Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data
Identifieur interne : 000328 ( Pmc/Checkpoint ); précédent : 000327; suivant : 000329Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data
Auteurs : Birgit Nikolay [France] ; Henrik Salje [France, États-Unis] ; Katharine Sturm-Ramirez [États-Unis, Bangladesh] ; Eduardo Azziz-Baumgartner [États-Unis] ; Nusrat Homaira [Bangladesh, Australie] ; Makhdum Ahmed [États-Unis] ; A. Danielle Iuliano [États-Unis] ; Repon C. Paul [Bangladesh, Australie] ; Mahmudur Rahman [Bangladesh] ; M. Jahangir Hossain [Gambie] ; Stephen P. Luby [États-Unis] ; Simon Cauchemez [France] ; Emily S. Gurley [Bangladesh]Source :
- PLoS Medicine [ 1549-1277 ] ; 2017.
Abstract
The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country’s ability to meet these requirements.
We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals.
We estimated that surveillance detected 26% (95% CI 18%–33%) of severe neurological disease cases and 18% (95% CI 16%–21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented.
Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and surveillance resources.
We present a new approach to evaluating the sensitivity and representativeness of hospital-based surveillance, making it possible to predict its ability to detect emerging threats.
Url:
DOI: 10.1371/journal.pmed.1002218
PubMed: 28095468
PubMed Central: 5240927
Affiliations:
- Australie, Bangladesh, France, Gambie, États-Unis
- Californie, Géorgie (États-Unis), Maryland, Texas, Île-de-France
- Paris
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type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Centre National de la Recherche Scientifique, URA3012, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre National de la Recherche Scientifique, URA3012, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Salje, Henrik" sort="Salje, Henrik" uniqKey="Salje H" first="Henrik" last="Salje">Henrik Salje</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Centre National de la Recherche Scientifique, URA3012, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre National de la Recherche Scientifique, URA3012, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff004"><addr-line>Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland</wicri:regionArea><placeName><region type="state">Maryland</region></placeName></affiliation></author><author><name sortKey="Sturm Ramirez, Katharine" sort="Sturm Ramirez, Katharine" uniqKey="Sturm Ramirez K" first="Katharine" last="Sturm-Ramirez">Katharine Sturm-Ramirez</name><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Azziz Baumgartner, Eduardo" sort="Azziz Baumgartner, Eduardo" uniqKey="Azziz Baumgartner E" first="Eduardo" last="Azziz-Baumgartner">Eduardo Azziz-Baumgartner</name><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Homaira, Nusrat" sort="Homaira, Nusrat" uniqKey="Homaira N" first="Nusrat" last="Homaira">Nusrat Homaira</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff007"><addr-line>Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Ahmed, Makhdum" sort="Ahmed, Makhdum" uniqKey="Ahmed M" first="Makhdum" last="Ahmed">Makhdum Ahmed</name><affiliation wicri:level="2"><nlm:aff id="aff008"><addr-line>School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>School of Public Health, University of Texas Health Science Center, Houston, Texas</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff009"><addr-line>Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas</wicri:regionArea><placeName><region type="state">Texas</region></placeName></affiliation></author><author><name sortKey="Iuliano, A Danielle" sort="Iuliano, A Danielle" uniqKey="Iuliano A" first="A. Danielle" last="Iuliano">A. Danielle Iuliano</name><affiliation wicri:level="2"><nlm:aff id="aff005"><addr-line>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia</wicri:regionArea><placeName><region type="state">Géorgie (États-Unis)</region></placeName></affiliation></author><author><name sortKey="Paul, Repon C" sort="Paul, Repon C" uniqKey="Paul R" first="Repon C." last="Paul">Repon C. Paul</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff010"><addr-line>School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia</addr-line></nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, New South Wales</wicri:regionArea><wicri:noRegion>New South