厄瓜多尔南部沿海地区基于被动监测和主动基于群的登革热监测的比较。
A comparison of passive surveillance and active cluster-based surveillance for dengue fever in southern coastal Ecuador.
机构信息
Institute for Global Health and Translational Science, SUNY Upstate Medical University, 505 Irving Avenue Suite 4200, Syracuse, NY, USA.
Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, 750 East Adams Street, Syracuse, NY, USA.
出版信息
BMC Public Health. 2020 Jul 6;20(1):1065. doi: 10.1186/s12889-020-09168-5.
BACKGROUND
Dengue is a major emerging infectious disease, endemic throughout the tropics and subtropics, with approximately 2.5 billion people at risk globally. Active (AS) and passive surveillance (PS), when combined, can improve our understanding of dengue's complex disease dynamics to guide effective, targeted public health interventions. The objective of this study was to compare findings from the Ministry of Health (MoH) PS to a prospective AS arbovirus research study in Machala, Ecuador in 2014 and 2015.
METHODS
Dengue cases in the PS system were compared to laboratory confirmed acute dengue illness cases that entered the AS study during the study period. Variables of interest included age class and sex. Outbreak detection curves by epidemiologic week, overall cumulative incidence and age-specific incidence proportions were calculated. Descriptive statistics were tabulated for all variables of interest. Chi-square tests were performed to compare demographic characteristics between the AS and PS data sets in 2014 and 2015.
RESULTS
177 and 245 cases were identified from 1/1/2014 to 12/31/2015 by PS and AS, respectively; nine cases appeared in both systems. AS identified a greater number of laboratory-confirmed cases in 2014, accounting for more than 60% of dengue cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue cases in the study area. Peak transmission time in laboratory confirmed dengue illness, as noted by AS and PS was similar in 2014, whereas earlier detection (7 weeks) was observed by AS in 2015. Younger patients were more frequently identified by PS, while older patients were identified more frequently by AS. The cumulative incidence proportion for laboratory confirmed dengue illness reported via PS to the MoH was 4.12 cases per 10,000 residents in 2014, and 2.21 cases per 10,000 residents in 2015.
CONCLUSIONS
Each surveillance system captured distinct demographic subgroups within the Machala population, possibly due to differences in healthcare seeking behaviors, access to care, emerging threats of other viruses transmitted by the same mosquito vector and/or differences in clinical presentation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously underdiagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of timely public health interventions.
背景
登革热是一种主要的新发传染病，流行于全球热带和亚热带地区，约有 25 亿人面临风险。主动监测（AS）和被动监测（PS）相结合，可以提高我们对登革热复杂疾病动态的认识，从而指导采取有效、有针对性的公共卫生干预措施。本研究的目的是比较 2014 年和 2015 年厄瓜多尔马查拉卫生部 PS 监测系统与前瞻性 AS 虫媒病毒研究的结果。
方法
将 PS 系统中的登革热病例与研究期间进入 AS 研究的实验室确诊急性登革热病例进行比较。感兴趣的变量包括年龄组和性别。按流行周计算暴发检测曲线、总体累积发病率和年龄特异性发病率比例。列出了所有感兴趣变量的描述性统计数据。对 2014 年和 2015 年 AS 和 PS 数据集中的人口统计学特征进行卡方检验。
结果
2014 年 1 月 1 日至 12 月 31 日，PS 和 AS 分别发现 177 例和 245 例病例；有 9 例病例同时出现在两个系统中。AS 发现了更多的实验室确诊病例，占研究地区登革热病例的 60%以上。2015 年，PS 发现研究地区 60%的登革热病例，出现了相反的趋势。AS 和 PS 检测到的实验室确诊登革热病例的传播高峰时间在 2014 年相似，但 2015 年 AS 更早（7 周）检测到。PS 更常发现年轻患者，而 AS 更常发现老年患者。通过 PS 向卫生部报告的实验室确诊登革热病例的累积发病率比例，2014 年为每 10000 名居民 4.12 例，2015 年为每 10000 名居民 2.21 例。
结论
每个监测系统都在马查拉人群中捕获了不同的人口统计学亚组，这可能是由于医疗保健寻求行为、获得医疗服务的机会、同一蚊虫传播的其他病毒的新出现威胁以及临床表现的差异所致。将 AS 与现有的 PS 相结合，可以帮助发现以前诊断不足的亚人群中的更多病例，提高我们对疾病动态的认识，并促进及时实施公共卫生干预措施。
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