Real time monitoring of respiratory viral infections in cohort studies using a smartphone app

Background and Objectives Cohort studies investigating respiratory disease pathogenesis aim to pair mechanistic investigations with longitudinal virus detection but are limited by the burden of methods tracking illness over time. In this study, we explored the utility of a smartphone app to robustly identify symptomatic respiratory illnesses, while reducing burden and facilitating real-time data collection and adherence monitoring. Methods The AERIAL TempTracker smartphone app was assessed in the AERIAL and COCOON birth cohort studies. Participants recorded daily temperatures and associated symptoms/medications in TempTracker for 6-months, with daily use adherence measured over this period. Regular participant feedback was collected at quarterly study visits. Symptomatic respiratory illnesses meeting study criteria prompted an automated app alert and collection of a nose/throat swab for testing of eight respiratory viruses. Results In total, 32,764 daily TempTracker entries from 348 AERIAL participants and 30,542 entries from 361 COCOON participants were recorded. This corresponded to an adherence median of 67.0% (range 1.9-100%) and 55.4% (range 1.1-100%) of each participant’s study period, respectively. Feedback was positive, with 75.5% of responding families reporting no barriers to use. A total of 648 symptomatic respiratory illness events from 249/709 participants were identified with significant variability between individuals in the frequency (0-16 events per participant), duration (1-13 days), and virus detected (rhinovirus in 42.7%). Conclusions A smartphone app provides a reliable method to capture the longitudinal virus data in cohort studies which facilitates the understanding of early life infections in chronic respiratory disease development. Summary at a Glance A smartphone app can facilitate capturing symptomatic respiratory viral infections in longitudinal cohort studies, while supporting adherence and reducing participant burden. The app helped identify community variations in virus prevalence as well as the individual variability in viral responses necessary to understand the mechanism of chronic disease development. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was funded by NHMRC. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This human study was approved by Ramsay Health Care WA-SA HREC - approvals: #1908 & #2024. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript, however additional information /data are available upon request to the authors