Department of Translational Research and New Surgical and Medical Technologies, University of Pisa, 56126 Pisa, Italy.
Tuscany Regional Health Agency (Agenzia Regionale di Sanità della Toscana), 50141 Florence, Italy.
Int J Environ Res Public Health. 2020 Oct 19;17(20):7581. doi: 10.3390/ijerph17207581.
Invasive pneumococcal disease (IPD) is a vaccine-preventable disease characterized by the presence of in normally sterile sites. Since 2007, Italy has implemented an IPD national surveillance system (IPD-NSS). This system suffers from high rates of underreporting. To estimate the level of underreporting of IPD in 2016-2017 in Tuscany (Italy), we integrated data from IPD-NSS and two other regional data sources, i.e., Tuscany regional microbiological surveillance (Microbiological Surveillance and Antibiotic Resistance in Tuscany, SMART) and hospitalization discharge records (HDRs). We collected (1) notifications to IPD-NSS, (2) SMART records positive for from normally sterile sites, and (3) hospitalization records with IPD-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes in discharge diagnoses. We performed data linkage of the three sources to obtain a combined surveillance system (CSS). Using the CSS, we calculated the completeness of the three sources and performed a three-source log-linear capture-recapture analysis to estimate total IPD underreporting. In total, 127 IPD cases were identified from IPD-NSS, 320 were identified from SMART, and 658 were identified from HDRs. After data linkage, a total of 904 unique cases were detected. The average yearly CSS notification rate was 12.1/100,000 inhabitants. Completeness was 14.0% for IPD-NSS, 35.4% for SMART, and 72.8% for HDRs. The capture-recapture analysis suggested a total estimate of 3419 cases of IPD (95% confidence interval (CI): 1364-5474), corresponding to an underreporting rate of 73.7% (95% CI: 34.0-83.6) for CSS. This study shows substantial underreporting in the Tuscany IPD surveillance system. Integration of available data sources may be a useful approach to complement notification-based surveillance and provide decision-makers with better information to plan effective control strategies against IPD.
侵袭性肺炎球菌病（IPD）是一种可通过疫苗预防的疾病，其特征是在正常无菌部位出现 。自 2007 年以来，意大利实施了一项侵袭性肺炎球菌病国家监测系统（IPD-NSS）。该系统存在高漏报率的问题。为了估计 2016-2017 年托斯卡纳（意大利）侵袭性肺炎球菌病的漏报水平，我们整合了 IPD-NSS 和另外两个区域数据源的数据，即托斯卡纳区域微生物监测（托斯卡纳微生物监测和抗生素耐药性，SMART）和住院记录（HDR）。我们收集了（1）向 IPD-NSS 的报告，（2）SMART 记录中来自正常无菌部位的 阳性结果，以及（3）在出院诊断中具有侵袭性肺炎球菌病相关国际疾病分类，第九修订版，临床修正（ICD9）编码的住院记录。我们对三个来源的数据进行了链接，以获得一个综合监测系统（CSS）。使用 CSS，我们计算了三个来源的完整性，并进行了三源对数线性捕获-再捕获分析，以估计总 IPD 漏报率。总共从 IPD-NSS 中确定了 127 例 IPD 病例，从 SMART 中确定了 320 例，从 HDR 中确定了 658 例。数据链接后，共发现 904 例独特病例。平均每年 CSS 报告率为 12.1/100,000 居民。IPD-NSS 的完整性为 14.0%，SMART 为 35.4%，HDR 为 72.8%。捕获-再捕获分析表明，总共有 3419 例 IPD 病例（95%置信区间（CI）：1364-5474），这对应于 CSS 的总漏报率为 73.7%（95% CI：34.0-83.6）。这项研究表明，托斯卡纳侵袭性肺炎球菌病监测系统存在大量漏报。整合现有数据源可能是一种有用的方法，可以补充基于报告的监测，并为决策者提供更好的信息，以制定有效的侵袭性肺炎球菌病控制策略。
