Abstract
Routine, passive surveillance systems tend to underestimate the burden of communicable diseases such as dengue. When empirical methods are unavailable, complimentary opinion-based or extrapolative methods have been employed. Here, an expert Delphi panel estimated the proportion of dengue captured by the Indonesian surveillance system, and associated health system parameters. Following presentation of medical and epidemiological data and subsequent discussions, the panel made iterative estimates from which expansion factors (EF), the ratio of total:reported cases, were calculated. Panelists estimated that of all symptomatic Indonesian dengue episodes, 57·8% (95% confidence interval (CI) 46·6-59·8) enter healthcare facilities to seek treatment; 39·3% (95% CI 32·8-42·0) are diagnosed as dengue; and 20·3% (95% CI 16·1-24·3) are subsequently reported in the surveillance system. They estimated most hospitalizations occur in the public sector, while ~55% of ambulatory episodes are seen privately. These estimates gave an overall EF of 5·00; hospitalized EF of 1·66; and ambulatory EF of 34·01 which, when combined with passive surveillance data, equates to an annual average (2006-2015) of 612 005 dengue cases, and 183 297 hospitalizations. These estimates are lower than those published elsewhere, perhaps due to case definitions, local clinical perceptions and treatment-seeking behavior. These findings complement global burden estimates, support health economic analyses, and can be used to inform decision-making.
Highlights
Dengue is a systemic viral disease, transmitted to Organization (WHO) estimated 50–100 million global humans by the bite of infected Aedes spp. mosquitoes infections per year including 500 000 dengue hemorthroughout the tropical and subtropical world
These estimates gave rise to an expansion factor (EFO) of 5·00; EFH of 1·66, and EFA of 34·01 and, when combined with passive surveillance data, a 2006–2015 annual average of 612 005 symptomatic cases (Fig. 1)
This varied from a low of 328 704 in 2011, to a high of 790 770 in 2007. This equates to a total from 2006 to 2015 of 3 537 238 cases entering health facilities; 2 476 067 dengue diagnoses and 1 832 969 hospitalizations, 1 164 543 of which are seen in the public sector
Summary
Dengue is a systemic viral disease, transmitted to Organization (WHO) estimated 50–100 million global humans by the bite of infected Aedes spp. mosquitoes infections per year including 500 000 dengue hemorthroughout the tropical and subtropical world. The panel was expected to estimate the proportion of symptomatic dengue cases captured in the surveillance system and enable calculation of national-level dengue burden estimates. Q5: Among all dengue cases entering healthcare facilities, what proportion is seen in the public sector if: (a) hospitalized; (b) outpatient (i.e. ambulatory).
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