Respiratory Virus Outpatient Study (FLU 002 Plus)

The purpose of this observational study is to describe participants in geographically
diverse locations with influenza virus infection and other viral respiratory diseases of
public health importance and their clinical course over a 14-day period following
enrollment.

Specific objectives related to influenza virus infection are to estimate the percentage of
participants who go on to develop severe disease or complications that require
hospitalization; to obtain information on risk factors for disease severity; and to
establish a central repository of specimens for use in virus characterization, including
subtyping, antigenic and genetic analyses, identification of signature mutations associated
with antiviral drug resistance, mutational evolution, and additional reassortment.

Specific objectives related to novel non-influenza respiratory viruses of potential major
public health importance are to characterize initial cases and their outcomes in order to
develop more specific protocols that could inform the prevention and treatment of these new
infections

Sample size is open-ended for this observational study. Based on experience to date, it is
estimated that 75 sites will participate and will enroll approximately 1,700 patients with
influenza each year, about one-half in the Northern Hemisphere and one-half in the Southern
Hemisphere. Sites in diverse geographic locations on several continents will participate.

Study Plan:

- Participants who meet the eligibility criteria will be enrolled at participating
clinical sites.

- At enrollment, consent is signed and information (demographics, medical history
(including prior influenza and pneumococcal vaccination), medications (including
antivirals) and treatments prescribed will be recorded. A blood sample for serum and
plasma will be obtained at enrollment, as well as an upper respiratory tract specimen.
The respiratory specimen will be sent for central reverse transcriptase polymerase
chain reaction (RT-PCR) testing for influenza.

- Status will be re-assessed at approximately 14 days after enrollment and another blood
sample for serum and plasma will be obtained. For participants with a confirmed novel
respiratory virus of public health importance, attempts will be made to obtain a sample
of the local specimen used to diagnose the infection.

In February 2012, the FLU 004 Genomics protocol v 1.0 was released to the field.

In August 2013 v 2.0 of the protocol was released as INSIGHT Genomics. The protocol was
expanded beyond the FLU 002 and FLU 003 studies to include all qualifying INSIGHT studies
(list posted on the INSIGHT website, www.insight-trials.org. The purpose of this substudy is
to obtain a whole blood sample from which DNA will be extracted to study polymorphisms in
immune response genes and other genetic variants that may be associated with an increased
risk of disease progression among individuals with infectious diseases of public health
importance who are enrolled in qualifying INSIGHT studies.

Participating FLU 002 Plus sites are given the option to also participate in INSIGHT
Genomics, which requires a separate protocol registration. Participants, once consented to
FLU 002 Plus, will be offered the option to also consent to INSIGHT Genomics, which includes
a single whole blood sample collection. Participation in FLU 002 Plus will not be
compromised if a participant opts not to participate in INSIGHT Genomics.

Inclusion Criteria:

- Be ≥ 18 years of age

- Have a signed informed consent by participant

- Have a fever (37.8 degrees C (100 degrees F) or higher on examination or
patient-reported fever (37.8 degrees C (100 degrees F) or higher, or feverishness
(felt febrile but did not take temperature) in the past 24 hours.

- Have a cough and/or sore throat

- Have suspected influenza or a suspected targeted non-influenza viral respiratory
infection

Exclusion Criteria:

- Current imprisonment, or compulsory detention (involuntary incarceration) for treatment
of a psychiatric or physical illness.