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Research article
Christina Lupone
SUNY Upstate Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9241-5788
License:
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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 from 2014-2015.
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.
177 and 245 cases were identified from January 1, 2014 to December 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 illness cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue illness cases in the region. 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 Machala residents in 2014, and 2.21 cases per 10,000 Machala residents in 2015.
Each surveillance system captured different 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 due to changes in the predominant dengue serotype in circulation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously under diagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of public health interventions to reduce the burden of disease.
Keywords
Dengue, Active Surveillance, Passive Surveillance, Latin America, Arboviral, Public Health Intervention, Ecuador
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On 24 Jun, 2020
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On 23 Jun, 2020
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On 22 Jun, 2020
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On 22 Jun, 2020
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Editorial decision: Minor revision
On 18 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 27 May, 2020
Review #2 received
Received 27 May, 2020
Reviewer #1 agreed
On 26 May, 2020
Editor assigned
On 25 May, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
Version 1
Posted 13 Mar, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #2 received
Received 29 Mar, 2020
Review #1 received
Received 29 Mar, 2020
Reviewer #1 agreed
On 23 Mar, 2020
Reviewer #2 agreed
On 23 Mar, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Editor assigned
On 16 Mar, 2020
Submission checks complete
On 11 Mar, 2020
Editor invited
On 11 Mar, 2020
First submitted
On 02 Mar, 2020
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Subject Areas
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See the published version of this preprint at BMC Public Health.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Christina Lupone
SUNY Upstate Medical University
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9241-5788
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Public Health.
No community comments so far
Editorial decision: Accept
On 24 Jun, 2020
Editor assigned
On 23 Jun, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 18 Jun, 2020
Review #1 received
Received 17 Jun, 2020
Reviewer #2 agreed
On 27 May, 2020
Review #2 received
Received 27 May, 2020
Reviewer #1 agreed
On 26 May, 2020
Editor assigned
On 25 May, 2020
Reviewers invited
Invitations sent on 25 May, 2020
Submission checks complete
On 24 May, 2020
Editor invited
On 24 May, 2020
Version 1
Posted 13 Mar, 2020
No comments provided
Editorial decision: Major revision
On 24 Apr, 2020
Review #2 received
Received 29 Mar, 2020
Review #1 received
Received 29 Mar, 2020
Reviewer #1 agreed
On 23 Mar, 2020
Reviewer #2 agreed
On 23 Mar, 2020
Reviewers invited
Invitations sent on 16 Mar, 2020
Editor assigned
On 16 Mar, 2020
Submission checks complete
On 11 Mar, 2020
Editor invited
On 11 Mar, 2020
First submitted
On 02 Mar, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Infectious Diseases
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Public Health.
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 from 2014-2015.
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.
177 and 245 cases were identified from January 1, 2014 to December 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 illness cases in the study area. In 2015, the opposite trend was observed with PS identifying 60% of the dengue illness cases in the region. 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 Machala residents in 2014, and 2.21 cases per 10,000 Machala residents in 2015.
Each surveillance system captured different 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 due to changes in the predominant dengue serotype in circulation. Integrating AS with pre-existing PS can aid in identifying additional cases in previously under diagnosed subpopulations, improving our understanding of disease dynamics, and facilitating the implementation of public health interventions to reduce the burden of disease.
Figure 1
Figure 2
Figure 3
Figure 4
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