Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Robert Koch Institute, Centre for International Health Protection (ZIG), Berlin, Germany.
BMC Infect Dis. 2020 Oct 17;20(1):766. doi: 10.1186/s12879-020-05467-9.
Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems. We conducted an inventory study to calculate TB underreporting in Germany in 2013-2017.
Acquisition of two pseudonymized case-based data sources (national TB notification data and antibiotic resistance surveillance data) was followed by two-source Capture-recapture (CRC) analysis, as case-based data from a third source was unavailable. Aggregated data on consumption of a key anti-TB drug (pyrazinamide [PZA]) was compared to an estimated need for PZA based on TB notification data to obtain an independent underreporting estimation. Additionally, notified TB incidence was compared to TB rate in an aggregated health insurance fund dataset.
CRC and PZA-based approaches indicated that between 93 and 97% (CRC) and between 91 and 95% (PZA) of estimated cases were captured in the national TB notification data in the years 2013-2017. Insurance fund dataset did not indicate TB underreporting on the national level in 2017.
Our results suggest that more than 90% of estimated TB cases are captured within the German TB surveillance system, and accordingly the TB notification rate is likely a good proxy of the diagnosed TB incidence rate. An increase in underreporting and discrepancies however should be further investigated.
评估结核病（TB）报告数据的完整性对于监测结核病监测系统非常重要。我们进行了一项清查研究，以计算 2013-2017 年德国的结核病漏报率。
获取两个化名的基于病例的数据源（国家结核病报告数据和抗生素耐药监测数据），然后进行两源捕获-再捕获（CRC）分析，因为第三个源的基于病例的数据不可用。将关键抗结核药物（吡嗪酰胺[PZA]）的使用汇总数据与基于结核病报告数据估计的 PZA 需求进行比较，以获得独立的漏报估计。此外，将报告的结核病发病率与汇总的健康保险基金数据集的结核病率进行比较。
CRC 和基于 PZA 的方法表明，2013-2017 年，国家结核病报告数据中分别有 93%至 97%（CRC）和 91%至 95%（PZA）的估计病例被捕获。保险基金数据集在 2017 年并未显示全国范围内的结核病漏报情况。
我们的结果表明，德国结核病监测系统中捕获了超过 90%的估计结核病病例，因此结核病报告率很可能是诊断结核病发病率的良好替代指标。然而，漏报率的增加和差异应该进一步调查。