Wales</wicri:noRegion></affiliation></author><author><name sortKey="Rahman, Mahmudur" sort="Rahman, Mahmudur" uniqKey="Rahman M" first="Mahmudur" last="Rahman">Mahmudur Rahman</name><affiliation wicri:level="1"><nlm:aff id="aff011"><addr-line>Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>Institute of Epidemiology, Disease Control and Research, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author><author><name sortKey="Hossain, M Jahangir" sort="Hossain, M Jahangir" uniqKey="Hossain M" first="M. Jahangir" last="Hossain">M. Jahangir Hossain</name><affiliation wicri:level="1"><nlm:aff id="aff012"><addr-line>Medical Research Council Unit The Gambia, Banjul, The Gambia</addr-line></nlm:aff><country xml:lang="fr">Gambie</country><wicri:regionArea>Medical Research Council Unit The Gambia, Banjul</wicri:regionArea><wicri:noRegion>Banjul</wicri:noRegion></affiliation></author><author><name sortKey="Luby, Stephen P" sort="Luby, Stephen P" uniqKey="Luby S" first="Stephen P." last="Luby">Stephen P. Luby</name><affiliation wicri:level="2"><nlm:aff id="aff013"><addr-line>Infectious Diseases Division, Stanford University, Stanford, California, United States of America</addr-line></nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Infectious Diseases Division, Stanford University, Stanford, California</wicri:regionArea><placeName><region type="state">Californie</region></placeName></affiliation></author><author><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name><affiliation wicri:level="3"><nlm:aff id="aff001"><addr-line>Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff002"><addr-line>Centre National de la Recherche Scientifique, URA3012, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Centre National de la Recherche Scientifique, URA3012, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff003"><addr-line>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France</addr-line></nlm:aff><country xml:lang="fr">France</country><wicri:regionArea>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris</wicri:regionArea><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Gurley, Emily S" sort="Gurley, Emily S" uniqKey="Gurley E" first="Emily S." last="Gurley">Emily S. Gurley</name><affiliation wicri:level="1"><nlm:aff id="aff006"><addr-line>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></nlm:aff><country xml:lang="fr">Bangladesh</country><wicri:regionArea>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka</wicri:regionArea><wicri:noRegion>Dhaka</wicri:noRegion></affiliation></author></analytic><series><title level="j">PLoS Medicine</title><idno type="ISSN">1549-1277</idno><idno type="eISSN">1549-1676</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="sec001"><title>Background</title><p>The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country’s ability to meet these requirements.</p></sec><sec id="sec002"><title>Methods and Findings</title><p>We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals.</p><p>We estimated that surveillance detected 26% (95% CI 18%–33%) of severe neurological disease cases and 18% (95% CI 16%–21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented.</p><p>Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and surveillance resources.</p></sec><sec id="sec003"><title>Conclusion</title><p>We present a new approach to evaluating the sensitivity and representativeness of hospital-based surveillance, making it possible to predict its ability to detect emerging threats.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Gostin, Lo" uniqKey="Gostin L">LO Gostin</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Garcia Abreu, A" uniqKey="Garcia Abreu A">A Garcia-Abreu</name></author><author><name sortKey="Halperin, W" uniqKey="Halperin W">W Halperin</name></author><author><name sortKey="Danel, I" uniqKey="Danel I">I Danel</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Ahmed, S" 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<front><journal-meta><journal-id journal-id-type="nlm-ta">PLoS Med</journal-id><journal-id journal-id-type="iso-abbrev">PLoS Med</journal-id><journal-id journal-id-type="publisher-id">plos</journal-id><journal-id journal-id-type="pmc">plosmed</journal-id><journal-title-group><journal-title>PLoS Medicine</journal-title></journal-title-group><issn pub-type="ppub">1549-1277</issn><issn pub-type="epub">1549-1676</issn><publisher><publisher-name>Public