Triggering interventions for influenza: The ALERT algorithm

Nicholas G. Reich, Derek A T Cummings, Stephen A. Lauer, Martha Zorn, Christine Robinson, Ann Christine Nyquist, Connie S. Price, Michael Simberkoff, Lewis J. Radonovich, Trish M. Perl

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background.Early, accurate predictions of the onset of influenza season enable targeted implementation of control efforts. Our objective was to develop a tool to assist public health practitioners, researchers, and clinicians in defining the community-level onset of seasonal influenza epidemics. Methods.Using recent surveillance data on virologically confirmed infections of influenza, we developed the Above Local Elevated Respiratory Illness Threshold (ALERT) algorithm, a method to identify the period of highest seasonal influenza activity. We used data from 2 large hospitals that serve Baltimore, Maryland and Denver, Colorado, and the surrounding geographic areas. The data used by ALERT are routinely collected surveillance data: weekly case counts of laboratory-confirmed influenza A virus. The main outcome is the percentage of prospective seasonal influenza cases identified by the ALERT algorithm. Results.When ALERT thresholds designed to capture 90% of all cases were applied prospectively to the 2011-2012 and 2012-2013 influenza seasons in both hospitals, 71%-91% of all reported cases fell within the ALERT period. Conclusions.The ALERT algorithm provides a simple, robust, and accurate metric for determining the onset of elevated influenza activity at the community level. This new algorithm provides valuable information that can impact infection prevention recommendations, public health practice, and healthcare delivery.

Original languageEnglish (US)
Pages (from-to)499-504
Number of pages6
JournalClinical Infectious Diseases
Issue number4
StatePublished - Feb 15 2015


  • hospital epidemiology
  • infection control
  • influenza
  • outbreak detection
  • surveillance

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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