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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 30; 334(7608): 1343.
PMCID: PMC1906666

NHS Direct could be a useful early warning system for respiratory infections

More than 600 000 calls about respiratory problems, including influenza and cough, were made over two years to NHS Direct, the NHS's 24 hour telephone helpline.

Almost half of these calls were about fever, says a new study in the Journal of Infection (doi: 10.1016/j.jinf.2007.04.353) that looked at the seasonality of calls concerning respiratory problems that were made to the nurse led service, which has been running for eight years.

Calls concerning cough and difficulty in breathing peaked in late December, and the numbers of calls concerning cold, flu, and fever were highest between November and April, says the study, which was based on an analysis of calls made between October 2002 and October 2004.

Of the 601 454 calls about respiratory problems—about 8% of the total number of calls to NHS Direct—272 812 (45%) were classified as fever, 190 578 (32%) as cough, 77 317 (13%) as breathing difficulty, and 60 747 (10%) as cold or flu. Of the 292 867 calls about respiratory problems in children aged under 5 years, 62% were about fever, 29% about cough, 8% about breathing difficulty, and 1% about cold or flu.

The authors, from the Health Protection Agency and NHS Direct, say that respiratory viruses, mostly flu and respiratory syncytial viruses, are responsible for at least 50% of the seasonal variation in calls concerning respiratory problems.

They say that monitoring the weekly figures will help in early warning of a rising incidence of respiratory infections in the community and in the interpretation of seasonal variation in calls.

“For example,” the report says, “a sharp rise in cold/flu calls from adults and/or rise in fever calls about children may represent an increase in influenza circulating in the community. A rise in cough calls during November/December may indicate a rise in RSV [respiratory syncytial virus] and also influenza; a rise during January to March suggests only influenza; and a rise during spring may indicate a rise in para-influenza infections.”

The main bacterial cause in calls about respiratory problems was Streptococcus pneumoniae, and these calls peaked in December and January. S pneumoniae disease accounted for an estimated 92 000 calls a year to NHS Direct, or a sixth of all calls about respiratory problems. In comparison, an estimated 700 000 GP consultations each year in England and Wales concern S pneumoniae disease.

The report also identified evidence of a “bank holiday effect” whereby closure of general practices on these days resulted in more calls to NHS Direct. A third of all calls about cough during Christmas week could be accounted for by a bank holiday effect, the authors say.

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