# Flu SAFE: Flu SMS Alerts to Freeze Exposure

> **NIH NIH R01** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2020 · $775,789

## Abstract

Problem: Influenza infection results in an estimated 31 million outpatient visits, 55,000 to 974,200
hospitalizations, and 3,000 to 49,000 deaths. Membership in household in which someone else has influenza
is the major risk factor for contracting influenza. The household secondary attack rate (SAR) is as high as 19%
based on laboratory-confirmed influenza and 30% based on symptoms. Non-pharmaceutical preventive
measures, including education, may play a role in decreasing transmission, but are only effective if started
within 36 hours of symptom onset in index cases. Yet, most interventions are delayed because they are not
initiated until care is sought. We have demonstrated in one primarily Latino, urban community sample, that text
messaging can be used to rapidly identify community members with influenza-like illness (ILI) early in an
illness. This early identification would enable implementation of an educational intervention in the optimal
timeframe to reduce influenza transmission. Providing education within a text message is a proven successful
strategy to influence behavior. Text messaging itself is scalable, low-cost, and can be used in low literacy
populations. However, using text-message based surveillance to trigger a real-time text-message behavioral
educational intervention to decrease household influenza transmission has not been assessed.
Aim: To assess the impact of an educational intervention delivered by text messaging on transmission
of influenza within households
Exploratory Aim: To compare the yield of text message ILI/ARI surveillance among subgroups in a
diverse, community sample
 Methods: We will enroll 400 households (n=~1500 individuals) with ≥1 child recruited from four
contiguous communities in New York City. We will randomize households stratified by community 1:1 to
receive surveillance-only (no text message education) vs. surveillance plus text message educational
intervention. For symptom surveillance, households in both arms will receive text messages 3x/week during
each influenza season (November-March) and report if someone in the household has ILI symptoms. For
those in the educational intervention arm, when an ILI/ARI is reported, a series of educational text messages
will be sent with information to decrease household transmission. Both arms will obtain one self-swab of the
index case, and self-swabs of all other household members on days 3 and 5 from index onset. To identify
respiratory tract pathogens, swabs will be analyzed using RT-PCR.
 Outcomes: The primary outcome will be SAR of laboratory-confirmed influenza. Secondarily, we will
assess SAR based on ILI/ARI symptoms, and of non-influenza viruses. Response rates will be compared
between arms and by demographic factors (age, education, race/ethnicity).

## Key facts

- **NIH application ID:** 9828586
- **Project number:** 5R01AI127812-04
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** LISA SAIMAN
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $775,789
- **Award type:** 5
- **Project period:** 2016-12-09 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9828586

## Citation

> US National Institutes of Health, RePORTER application 9828586, Flu SAFE: Flu SMS Alerts to Freeze Exposure (5R01AI127812-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9828586. Licensed CC0.

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