Secretaria de Estado da Saúde de São Paulo. Instituto de Infectologia Emílio Ribas. São Paulo, SP, Brasil.
Universidade Municipal de São Caetano do Sul. Faculdade de Medicina. São Paulo, SP, Brasil.
Rev Saude Publica. 2023 Aug 4;57:46. doi: 10.11606/s1518-8787.2023057005001. eCollection 2023.
To evaluate the accuracy of yellow fever (YF) suspected case definitions from the Brazilian Ministry of Health (BMH) and World Health Organization (WHO), as well as propose and evaluate new definitions of suspected cases, considering confirmed and discarded cases.
The retrospective study was conducted at the Instituto de Infectologia Emílio Ribas (IIER), using the Epidemiologic Surveillance Form of YF cases. From the confirmed and discarded cases of YF, a logistic regression model was developed. The independent variables were used in a proposed definition of a suspected case of YF and its accuracy was evaluated.
In total, 113 YF suspect cases were reported, with 78 confirmed (69.0%). The definitions by BMH and WHO presented low sensitivity, 59% and 53.8%, and reduced accuracy, 53.1% and 47.8%, respectively. Predictive factors for YF were thrombocytopenia, leukopenia, and elevation of transaminases greater than twice normal. The definition including individual with acute onset of fever, followed by elevation of ALT or AST greater than twice the reference value AND leukopenia OR thrombocytopenia presented high sensitivity (88.3%), specificity (62.9%), and the best accuracy (80.4%), as proposed in the model.
The YF suspected case definitions of the BMH and the WHO have low sensitivity. The inclusion of nonspecific laboratory tests increases the accuracy of YF definition.
评估巴西卫生部（BMH）和世界卫生组织（WHO）制定的黄热病（YF）疑似病例定义的准确性，并提出并评估新的疑似病例定义，同时考虑确诊和排除病例。
该回顾性研究在埃米利奥·里巴斯传染病研究所（IIER）进行，使用 YF 病例的流行病学监测表。从确诊和排除的 YF 病例中，开发了一个逻辑回归模型。将独立变量用于提出的 YF 疑似病例定义，并评估其准确性。
共报告了 113 例 YF 疑似病例，其中 78 例确诊（69.0%）。BMH 和 WHO 的定义敏感性较低，分别为 59%和 53.8%，准确性也降低，分别为 53.1%和 47.8%。YF 的预测因素包括血小板减少症、白细胞减少症和转氨酶升高超过正常的两倍。模型中提出的定义包括急性发热患者，随后 ALT 或 AST 升高超过正常参考值的两倍，同时伴有白细胞减少症或血小板减少症，具有较高的敏感性（88.3%）、特异性（62.9%）和最佳准确性（80.4%）。
BMH 和 WHO 的 YF 疑似病例定义敏感性较低。纳入非特异性实验室检查可提高 YF 定义的准确性。
