Abstract
Enhanced laboratory-based surveillance of invasive meningococcal disease (IMD) in Italy was only assessed indirectly by numerically comparing surveillance data cases with hospital discharge records (HDR). In this study, we evaluated the completeness, timeliness and sensitivity of the IMD surveillance in Italy from 2015 to 2018. Completeness and timeliness were described at the national and subnational level. A capture-recapture analysis was conducted to evaluate the sensitivity and positive predictive value (PPV) using HDR as the external source with a combination of deterministic and probabilistic approaches. The characteristics of the unmatched vs. matched cases were compared using multivariable Poisson modeling. Overall, the completeness of data improved, except for specific variables. Timeliness of notifications also improved to a median of 4 days from onset to reporting. For the years 2015–2017, the sensitivity of the surveillance was estimated at 71.4% and the PPV at 77.5%, changing to 80.6% and 66.9% respectively after removing cases with a secondary meningitis diagnosis. We noted substantial sub-national differences. In 2018 sensitivity was 66.5% (135/203) and the PPV was 79.4% (135/170). The adjusted relative risk of being unmatched in 2015–2017 was higher in cases that were ≥60 years, had missing information or symptom onset in December. The IMD surveillance system overall performs well with completeness and timeliness improving in time. Specific challenges identified for individual variables should guide further improvement. Notwithstanding limitations posed by the comparison database, sensitivity and PPV are promising. The study highlights that promoting etiological ascertainment in people ≥60 years and addressing sub-national challenges are the main current challenges to address.
Highlights
The Gram-negative Neisseria meningitidis is transmitted from person to person and is the main causal agent for invasive meningococcal disease (IMD)
In this study we evaluated the completeness, timeliness, sensitivity and positive predictive value (PPV) of IMD surveillance in Italy, at national level
Given the different approaches used by the different regions/autonomous provinces in sharing their surveillance forms on IMD, the longer lag between onset and date of upload in the platform, compared to the lab between onset and notification, was expected
Summary
The Gram-negative Neisseria meningitidis is transmitted from person to person and is the main causal agent for invasive meningococcal disease (IMD). In Italy, the incidence of reported laboratory confirmed IMD cases was 0.3/100000 in 2017 and the vaccination is included in the National Immunization Plan which recommends vaccination with one dose of the serogroup C meningococcal vaccine for children aged 13–15 months-old, four doses of the serogroup B vaccine administered between 3 and months and one dose of the tetravalent vaccine against serogroups A, C, W and Y for adolescents (12– years old) [3,4,5]. Is divided in 19 regions and 2 autonomous provinces that are responsible for planning and delivering health care services. This includes the coordination and management of infectious diseases surveillance, with the support of the Ministry of Health and the Italian National Institute of Health (Istituto Superiore di Sanità, ISS). The system has been operating since 2007 with the objectives of: (i) monitoring the temporal and spatial distribution of cases, (ii) describing epidemic trends and circulating serogroups, (iii) estimating the number of cases that can be prevented, and (iv) identifying vaccination failures
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