Under-recognition and reporting of dengue in Cambodia: a capture–recapture analysis of the National Dengue Surveillance System

Abstract

SUMMARYRobust disease burden estimates are important for decision-making concerning introduction of new vaccines. Dengue is a major public health problem in the tropics but robust disease burden estimates are lacking. We conducted a two-sample, capture–recapture study in the largest province in Cambodia to determine disease under-recognition to the National Dengue Surveillance System (NDSS). During 2006–2008, community-based active surveillance for acute febrile illness was conducted in 0- to 19-year-olds in rural and urban areas combined with testing for dengue virus infection. Of 14 354 individuals under active surveillance (22 498 person-seasons), the annual incidence ranged from 13·4 to 57·8/1000 person-seasons. During the same period, NDSS incidence rates ranged from 1·1/1000 to 5·7/1000, which was 3·9- to 29·0-fold lower than found in the capture–recapture study. In hospitalized cases, the rate of under-recognition was 1·1- to 2·4-fold. This study shows the substantial degree of under-recognition/reporting of dengue and that reported hospitalized cases are not a good surrogate for estimating dengue disease burden.

Burden of Dengue Infection and Disease in a Pediatric Cohort in Urban Sri Lanka

“…Recent studies in Southeast Asia have estimated expansion factors of 8.9 and 9.6 when comparing national data with true disease incidence for Thailand and Cambodia, respectively. 7,32 Moreover, a recent study of the global burden of dengue estimated that there are three times as many infections and dengue cases compared with cases reported to the World Health Organization. 4 For most regions in the world with endemic dengue transmission, we do not have accurate estimates of infection and disease because of the cost and infrastructure required to conduct cohort studies.…”

“…2,3 Globally, an estimated four billion persons are at risk for DENV infection, and there are an estimated 390 million annual DENV infections and 96 million dengue cases. 4 From prospective community and school-based cohort studies, it has been possible to obtain estimates for the incidence of DENV infection and disease for sites in southeast Asia [5][6][7][8][9][10] and Latin America. [11][12][13] Although dengue is emerging in the Indian subcontinent and is considered a major health issue, we do not have estimates of the true burden of DENV infection and disease in this region.…”

Spatial epidemiology and climatic predictors of paediatric dengue infections captured via sentinel site surveillance, Phnom Penh Cambodia 2011–2012

“…During the period 2002–2008, the National Dengue Control Program (NDCP) has reported on average 103 cases per 100,000 with an annual case fatality rate (CFR) ranging from 0.7 to 1.7% [3]. However, these sentinel sites are not able to capture detailed epidemiological, clinical or laboratory data, and reporting is generally incomplete; a capture-recapture study in Cambodia indicated a 4- to 29-fold underreporting rate [6]. The 2012 epidemic season was the most severe in the country since 2007, with more than 42,000 suspect or confirmed cases reported, and serves to highlight the serious epidemic potential within Cambodia.…”

Dengue, Chikunguña y Zika en Colombia 2015-2016

“…In this study, it is likely that, due to the similarities in the symptomatology of the three diseases, there has been a greater tendency to diagnose Zika when compared to the other two, as a result of the outbreak and proliferation of the virus and alert generated by health authorities at a national and international level (20); however, an analysis stratified by department is required. Vong et al (22) found similar results in Cambodia, in a study for which a capture-recapture method to determine the effectiveness of the national dengue surveillance system was used. The estimated annual occurrence ranged from 13.4 to 57.8 per 1,000 people, compared to the rate reported by the national system of 1.1 to 5.7 per 1,000 people, with a difference of 3.9 and 29 points less.…”