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Indeed, studies that have relied on active surveillance and testing, most often with RT-PCR, can improve estimates of influenza-associated hospitalization rates (32,34-38); however, as our study shows, failing to account for diagnostic test sensitivity can result in continued underestimation of influenza-associated hospitalizations, especially among older adults.
Nevertheless, sensitivity adjustments enable us to further improve the accuracy of estimated rates of influenza-associated hospitalization and provide timely results that account for changes in diagnostic test sensitivity over time.
Although this is a limitation of our analysis because diagnostic test sensitivity can vary on the basis of type or subtype of influenza viruses (7,21,23), differences in sensitivity based on type or subtype would have been difficult to assess, especially before the 2009 pandemic, when those data were not routinely available because of lack of RT-PCR or viral culture data in our network.

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