High Dengue Case Capture Rate in Four Years of a Cohort Study in Nicaragua Compared to National Surveillance Data

Abstract

Dengue is a major public health problem in tropical and subtropical regions; however, under-reporting of cases to national surveillance systems hinders accurate knowledge of disease burden and costs. Laboratory-confirmed dengue cases identified through the Nicaraguan Pediatric Dengue Cohort Study (PDCS) were compared to those reported from other health facilities in Managua to the National Epidemiologic Surveillance (NES) program of the Nicaraguan Ministry of Health. Compared to reporting among similar pediatric populations in Managua, the PDCS identified 14 to 28 (average 21.3) times more dengue cases each year per 100,000 persons than were reported to the NES. Applying these annual expansion factors to national-level data, we estimate that the incidence of confirmed pediatric dengue throughout Nicaragua ranged from 300 to 1000 cases per 100,000 persons. We have estimated a much higher incidence of dengue than reported by the Ministry of Health. A country-specific expansion factor for dengue that allows for a more accurate estimate of incidence may aid governments and other institutions calculating disease burden, costs, resource needs for prevention and treatment, and the economic benefits of drug and vaccine development.

Total Economic Cost and Burden of Dengue in Nicaragua: 1996–2010

“…The years [1998][1999][2000]2009, and 2010 were considered epidemic years, whereas the remaining years were endemic; Table 1 lists the expansion factors used in this analysis. These expansion factor estimates were in concordance with the published literature values previously described in Nicaragua 9 and Puerto Rico, 21 as these were used to inform the ultimate expansion factor ranges used in this analysis. Economic data collection.…”

“…The MINSA data served to establish the annual age-specific case distributions, to determine the expansion factors used in this analysis to account for the large portions of underreported and asymptomatic cases, and to inform the length of stay for hospitalized cases, which were also compared with the published literature. 9,21,22 The MINSA dataset also yielded information about the ratio of total number of suspected dengue cases to confirmed cases.…”

“…9,11,21,23 Separate expansion factors were chosen for the different syndromes of dengue (DF and DHF). Luz and others, 23 Suaya and others, 24 and Gubler,25 have shown that the burden of dengue is underreported between epidemic periods, although it is more appropriately reported during epidemic years.…”

“…8 Since then, efforts have been made to characterize the epidemiology and burden of disease in Nicaragua, but few efforts have quantified the overall cost to society. [8][9][10] Previously, Ferrando 10 described the total cost of the 1994 epidemic in Nicaragua to be US$2.7 million, with an estimated 60,916 cases. Likewise, Shepard and others 11 estimated the average cost of dengue to be US$144/ambulatory case and US$306/hospitalized case during 2000-2007.…”

Incidence of Dengue in Ozamiz City, Philippines

“…However, a study in Cambodia yielded different results in which infants aged <1 year old were mostly affected (Huy et al, 2010). In Puerto Rico, Nicaragua and India, the age group most commonly affected was 10-20 years (Rigau-Perez et al, 2001;Standish et al, 2010;Kumar et al, 2010). Dengue mainly affected adults in Brazil (Cordeiro et al, 2007).…”