Bug Watch

Bug Watch is an cohort study of common infection symptoms in England. Bug Watch measures often people go to the doctor or take antibiotics for common infections.

A cohort study about common infections

Bug Watch was a cohort study of people in the community in England who recorded information about common infection symptoms and use of healthcare services.

Bug Watch tells us about symptoms of infection in the community before people go to see their doctor or use other healthcare services. It means that we can describe the severity and duration of symptoms from the start of an episode of infection. It also allows us to find out what people usually do when they get an infection, and the differences between infections that lead to GP appointments and those that do not.

In total, 1,242 adults and children registered for Bug Watch between March and November 2018. Participants filled out weekly surveys reporting symptoms of infection in seven different categories (general/nonspecific, respiratory, gastrointestinal, urinary tract, mouth/dental, skin/soft tissue, and eye). They completed the surveys for six months.

Bug Watch microdata

The cohort data is available for reuse by students and researchers from the UK Data Service

What is already known on the subject?

  • Most antibiotics are prescribed in primary care, and at least 23% of prescriptions are thought to be inappropriate.
  • One way to reduce inappropriate antibiotic prescribing in primary care is to encourage fewer the people to visit their GP when they have symptoms of infection.
  • Previous studies have shown that most people safely self-manage symptoms of respiratory tract and gastrointestinal infections. This is known as a clinical “iceberg” of infection.
  • There is little information on how people manage other symptoms of infection, or what other sources of information people use to get advice about their symptoms.

What questions did we ask?

  • What is the incidence of common acute infections in the general population in England? We looked at symptoms of respiratory tract, gastrointestinal, urinary tract, skin/soft tissue, mouth/dental, and eye infections.
  • What are the most commonly used sources of healthcare advice for different symptoms of infection?
  • What proportion of people with symptoms of infection use an antibiotic?
  • How long to symptoms usually last and how do they impact quality of life?

What did we find?

  • There is a large clinical iceberg of infection across all symptom categories. Most people manage symptoms of infection without seeking medical advice.
  • Overall, 14% of infections led to a GP or dentist consultation and 1 in 10 to antibiotic use.
There was a large clinical “iceberg” for all infection types, with most people not consulting a GP or dentist about their symptoms. Although the proportion of people seeking medical attention was highest for urinary tract infections, the largest number was for respiratory tract infections.
Clinical "icebergs" of infection: Number and percentage of people who consulted a GP or dentist about their symptoms
  • People most frequently consulted a GP (or dentist) about their symptoms but a variety of other sources including pharmacies and the internet were also used frequently. The NHS 111 service was not used often.
  • Most antibiotics were prescribed by GPs but hospital doctors were also an important source, particularly for urinary tract infections.
  • Half of the antibiotics used were prescribed within three days of the onset of symptoms.
  • Symptoms usually resolved within a week but more than a quarter of syndromes lasted longer for all except urinary tract and gastrointestinal symptoms.
  • The worst day of symptoms occurred on average after three days and overall impacts on health-related quality of life lost were less than one day.
  • Detailed results are published in Smith et al. (2021).
  • Anonymised data (Smith et al. 2020) from Bug Watch are available through the UK Data Service.


References

Smith, C. M., Conolly, A., Fuller, C., Hill, S., Lorencatto, F., Marcheselli, F., … Fragaszy, E. B. (2019). Symptom reporting, healthcare-seeking behaviour and antibiotic use for common infections: protocol for Bug Watch, a prospective community cohort study. BMJ Open, 9(5), e028676. DOI: 10.1136/bmjopen-2018-028676

Smith, C., Hayward, A., Fragaszy, E., Michie, S. (2020). Bug Watch: Baseline Data, Symptom Reporting, Healthcare-seeking Behaviours and Antibiotic Use, 2018-2019. [data collection]. UK Data Service. SN: 8734. DOI: 10.5255/UKDA-SN-8734-1

Smith, C. M., Shallcross, L. J., Dutey-Magni, P., Conolly, A., Fuller, C., Hill, S., Jhass, A., Marcheselli, F., Michie, S., Mindell, J. S., Ridd, M. J., Tsakos, G., Hayward, A. C., & Fragaszy, E. B. (2021). Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: Results from the Bug Watch community cohort study. BMC Infectious Diseases, 21(1), 105. DOI: 10.1186/s12879-021-05811-7

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