Library of Science</publisher-name><publisher-loc>San Francisco, CA USA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">28095468</article-id><article-id pub-id-type="pmc">5240927</article-id><article-id pub-id-type="doi">10.1371/journal.pmed.1002218</article-id><article-id pub-id-type="publisher-id">PMEDICINE-D-16-02359</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Disease Surveillance</subject><subj-group><subject>Infectious Disease Surveillance</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Infectious Disease Control</subject><subj-group><subject>Infectious Disease Surveillance</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>People and Places</subject><subj-group><subject>Geographical Locations</subject><subj-group><subject>Asia</subject><subj-group><subject>Bangladesh</subject></subj-group></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Epidemiology</subject><subj-group><subject>Disease Surveillance</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Pulmonology</subject><subj-group><subject>Respiratory Infections</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Health Care</subject><subj-group><subject>Health Care Providers</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Public and Occupational Health</subject></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Infectious Diseases</subject><subj-group><subject>Infectious Diseases of the Nervous System</subject></subj-group></subj-group></subj-group><subj-group subj-group-type="Discipline-v3"><subject>Medicine and Health Sciences</subject><subj-group><subject>Neurology</subject><subj-group><subject>Infectious Diseases of the Nervous System</subject></subj-group></subj-group></subj-group></article-categories><title-group><article-title>Evaluating Hospital-Based Surveillance for Outbreak Detection in Bangladesh: Analysis of Healthcare Utilization Data</article-title><alt-title alt-title-type="running-head">Evaluating Hospital-Based Surveillance</alt-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Nikolay</surname><given-names>Birgit</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref></contrib><contrib contrib-type="author"><name><surname>Salje</surname><given-names>Henrik</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="aff" rid="aff004"><sup>4</sup></xref><xref ref-type="corresp" rid="cor001">*</xref></contrib><contrib contrib-type="author"><name><surname>Sturm-Ramirez</surname><given-names>Katharine</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref><xref ref-type="aff" rid="aff006"><sup>6</sup></xref></contrib><contrib contrib-type="author"><name><surname>Azziz-Baumgartner</surname><given-names>Eduardo</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Homaira</surname><given-names>Nusrat</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref><xref ref-type="aff" rid="aff007"><sup>7</sup></xref></contrib><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-0772-8710</contrib-id><name><surname>Ahmed</surname><given-names>Makhdum</given-names></name><xref ref-type="aff" rid="aff008"><sup>8</sup></xref><xref ref-type="aff" rid="aff009"><sup>9</sup></xref></contrib><contrib contrib-type="author"><name><surname>Iuliano</surname><given-names>A. Danielle</given-names></name><xref ref-type="aff" rid="aff005"><sup>5</sup></xref></contrib><contrib contrib-type="author"><name><surname>Paul</surname><given-names>Repon C.</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref><xref ref-type="aff" rid="aff010"><sup>10</sup></xref></contrib><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0002-3698-4852</contrib-id><name><surname>Rahman</surname><given-names>Mahmudur</given-names></name><xref ref-type="aff" rid="aff011"><sup>11</sup></xref></contrib><contrib contrib-type="author"><name><surname>Hossain</surname><given-names>M. Jahangir</given-names></name><xref ref-type="aff" rid="aff012"><sup>12</sup></xref></contrib><contrib contrib-type="author"><contrib-id authenticated="true" contrib-id-type="orcid">http://orcid.org/0000-0001-5385-899X</contrib-id><name><surname>Luby</surname><given-names>Stephen P.</given-names></name><xref ref-type="aff" rid="aff013"><sup>13</sup></xref></contrib><contrib contrib-type="author"><name><surname>Cauchemez</surname><given-names>Simon</given-names></name><xref ref-type="aff" rid="aff001"><sup>1</sup></xref><xref ref-type="aff" rid="aff002"><sup>2</sup></xref><xref ref-type="aff" rid="aff003"><sup>3</sup></xref><xref ref-type="author-notes" rid="fn001"><sup>¶</sup></xref></contrib><contrib contrib-type="author"><name><surname>Gurley</surname><given-names>Emily S.