{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T09:50:41Z","timestamp":1770717041333,"version":"3.49.0"},"posted":{"date-parts":[[2025,5,13]]},"group-title":"Public and Global Health","reference-count":34,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T00:00:00Z","timestamp":1747094400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,2,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>Effective pandemic preparedness relies on integrating diverse data sources for early outbreak detection. This study assessed whether over-the-counter (OTC) drug sales and primary health care (PHC) data could anticipate surges in respiratory-disease\u2013related hospitalizations in Brazil. From November 2022 to June 2025, we analysed weekly time-series across 510 regions using a negative binomial autoregressive model within Statistical Process Control techniques. OTC data anticipated 56.6% of 746 hospitalization surges 1\u20133 weeks in advance, detected 9.5% concurrently, and missed 33.9%. PHC data anticipated 59.5%, detected 10.3% concurrently, and missed 30.2%. PHC data showed higher sensitivity and specificity than OTC (69.8% vs. 66.1%, and 49.5% vs. 47.8%). Performance varied regionally, and in 76.7% of regions, at least one stream showed high precision. These findings support the value of OTC drug sales, alongside PHC data, as early indicators of hospitalization surges in respiratory illness surveillance.<\/jats:p>","DOI":"10.1101\/2025.05.12.25327459","type":"posted-content","created":{"date-parts":[[2025,5,13]],"date-time":"2025-05-13T12:05:17Z","timestamp":1747137917000},"source":"Crossref","is-referenced-by-count":0,"title":["Anticipating influenza-like illness outbreaks via syndromic surveillance using over-the-counter drug sales and primary health care data"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7167-8754","authenticated-orcid":false,"given":"Juliane F.","family":"Oliveira","sequence":"first","affiliation":[{"name":"Center for Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 41745-715, Brazil"},{"name":"Centre of Mathematics of the University of Porto (CMUP), Department of Mathematics, Porto, Portugal"},{"name":"Digi-Saude National Institute of Science and Technology in Digital Health (DigiSaude-INCT)"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4534-2509","authenticated-orcid":false,"given":"Thiago","family":"Cerqueira-Silva","sequence":"additional","affiliation":[{"name":"Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom"},{"name":"Medicine and Precision Public Health Laboratory (MeSP2), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 40296-710, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4794-4231","authenticated-orcid":false,"given":"Pedro Anibal N.","family":"Brito","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Bahia, Salvador, Brazil"}]},{"given":"N\u00edvea B.","family":"da Silva","sequence":"additional","affiliation":[{"name":"Institute of Mathematics and Statistics of Federal University of Bahia, Salvador, Brazil"}]},{"given":"Rosemeire L.","family":"Fiaconne","sequence":"additional","affiliation":[{"name":"Institute of Mathematics and Statistics of Federal University of Bahia, Salvador, Brazil"}]},{"given":"Maria C\u00e9lia S. L.","family":"Cunha","sequence":"additional","affiliation":[{"name":"Luiz Coimbra Institute of Graduate and Engineering Research (COPPE), Federal University of Rio de Janeiro (UFRJ); Rio de Janeiro, 21941-859, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7752-9090","authenticated-orcid":false,"given":"Gerson G.","family":"Cunha","sequence":"additional","affiliation":[{"name":"Luiz Coimbra Institute of Graduate and Engineering Research (COPPE), Federal University of Rio de Janeiro (UFRJ); Rio de Janeiro, 21941-859, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5001-1873","authenticated-orcid":false,"given":"Ray B.","family":"Miranda","sequence":"additional","affiliation":[{"name":"Luiz Coimbra Institute of Graduate and Engineering Research (COPPE), Federal University of Rio de Janeiro (UFRJ); Rio de Janeiro, 21941-859, Brazil"}]},{"given":"Lucas M.","family":"Dias","sequence":"additional","affiliation":[{"name":"Luiz Coimbra Institute of Graduate and Engineering Research (COPPE), Federal University of Rio de Janeiro (UFRJ); Rio de Janeiro, 21941-859, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4420-1731","authenticated-orcid":false,"given":"F\u00e1bio M. 