Abstract
BackgroundEvaluating 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.MethodsAcquisition 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.ResultsCRC 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.ConclusionsOur 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.
Highlights
Evaluating the completeness of tuberculosis (TB) notification data is important for monitoring of TB surveillance systems
Tuberculosis (TB) is one of the biggest public health infectious disease threats globally, with an estimated 10 million people who fell sick with TB and 1.6 million people who died of TB in 2017 [1]
Since TB is a notifiable disease [5], pseudonymized casebased data on TB patients is reported to the national surveillance database of the Robert Koch Institute (RKI) (SurvNet@rki [6]) by the local district health authorities via state health departments
Summary
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. In Germany, the Robert Koch Institute (RKI), as the national public health institute, is responsible for Domaszewska et al BMC Infectious Diseases (2020) 20:766 conducting nationwide infectious disease surveillance. Since TB is a notifiable disease [5], pseudonymized casebased data on TB patients is reported to the national surveillance database of the RKI (SurvNet@rki [6]) by the local district health authorities via state health departments. Assessing reporting completeness of the electronic surveillance systems is best done through inventory studies [7], which reveal datadriven and, more certain underreporting estimates that are tailored to each country’s unique health care system and TB epidemiology
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