U.S. Naval Medical Research Unit-3, Cairo, Egypt.
Egyptian Ministry of Health and Population, Cairo, Egypt.
PLoS One. 2021 Mar 25;16(3):e0248563. doi: 10.1371/journal.pone.0248563. eCollection 2021.
Multiple case definitions are used to identify hospitalized patients with community-acquired acute respiratory infections (ARI). We evaluated several commonly used hospitalized ARI case definitions to identify influenza cases.
The study included all patients from a population-based surveillance site in Damanhour, Egypt hospitalized for a broad set of criteria consistent with community acquired ARIs. Naso- and oropharyngeal (NP/OP) swabs were tested for influenza using RT-PCR. Sensitivity, specificity and PPV for influenza identification was compared between the 2014 WHO Severe Acute Respiratory Infection (SARI) definition (fever ≥38°C and cough with onset within 10 days), the 2011 WHO SARI definition (fever ≥38°C and cough with onset within 7 days), the 2006 PAHO SARI definition, the International Emerging Infections Program (IEIP) pneumonia case definition, and the International Management of Childhood Illness (IMCI) case definitions for moderate and severe pneumonia.
From June 2009-December 2012, 5768 NP/OP swabs were obtained from 6113 hospitalized ARI patients; 799 (13.9%) were influenza positive. The 2014 WHO SARI case definition captured the greatest number of ARI patients, influenza positive patients and ARI deaths compared to the other case definitions examined. Sensitivity for influenza detection was highest for the 2014 WHO SARI definition with 88.6%, compared to the 2011 WHO SARI (78.2%) the 2006 PAHO SARI (15.8%) the IEIP pneumonia (61.0%) and the IMCI moderate and severe pneumonia (33.8% and 38.9%) case definitions (IMCI applies to <5 only).
Our results support use of the 2014 WHO SARI definition for identifying influenza positive hospitalized SARI cases as it captures the highest proportion of ARI deaths and influenza positive cases. Routine use of this case definition for hospital-based surveillance will provide a solid, globally comparable foundation on which to build needed response efforts for novel pandemic viruses.
多种病例定义被用于识别社区获得性急性呼吸道感染（ARI）住院患者。我们评估了几种常用的住院ARI 病例定义，以识别流感病例。
本研究纳入了来自埃及达曼胡尔基于人群监测点的所有因广泛符合社区获得性ARI 标准而住院的患者。使用 RT-PCR 对鼻和口咽（NP/OP）拭子进行流感检测。比较了 2014 年世卫组织严重急性呼吸道感染（SARI）定义（体温≥38°C 和咳嗽发病在 10 天内）、2011 年世卫组织 SARI 定义（体温≥38°C 和咳嗽发病在 7 天内）、2006 年泛美卫生组织 SARI 定义、国际新发传染病计划（IEIP）肺炎病例定义和国际儿童疾病管理（IMCI）中度和重度肺炎病例定义对流感识别的敏感性、特异性和阳性预测值。
2009 年 6 月至 2012 年 12 月，从 6113 例住院 ARI 患者中获得了 5768 份 NP/OP 拭子；799 份（13.9%）为流感阳性。与其他评估的病例定义相比，2014 年世卫组织 SARI 病例定义捕获了最多的 ARI 患者、流感阳性患者和 ARI 死亡病例。流感检测的敏感性以 2014 年世卫组织 SARI 定义最高，为 88.6%，其次是 2011 年世卫组织 SARI（78.2%）、2006 年泛美卫生组织 SARI（15.8%）、IEIP 肺炎（61.0%）和 IMCI 中度和重度肺炎（33.8%和 38.9%）病例定义（IMCI 仅适用于<5 岁）。
我们的结果支持使用 2014 年世卫组织 SARI 定义来识别流感阳性住院 SARI 病例，因为它捕获了最高比例的 ARI 死亡和流感阳性病例。常规使用该病例定义进行基于医院的监测将为建立应对新型大流行病毒所需的努力提供坚实的、具有全球可比性的基础。