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S.","family":"Filho","sequence":"additional","affiliation":[{"name":"Center for Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 41745-715, Brazil"}]},{"given":"Gerson O.","family":"Penna","sequence":"additional","affiliation":[{"name":"Tropical Medicine Centre, University of Bras\u00edlia, Fiocruz School of Government; Bras\u00edlia, 70910-900, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9075-7861","authenticated-orcid":false,"given":"Pablo Ivan P.","family":"Ramos","sequence":"additional","affiliation":[{"name":"Center for Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 41745-715, Brazil"},{"name":"Digi-Saude National Institute of Science and Technology in Digital Health (DigiSaude-INCT)"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2914-6535","authenticated-orcid":false,"given":"Izabel","family":"Marcilio","sequence":"additional","affiliation":[{"name":"Center for Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 41745-715, Brazil"},{"name":"Bahiana School of Medicine and Public Health (EBMSP); Salvador, 40290-000, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5823-7903","authenticated-orcid":false,"given":"Manoel","family":"Barral-Netto","sequence":"additional","affiliation":[{"name":"Center for Data and Knowledge Integration for Health (CIDACS), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 41745-715, Brazil"},{"name":"Digi-Saude National Institute of Science and Technology in Digital Health (DigiSaude-INCT)"},{"name":"Medicine and Precision Public Health Laboratory (MeSP2), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 40296-710, Brazil"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7241-6844","authenticated-orcid":false,"given":"Viviane S.","family":"Boaventura","sequence":"additional","affiliation":[{"name":"Digi-Saude National Institute of Science and Technology in Digital Health (DigiSaude-INCT)"},{"name":"Medicine and Precision Public Health Laboratory (MeSP2), Gon\u00e7alo Moniz Institute, Oswaldo Cruz Foundation (FIOCRUZ); Salvador, 40296-710, Brazil"},{"name":"Faculty of Medicine, Federal University of Bahia, Salvador, Brazil"}]}],"member":"54368","reference":[{"key":"2026020906150858000_2025.05.12.25327459v2.1","doi-asserted-by":"crossref","first-page":"2317","DOI":"10.1016\/S0140-6736(21)01096-5","article-title":"Disease surveillance for the COVID-19 era: time for bold changes","volume":"397","year":"2021","journal-title":"Lancet"},{"key":"2026020906150858000_2025.05.12.25327459v2.2","doi-asserted-by":"crossref","first-page":"e47673","DOI":"10.2196\/47673","article-title":"Combining digital and molecular approaches using health and alternate data sources in a next-generation surveillance system for anticipating outbreaks of pandemic potential","volume":"10","year":"2024","journal-title":"JMIR Public Health Surveill"},{"key":"2026020906150858000_2025.05.12.25327459v2.3","doi-asserted-by":"crossref","first-page":"1537","DOI":"10.1016\/S0140-6736(20)31978-4","article-title":"The Riyadh Declaration: the role of digital health in fighting pandemics","volume":"396","year":"2020","journal-title":"Lancet"},{"key":"2026020906150858000_2025.05.12.25327459v2.4","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00194-1"},{"key":"2026020906150858000_2025.05.12.25327459v2.5","doi-asserted-by":"crossref","first-page":"e69048","DOI":"10.2196\/69048","article-title":"Balancing human mobility and health care coverage in sentinel surveillance of Brazilian Indigenous areas: Mathematical optimization approach","volume":"11","year":"2025","journal-title":"JMIR Public Health Surveill"},{"key":"2026020906150858000_2025.05.12.25327459v2.6","first-page":"1","article-title":"Planning a public health surveillance system","volume":"16","year":"1995","journal-title":"Epidemiol. 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