Use of Internet Search Data to Monitor Rotavirus Vaccine Impact in the United States, United Kingdom, and Mexico

Abstract

Background: Previous studies have found a strong correlation between internet search and public health surveillance data. Less is known about how search data respond to public health interventions, such as vaccination, and the consistency of responses in different countries. In this study, we aimed to study the correlation between internet searches for "rotavirus" and rotavirus disease activity in the United States, United Kingdom, and Mexico before and after introduction of rotavirus vaccine.

Methods: We compared time series of internet searches for "rotavirus" from Google Trends with rotavirus laboratory reports from the United States and United Kingdom and with hospitalizations for acute gastroenteritis in the United States and Mexico. Using time and location parameters, Google quantifies an internet query share (IQS) to measure the relative search volume for specific terms. We analyzed the correlation between IQS and laboratory and hospitalization data before and after national vaccine introductions.

Results: There was a strong positive correlation between the rotavirus IQS and laboratory reports in the United States (R2 = 0.79) and United Kingdom (R2 = 0.60) and between the rotavirus IQS and acute gastroenteritis hospitalizations in the United States (R2 = 0.87) and Mexico (R2 = 0.69) (P < .0001 for all correlations). The correlations were stronger in the prevaccine period than in the postvaccine period. After vaccine introduction, the mean rotavirus IQS decreased by 40% (95% confidence interval [CI], 25%-55%) in the United States and by 70% (95% CI, 55%-86%) in Mexico. In the United Kingdom, there was a loss of seasonal variation after vaccine introduction.

Conclusions: Rotavirus internet search data trends mirrored national rotavirus laboratory trends in the United States and United Kingdom and gastroenteritis-hospitalization data in the United States and Mexico; lower correlations were found after rotavirus vaccine introduction.

Figure 1

Rotavirus Internet Query Share (IQS) compared to rotavirus laboratory detection in the United States (A) and United Kingdom (B). United Kingdom data is from England and Wales only

Figure 2

Rotavirus Internet Query Share (IQS) compared to under 5 acute gastroenteritis (AGE) hospitalization rates in the United States (A) and Mexico (B). US AGE rates are for the 31 states that consistently reported to State Inpatient Database from 2004–2013.

Figure 3

Impact of laboratory-confirmed norovirus outbreaks in the United States (A) and United Kingdom (B) on rotavirus Internet Query Share (IQS), all available data. *Y-axis values are: Norovirus outbreaks (US) or laboratory reports (UK), Rotavirus Internet Query Share, and Proportion (US) or Number (UK) of Rotavirus-positive laboratory tests. Shaded bars show seasons where peaks in Norovirus Outbreaks match Rotavirus IQS trend despite low Rotavirus Laboratory activity. UK data is from England and Wales only and excludes July 2013 (vaccine introduction).

Figure 4

Seasonal Variation in Rotavirus Internet Query Share (IQS) in the United States (A), United Kingdom (B) and Mexico (C). Seasons are from July of first year to June of second year. Months of rotavirus vaccine introduction are excluded.

Figure 4

Seasonal Variation in Rotavirus Internet Query Share (IQS) in the United States (A), United Kingdom (B) and Mexico (C). Seasons are from July of first year to June of second year. Months of rotavirus vaccine introduction are excluded.