Background Public health (PH) surveillance, crucial for timely PH interventions, was strengthened in Scotland post-pandemic, particularly in respiratory surveillance. The Community Acute Respiratory Infection (CARI) surveillance programme, launched by Public Health Scotland (PHS) in 2021, follows WHO guidelines and is key to PHS’ national infectious respiratory diseases plan, monitoring acute respiratory infections (ARI) in the community.

This study evaluates CARI’s performance from the start of the 2023/24 season (October 2, 2023) to present (February 10, 2024).

Methods CARI recruits sentinel GP practices to identify and test patients with ARI for ten common pathogens, allowing monitoring of pathogen trends.

To evaluate CARI, key attributes were assessed. Simplicity and flexibility were gauged through daily operations and GP feedback via an online survey, while acceptability was measured by recruitment and withdrawal rates. Representativeness was determined by comparing CARI data with demographics and examining data quality. Timeliness and stability were assessed using publication speed and reliability. Sensitivity/predictive value positive, crucial for detection accuracy, remains uncertain due to limited knowledge of true case numbers.

Results Across 177 GP practices, 15,038 samples were tested, giving 58.4% overall swab positivity, peaking at 65.2% in week 51, 2023.

Rhinovirus dominated, with 18.6% overall swab positivity, peaking in autumn. This was followed by influenza A with 12.9%, reaching 25.0% in week 52, 2023, lower than the previous year. Mycoplasma pneumoniae showed 9.1% overall swab positivity, peaking at 12.8% in weeks 2-3, 2024, notably higher than in 2023. Children aged 5-14 had particularly high Mycoplasma pneumoniae swab positivity, reaching 47.6% in week 1, 2024.

Evaluating CARI, its simplicity, flexibility, and acceptability were evident through streamlined processes for ordering/using swab kits, adapting processes to changing conditions and positive GP feedback from 78 survey responses. Representativeness was satisfactory across health boards, however some discrepancies emerged, with higher swab submissions from younger age groups. Data quality was high, with high completeness and minimal lab rejections. CARI data aligned with European trends, illustrated by the detection of increased Mycoplasma pneumoniae swab positivity. Timeliness was evident in publication of weekly trends and the programme demonstrated growth and resilience, despite occasional disruptions.

Conclusion CARI’s key findings underscore the dynamic nature of ARIs. The evaluation demonstrates CARI’s efficacy in monitoring community respiratory pathogen trends.

Data generated through CARI are crucial for guiding local and national evidence-based PH actions and strategic decisions. By fostering collaboration between healthcare providers, policymakers, and researchers, CARI enhances PH infrastructure to address respiratory pathogen challenges more effectively.