Cross-sectional telephone surveys as a tool to study epidemiological factors and monitor seasonal influenza activity in Malta

Marmara, V. and Marmara, D. and McMenemy, P. and Kleczkowski, A. (2021) Cross-sectional telephone surveys as a tool to study epidemiological factors and monitor seasonal influenza activity in Malta. BMC Public Health, 21 (1). 1828. ISSN 1471-2458 (

[thumbnail of Marmara-etal-BMCPH-2021-Cross-sectional-telephone-surveys-as-a-tool-to-study-epidemiological-factors]
Text. Filename: Marmara_etal_BMCPH_2021_Cross_sectional_telephone_surveys_as_a_tool_to_study_epidemiological_factors.pdf
Final Published Version
License: Creative Commons Attribution 4.0 logo

Download (658kB)| Preview


Abstract: Background: Seasonal influenza has major implications for healthcare services as outbreaks often lead to high activity levels in health systems. Being able to predict when such outbreaks occur is vital. Mathematical models have extensively been used to predict epidemics of infectious diseases such as seasonal influenza and to assess effectiveness of control strategies. Availability of comprehensive and reliable datasets used to parametrize these models is limited. In this paper we combine a unique epidemiological dataset collected in Malta through General Practitioners (GPs) with a novel method using cross-sectional surveys to study seasonal influenza dynamics in Malta in 2014–2016, to include social dynamics and self-perception related to seasonal influenza. Methods: Two cross-sectional public surveys (n = 406 per survey) were performed by telephone across the Maltese population in 2014–15 and 2015–16 influenza seasons. Survey results were compared with incidence data (diagnosed seasonal influenza cases) collected by GPs in the same period and with Google Trends data for Malta. Information was collected on whether participants recalled their health status in past months, occurrences of influenza symptoms, hospitalisation rates due to seasonal influenza, seeking GP advice, and other medical information. Results: We demonstrate that cross-sectional surveys are a reliable alternative data source to medical records. The two surveys gave comparable results, indicating that the level of recollection among the public is high. Based on two seasons of data, the reporting rate in Malta varies between 14 and 22%. The comparison with Google Trends suggests that the online searches peak at about the same time as the maximum extent of the epidemic, but the public interest declines and returns to background level. We also found that the public intensively searched the Internet for influenza-related terms even when number of cases was low. Conclusions: Our research shows that a telephone survey is a viable way to gain deeper insight into a population’s self-perception of influenza and its symptoms and to provide another benchmark for medical statistics provided by GPs and Google Trends. The information collected can be used to improve epidemiological modelling of seasonal influenza and other infectious diseases, thus effectively contributing to public health.


Marmara, V., Marmara, D., McMenemy, P. and Kleczkowski, A. ORCID logoORCID:;