</given-names></name><xref ref-type="aff" rid="aff006"><sup>6</sup></xref><xref ref-type="author-notes" rid="fn001"><sup>¶</sup></xref></contrib></contrib-group><aff id="aff001"><label>1</label><addr-line>Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Paris, France</addr-line></aff><aff id="aff002"><label>2</label><addr-line>Centre National de la Recherche Scientifique, URA3012, Paris, France</addr-line></aff><aff id="aff003"><label>3</label><addr-line>Center of Bioinformatics, Biostatistics and Integrative Biology, Institut Pasteur, Paris, France</addr-line></aff><aff id="aff004"><label>4</label><addr-line>Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America</addr-line></aff><aff id="aff005"><label>5</label><addr-line>Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America</addr-line></aff><aff id="aff006"><label>6</label><addr-line>Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh</addr-line></aff><aff id="aff007"><label>7</label><addr-line>Discipline of Paediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, New South Wales, Australia</addr-line></aff><aff id="aff008"><label>8</label><addr-line>School of Public Health, University of Texas Health Science Center, Houston, Texas, United States of America</addr-line></aff><aff id="aff009"><label>9</label><addr-line>Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America</addr-line></aff><aff id="aff010"><label>10</label><addr-line>School of Public Health and Community Medicine, University of New South Wales Australia, Sydney, New South Wales, Australia</addr-line></aff><aff id="aff011"><label>11</label><addr-line>Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh</addr-line></aff><aff id="aff012"><label>12</label><addr-line>Medical Research Council Unit The Gambia, Banjul, The Gambia</addr-line></aff><aff id="aff013"><label>13</label><addr-line>Infectious Diseases Division, Stanford University, Stanford, California, United States of America</addr-line></aff><contrib-group><contrib contrib-type="editor"><name><surname>Lipsitch</surname><given-names>Marc</given-names></name><role>Academic Editor</role><xref ref-type="aff" rid="edit1"></xref></contrib></contrib-group><aff id="edit1"><addr-line>Harvard School of Public Health, UNITED STATES</addr-line></aff><author-notes><fn fn-type="COI-statement" id="coi001"><p>The authors have declared that no competing interests exist.</p></fn><fn fn-type="con"><p><list list-type="simple"><list-item><p><bold>Conceptualization:</bold> BN HS SC ESG.</p></list-item><list-item><p><bold>Formal analysis:</bold> BN.</p></list-item><list-item><p><bold>Investigation:</bold> KSR EAB NH MA ADI RCP MR MJH SPL.</p></list-item><list-item><p><bold>Methodology:</bold> BN HS SC ESG.</p></list-item><list-item><p><bold>Writing – original draft:</bold> BN HS SC ESG.</p></list-item><list-item><p><bold>Writing – review & editing:</bold> BN HS KSR EAB NH MA ADI RCP MR MJH SPL SC ESG.</p></list-item></list></p></fn><fn fn-type="other" id="fn001"><p>¶ These authors are joint senior authors on this work.</p></fn><corresp id="cor001">* E-mail: <email>henrik.salje@pasteur.fr</email></corresp></author-notes><pub-date pub-type="epub"><day>17</day><month>1</month><year>2017</year></pub-date><pub-date pub-type="collection"><month>1</month><year>2017</year></pub-date><volume>14</volume><issue>1</issue><elocation-id>e1002218</elocation-id><history><date date-type="received"><day>22</day><month>7</month><year>2016</year></date><date date-type="accepted"><day>9</day><month>12</month><year>2016</year></date></history><permissions><license xlink:href="https://creativecommons.org/publicdomain/zero/1.0/"><license-p>This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the <ext-link ext-link-type="uri" xlink:href="https://creativecommons.org/publicdomain/zero/1.0/">Creative Commons CC0</ext-link> public domain dedication.</license-p></license></permissions><self-uri content-type="pdf" xlink:href="pmed.1002218.pdf"></self-uri><abstract><sec id="sec001"><title>Background</title><p>The International Health Regulations outline core requirements to ensure the detection of public health threats of international concern. Assessing the capacity of surveillance systems to detect these threats is crucial for evaluating a country’s ability to meet these requirements.