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To the editor: We read with great interest your special issue on the Experiences with the pandemic in Europe (Vol. 15, issue 49, 9 December 2010). The reports in that issue clearly highlight the importance of surveillance and monitoring of both emergence and spread of influenza outbreaks through syndromic and laboratory surveillance networks [1]. We would however like to highlight that, in medical practice, it is hardly possible to determine the aetiology of viral respiratory infections by using only clinical symptoms as a basis for diagnosis. For example the correlation between the influenza and influenza-like illnesses (ILI) presentation and the diagnosis of influenza may vary considerably depending on the definition of ILI, the accuracy of the clinician, the epidemiological context, and the presence of co-circulating confounding respiratory viruses. Collecting virological data is mandatory for such networks. The early phase of the A(H1N1)2009 pandemic in France is an interesting example of this risk of confusion. In France, two independant surveillance networks are involved in influenza surveillance: the ‘réseau sentinelle’ or sentinel network and the Groupes Régionaux d’Observation de la Grippe (GROG). The sentinel network [2] declared the A(H1N1)2009 pandemic in France the first week of September 2009 (week 36), based on the increase in ILI reports. At the same time, GROG [3] and the laboratory network linked to the National Influenza Centre reported a low incidence of pandemic influenza A(H1N1)2009 [4]. From week 36 to week 43, the GROG network reported a limited pandemic influenza A(H1N1)2009 activity. The pandemic started only mid-October (week 44), according to clinical and virological data. This discrepancy is explained by the difference in the surveillance methods of the two networks. The sentinel network uses clinical surveillance

Beyond the influenza-like illness surveillance: The need for real-time virological data