Sentinel and Influenza Surveillance

Hawaii Department of Health (HDOH) is partnering with the Centers for Disease Control and Prevention (CDC) to conduct community sentinel surveillance targeting outpatient healthcare settings to identify cases of COVID-19 among patients who have mild to moderate febrile respiratory illness. 


Sentinel Surveillance has found 28 cases of COVID-19 among 1,876 specimens tested (1.6%). Specimens were selected from persons with respiratory symptoms (fever and cough or shortness of breath) in outpatient care settings who tested negative for influenza, and who had no travel history outside of the state of Hawaii. This COVID-19 surveillance program expands upon the existing influenza surveillance framework in order to detect community transmission of COVID-19. The samples were collected from providers throughout the state between 3/1 and 6/6 and were selected to ensure geographic and age representation proportional to the state’s population.

Key Points

  • The COVID-19 Sentinel Surveillance program is designed to detect community spread of the disease and will be operated based on the framework of the existing influenza surveillance program.
  • Providers should continue to evaluate patients with respiratory illness and order influenza diagnostic testing as clinically indicated.
  • Complete all fields on the HDOH influenza requisition form (used for both the influenza and COVID-19 surveillance programs) and submit with respiratory specimens collected for a clinical diagnosis of influenza-like illness, in order to facilitate HDOH’s investigations.


About the COVID-19 Surveillance Program

Respiratory specimens (i.e., nasopharyngeal swabs using nylon or Dacron swabs placed in viral transport medium) from a random subset of patients with a negative influenza test will be sent to the State Laboratories Division (SLD) for COVID-19 testing. This sentinel surveillance system is intended to identify early potential COVID-19 introduction and transmission in our community.

HDOH recommends healthcare providers remain vigilant for COVID-19 infection in people who present with a febrile respiratory illness and who report recent travel to areas with community spread of the disease.  This surveillance is being conducted in addition to ongoing testing and investigations of Persons Under Investigation (PUI) who meet the following criteria: symptoms of fever plus cough or shortness of breath, history of travel within 14 days of illness onset to a location with community spread of COVID-19, and consultation with HDOH Disease Outbreak Control Division staff.

Providers should continue to evaluate patients with respiratory illness and order influenza diagnostic testing as clinically indicated. Providers can consider informing patients undergoing influenza testing that their specimen may be randomly selected by HDOH for COVID-19 testing. If a specimen tests positive for COVID-19, HDOH will notify the ordering provider and patient and provide recommendations to prevent further transmission of the virus