"}],"name":"Graduate School of Informatics, Middle East Technical University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"S095026882610209X_r28","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2024.1332109"},{"key":"S095026882610209X_r20","year":"2025"},{"key":"S095026882610209X_r5","doi-asserted-by":"publisher","DOI":"10.1111\/j.1750-2659.2012.00422.x"},{"key":"S095026882610209X_r34","volume-title":"Seasonal Influenza, 2023\u20132024: Annual Epidemiological Report","year":"2024"},{"key":"S095026882610209X_r21","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2017.22.35.30606"},{"key":"S095026882610209X_r8","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.211508"},{"key":"S095026882610209X_r1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)33293-2"},{"key":"S095026882610209X_r17","doi-asserted-by":"publisher","DOI":"10.1080\/21645515.2018.1452577"},{"key":"S095026882610209X_r29","unstructured":"[29] World Health Organization (2025) FluNet: Global Influenza Programme. https:\/\/www.who.int\/tools\/flunet (accessed 1 March 2026)."},{"key":"S095026882610209X_r10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jiph.2019.05.005"},{"key":"S095026882610209X_r11","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-020-09145-y"},{"key":"S095026882610209X_r3","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193263"},{"key":"S095026882610209X_r22","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.1.17-00302"},{"key":"S095026882610209X_r35","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2019.24.9.1900125"},{"key":"S095026882610209X_r12","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12748"},{"key":"S095026882610209X_r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijregi.2023.12.005"},{"key":"S095026882610209X_r23","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7029a1"},{"key":"S095026882610209X_r26","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-022-29402-5"},{"key":"S095026882610209X_r4","volume-title":"Pandemic Influenza Severity Assessment (PISA): A WHO Guide to Assess the Severity of Influenza in Seasonal Epidemics and Pandemics","year":"2024"},{"key":"S095026882610209X_r18","first-page":"235","article-title":"Influenza surveillance results in 2007\u20132008 winter season in nine provinces of Turkey","volume":"43","author":"Carhan","year":"2009","journal-title":"Mikrobiyoloji B\u00fclteni"},{"key":"S095026882610209X_r24","doi-asserted-by":"publisher","DOI":"10.1111\/irv.13297"},{"key":"S095026882610209X_r31","doi-asserted-by":"publisher","DOI":"10.1111\/irv.70050"},{"key":"S095026882610209X_r7","unstructured":"[7] Lozano, JE and Vega, T (2024) The Moving Epidemic Method: The MEM Web Application \u2013 Technical Manual, Version 2.16 (last updated 24 May 2024). GitHub. https:\/\/github.com\/lozalojo\/memapp (accessed 1 March 2026)."},{"key":"S095026882610209X_r36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001051"},{"key":"S095026882610209X_r14","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2018.23.11.18-00079"},{"key":"S095026882610209X_r9","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph19031677"},{"key":"S095026882610209X_r2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2334-7-141"},{"key":"S095026882610209X_r6","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12330"},{"key":"S095026882610209X_r37","unstructured":"[37] World Health Organization Regional Office for Europe (2026) European Respiratory Virus Surveillance Summary (ERVISS). T\u00fcrkiye \u2013 SARI Virological \u2013 Weekly Detections 2025-W40\/2026-W20. https:\/\/erviss.org\/ (accessed 1 June 2026)."},{"key":"S095026882610209X_r15","first-page":"575","article-title":"Influenza surveillance in nine consecutive seasons, 2003\u20132012: Results from National Influenza Reference Laboratory, Istanbul Faculty of Medicine, Turkey","volume":"46","author":"Akcay Ciblak","year":"2012","journal-title":"Mikrobiyoloji B\u00fclteni"},{"key":"S095026882610209X_r19","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0139431"},{"key":"S095026882610209X_r30","unstructured":"[30] Republic of T\u00fcrkiye Ministry of Health (2026) Weekly Respiratory Virus Surveillance Report, 2026-W27. https:\/\/grip.saglik.gov.tr\/tr\/hir (accessed 31 July 2026)."},{"key":"S095026882610209X_r32","doi-asserted-by":"publisher","DOI":"10.32614\/CRAN.package.mem"},{"key":"S095026882610209X_r25","doi-asserted-by":"publisher","DOI":"10.1002\/advs.202410513"},{"key":"S095026882610209X_r27","year":"2022"},{"key":"S095026882610209X_r16","doi-asserted-by":"publisher","DOI":"10.5578\/mb.27775"},{"key":"S095026882610209X_r33","doi-asserted-by":"publisher","DOI":"10.2307\/2532051"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S095026882610209X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T06:58:33Z","timestamp":1792047513000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S095026882610209X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026]]},"references-count":37,"alternative-id":["S095026882610209X"],"URL":"https:\/\/doi.org\/10.1017\/s095026882610209x","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026]]},"assertion":[{"value":"\u00a9 The Author(s), 2026. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e129"}}