12 Chapter 1 have been detected since early 200426. In 2012 a new virus was isolated after a fatal pneumonia in Saudi Arabia: Middle East Respiratory Syndrome Coronavirus (MERSCoV)26. At the end of 2021, over 2500 confirmed cases and over 900 deaths have been reported27. The most recent pandemic, caused by SARS-CoV-2, lead to an estimated 287 million infections and 5.4 million deaths by the end of 202128. However, those where numbers reported to the World Health Organisation (WHO), and the estimated global excess mortality is significantly higher, with almost 15 million deaths in 2020 and 202128. Apart from the irregular but recurrent influenza pandemics, influenza is also known as a cause of seasonal epidemics, possibly occurring since the middle ages24,29. Even though pandemic viruses are typically better known and get more public attention than seasonal viruses, the cumulative morbidity and mortality is higher for seasonal outbreaks21. In the European Union, each year an estimated 4 to 50 million people get seasonal influenza virus, with over 26.000 respiratory deaths on average every winter30. Globally, it is estimated that between 290.000-645.000 people die from respiratory disease caused by seasonal influenza21. Excess mortality is mainly in older adults and those with underlying health conditions24. In (sub)tropical areas, there is year-round occurrence of influenza, with a similar impact of disease as in temperate regions with peaks in the colder months24. Humans, domestic animals and wild animals living in close proximity to each other increases the probability of the emergence of a new virus24,31. The growing human population, global movements of people (travel, immigration)14 and shift to living more crowded in urban area’s32 makes it easier for new viruses to spread and become pandemic32. The SARS-CoV-2 pandemic demonstrated that many countries were not adequately prepared to deal with a new pandemic15. The pandemic highlighted weaknesses in pandemic preparedness for many countries33, but also many successes, such as the development of effective vaccines within a year of the start of the pandemic34, and the speed at which large numbers of patients were included in observational studies and clinical trials to learn more about this new disease35,36 In the period between two pandemics, it is essential to learn from the last and prepare for the next pathogen or seasonal outbreak. In this time of technological developments and an exponential increase in the amount of data available, utilising these new data opportunities can increase the efficiency of research, and accelerate discoveries. Real-time or near real-time automated data collection and analysis can help with many challenges that we continuously face when it comes to viral respiratory diseases research: improve surveillance and clinical care. Ultimately, more efficient research and faster results make it possible to make informed decisions for both public health and individual patient care. The aim of this thesis is to learn from seasonal and pandemic outbreaks of viral respiratory diseases, with a focus on large datasets containing routinely collected data. The aim was to efficiently use existing datasets to learn about different aspects
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