</p></sec><sec id="sec002"><title>Methods and Findings</title><p>We propose a framework to evaluate the sensitivity and representativeness of hospital-based surveillance and apply it to severe neurological infectious diseases and fatal respiratory infectious diseases in Bangladesh. We identified cases in selected communities within surveillance hospital catchment areas using key informant and house-to-house surveys and ascertained where cases had sought care. We estimated the probability of surveillance detecting different sized outbreaks by distance from the surveillance hospital and compared characteristics of cases identified in the community and cases attending surveillance hospitals.</p><p>We estimated that surveillance detected 26% (95% CI 18%–33%) of severe neurological disease cases and 18% (95% CI 16%–21%) of fatal respiratory disease cases residing at 10 km distance from a surveillance hospital. Detection probabilities decreased markedly with distance. The probability of detecting small outbreaks (three cases) dropped below 50% at distances greater than 26 km for severe neurological disease and at distances greater than 7 km for fatal respiratory disease. Characteristics of cases attending surveillance hospitals were largely representative of all cases; however, neurological disease cases aged <5 y or from the lowest socioeconomic group and fatal respiratory disease cases aged ≥60 y were underrepresented.</p><p>Our estimates of outbreak detection rely on suspected cases that attend a surveillance hospital receiving laboratory confirmation of disease and being reported to the surveillance system. The extent to which this occurs will depend on disease characteristics (e.g., severity and symptom specificity) and surveillance resources.</p></sec><sec id="sec003"><title>Conclusion</title><p>We present a new approach to evaluating the sensitivity and representativeness of hospital-based surveillance, making it possible to predict its ability to detect emerging threats.</p></sec></abstract><abstract abstract-type="toc"><p>Henrik Salje and colleagues propose a framework to examine the capacity of hospital-based surveillance data to detect public health threats in Bangladesh.</p></abstract><abstract abstract-type="summary"><title>Author Summary</title><sec id="sec004"><title>Why Was This Study Done?</title><list list-type="bullet"><list-item><p>Many countries rely on hospital-based surveillance for the detection of infectious diseases of national and global public health relevance.</p></list-item><list-item><p>It is often difficult to access suitable external reference data to assess the capacity of a surveillance system to detect cases and outbreaks or to characterize cases.</p></list-item></list></sec><sec id="sec005"><title>What Did the Researchers Do and Find?</title><list list-type="bullet"><list-item><p>We demonstrate a novel approach using healthcare utilization data to evaluate the sensitivity and representativeness of severe infectious disease surveillance in Bangladesh.</p></list-item><list-item><p>The capacity to detect cases and outbreaks decreased with distance from surveillance hospitals.</p></list-item><list-item><p>Cases captured by surveillance differed from cases in communities by age and socioeconomic status.</p></list-item><list-item><p>Geographic coverage of surveillance could be improved by including other hospitals in the surveillance system.</p></list-item></list></sec><sec id="sec006"><title>What Do These Findings Mean?</title><list list-type="bullet"><list-item><p>The presented approach is applicable for a wide range of infectious diseases in different settings, taking some practical considerations into account.</p></list-item><list-item><p>Hospital-based surveillance may have low sensitivity in rural areas at greater distances from surveillance hospitals, suggesting a risk of unrecognized transmission of emerging infectious diseases.</p></list-item><list-item><p>Alternative surveillance strategies, such as including additional hospitals in the surveillance system or considering alternative data streams, may help to increase surveillance performance in such remote regions.</p></list-item></list></sec></abstract><funding-group><funding-statement>The study was funded by the European Union Seventh Framework Programme (FP7/2007-2013) under Grant Agreement number 278433- PREDEMICS (<ext-link ext-link-type="uri" xlink:href="http://predemics.biomedtrain.eu/cms/">http://predemics.biomedtrain.eu/cms/</ext-link>), The Laboratory of Excellence – Integrative Biology of Emerging Infectious Diseases (<ext-link ext-link-type="uri" xlink:href="https://research.pasteur.fr/fr/program_project/integrative-biology-of-emerging-infectious-diseases/">https://research.pasteur.fr/fr/program_project/integrative-biology-of-emerging-infectious-diseases/</ext-link>), AXA Research Fund (<ext-link ext-link-type="uri" xlink:href="https://www.axa-research.org">https://www.axa-research.org</ext-link>), National Institute for General Medical Sciences–The Models of Infectious Disease Agent Study (<ext-link ext-link-type="uri" xlink:href="https://www.nigms.nih.gov/Research/SpecificAreas/MIDAS/Pages/default.aspx">https://www.nigms.nih.gov/Research/SpecificAreas/MIDAS/Pages/default.aspx</ext-link>), and US Centers for Disease Control and Prevention (<ext-link ext-link-type="uri" xlink:href="http://www.cdc.gov/">http://www.cdc.gov/</ext-link>). Co-authors who work for CDC were involved in survey design and report writing. Other sponsors had no involvement in study design; collection, analysis, and interpretation of data; writing of the report; or the decision to publish.</funding-statement></funding-group><counts><fig-count count="5"></fig-count><table-count count="0"></table-count><page-count count="18"></page-count></counts><custom-meta-group><custom-meta id="data-availability"><meta-name>Data Availability</meta-name><meta-value>The data are available to download as Supporting Information files (S1 Dataset and S2 Dataset).</meta-value></custom-meta></custom-meta-group></article-meta><notes><title>Data Availability</title><p>The data are available to download as Supporting Information files (S1 Dataset and S2 Dataset).</p></notes></front></pmc><affiliations><list><country><li>Australie</li><li>Bangladesh</li><li>France</li><li>Gambie</li><li>États-Unis</li></country><region><li>Californie</li><li>Géorgie (États-Unis)</li><li>Maryland</li><li>Texas</li><li>Île-de-France</li></region><settlement><li>Paris</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Nikolay, Birgit" sort="Nikolay, Birgit" uniqKey="Nikolay B" first="Birgit" last="Nikolay">Birgit Nikolay</name></region><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name><name sortKey="Cauchemez, Simon" sort="Cauchemez, Simon" uniqKey="Cauchemez S" first="Simon" last="Cauchemez">Simon Cauchemez</name><name sortKey="Nikolay, Birgit" sort="Nikolay, Birgit" uniqKey="Nikolay B" first="Birgit" last="Nikolay">Birgit Nikolay</name><name sortKey="Nikolay, Birgit" sort="Nikolay, Birgit" uniqKey="Nikolay B" first="Birgit" last="Nikolay">Birgit Nikolay</name><name sortKey="Salje, Henrik" sort="Salje, Henrik" uniqKey="Salje H" first="Henrik" last="Salje">Henrik Salje</name><name sortKey="Salje, Henrik" sort="Salje, Henrik" uniqKey="Salje H" first="Henrik" last="Salje">Henrik Salje</name><name sortKey="Salje, Henrik" sort="Salje, Henrik" uniqKey="Salje H" first="Henrik" last="Salje">Henrik Salje</name></country><country name="États-Unis"><region name="Maryland"><name sortKey="Salje, Henrik" sort="Salje, Henrik" uniqKey="Salje H" first="Henrik" last="Salje">Henrik Salje</name></region><name sortKey="Ahmed, Makhdum" sort="Ahmed, Makhdum" uniqKey="Ahmed M" first="Makhdum" last="Ahmed">Makhdum Ahmed</name><name sortKey="Ahmed, Makhdum" sort="Ahmed, Makhdum" uniqKey="Ahmed M" first="Makhdum" last="Ahmed">Makhdum Ahmed</name><name sortKey="Azziz Baumgartner, Eduardo" sort="Azziz Baumgartner, Eduardo" uniqKey="Azziz Baumgartner E" first="Eduardo" last="Azziz-Baumgartner">Eduardo Azziz-Baumgartner</name><name sortKey="Iuliano, A Danielle" sort="Iuliano, A Danielle" uniqKey="Iuliano A" first="A. Danielle" last="Iuliano">A. Danielle Iuliano</name><name sortKey="Luby, Stephen P" sort="Luby, Stephen P" uniqKey="Luby S" first="Stephen P." last="Luby">Stephen P. Luby</name><name sortKey="Sturm Ramirez, Katharine" sort="Sturm Ramirez, Katharine" uniqKey="Sturm Ramirez K" first="Katharine" last="Sturm-Ramirez">Katharine Sturm-Ramirez</name></country><country name="Bangladesh"><noRegion><name sortKey="Sturm Ramirez, Katharine" sort="Sturm Ramirez, