The future is personalised care for influenza and flu-like illness

A new research review to be given at a pre-congress day for this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2024, Barcelona, 27-30 April) will focus on a future of more personalised care for diseases such as influenza, so that patients and doctors can work more closely together and be able to more accurately determine when the infectious part of the illness has passed and it is safe for someone to return to work or send their child back to school or nursery.

The talk will be given by Professor Barbara Rath, Co-founder & Chair of Vaccine Safety Initiative (VIVI) and Research Director, Université de Bourgogne Franche Comté, France.

Individualised care

“We have asked ourselves how much we actually offer to patients who seek medical care for flu-like illness and respiratory viral infections. From the doctor’s perspective, there has always been focus on discriminating viral from bacterial causes. Yet, the job of caring for the patient is not complete with the initial diagnosis - there should be more individualised care offered throughout the course of illness, This includes dialogue about treatment and prevention options and when it is safe to start mixing with other people again,” explains Prof Rath.

“The COVID pandemic may have accelerated interest in understanding which virus is causing the illness, and how it can be diagnosed, prevented and treated. This means, in addition to making accurate diagnoses early on, we need to pay attention to individual differences in disease severity and progression.”

Rapid tests in follow-up

Prof Rath will explain how the public are now very used to, for example, performing rapid tests at home determine if they are infected. In the future, such rapid tests (and new generations of such tests) in conjunction with precise clinical assessments, could be used also during follow-up (to tailor how long treatment is needed and, to promote prudent use of antimicrobials), to talk about the patient’s individual risk and modes of disease prevention, and to see when it is safe to resume normal activities.

“Transparent, shared decision making keeps the patient on board – and can be particularly helpful for respiratory viral infections that have become treatable and/or preventable through vaccination, such as influenza, COVID and RSV,” explains Prof Rath.  

Her team has been studying how quality of care can be improved for influenza and other respiratory viral infections, for more than a decade. She says: “We have learned that there may be a need to personalise decisions around treatment, and infection control measures, especially in infants and children, the elderly and intensive care patients, since very large differences between individuals are possible for both the severity and duration of disease.”  

Evolving options

Prof Rath explains further: “A lot has changed in recent years in how we approach flu-like illness and respiratory viral infections. The COVID pandemic has shown how new diagnostic tests, treatment options and vaccines can evolve. It is important to keep the patient on board with decisions made regarding their health, and to allocate resources to where they will benefit most. Objective, real-time data on virus diagnostics, virus load, disease severity and risk can help to tailor interventions while promoting equity and justice in medical care.”

Her team has exploring ways to practically do this, using sensitive rapid tests, structured disease severity assessments, apps and chatbots, next generation sequencing and biomarker assays at the point of care.

To understand better the differences between patients and provider perspectives on disease severity, the Vaccine Safety Initiative (led by Prof Rath) has teamed up with patient and civic society organizations. Together, they developed the SymptomSurvey (https://symptomsurvey.org/) where patients educate doctors and nurses, about what really matters to them when they experience COVID or flu-like symptoms. This is part of an EU-funded project (www.immunisationhubs.eu) to improve access to vaccines and vaccine information among disadvantaged, isolated, and difficult to reach population groups in Europe.

Disease severity

The team is also about to release the third version of the VIVI ScoreApp, a mobile application that measures disease severity systematically in relation to individual risk (see links below for examples of research using this App). The new version will allow both healthcare professionals and patients, to score severity from their perspective. Accurate assessments that are done consistently over time from both, a patient and a provider perspective, may help to take a precision medicine approach, and put the patients’ preferences into the centre of care.

In a perfectly fair system, medical decisions taken at the point of care should mostly be governed by the clinical assessment of disease severity and individual risk, as well as laboratory values (such as virus type/load/resistance and biomarkers). Having objective data readily available at the point of care may be useful to minimise bias and to promote justice and equity. The team has intensified research to study the role of social determinants of health to see where digital tools can assist to improve the quality of care provided in busy medical settings.

Lost in translation

Prof Rath concludes: “We keep exploring how we could envision better quality of care for individual patients with flu-like illness and respiratory viral infections in the future. Most certainly, we need different approaches depending on whether we are dealing with a child or a caregiver, a working adult, or an elderly person with underlying conditions. But we may also need to differentiate among these groups and to help the individual understand why we think a medical intervention would (or would not) benefit them personally. In modern healthcare, communication has not kept up with our technical advancement. There is always a risk of important messages getting lost in translation, due to fragmentation of care, rapid staff turnover and logistical challenges.

“The dynamic changes in guidelines and recommendations during the recent pandemic have shown us how important it is to keep the public actively engaged. There will need to be more consistency in communication, keeping patients informed about the rate at which an illness is improving, and weather any measures taken (such as antivirals or vaccines, or measures to prevent household transmission) are working for them. Digital tools may help us deliver better care in a timelier fashion. Patient-centred care means we make it easy to understand medical recommendations, and to make them their own.

”There is plenty of room for improvement, whether we use AI and predictive algorithms to improve logistics and make vaccines, diagnostics, and medicines available where they are needed most, whether we improve access by collaborating with pharmacies and decentralised community clinics, whether we reduce language and cultural barriers, or whether we facilitate self-assessments (such as severity scoring and testing) from home, as well as creating efficient means of communication and interaction with healthcare professionals. There is lots to do. – our team’s ethos is: ‘Don’t wait, innovate!’”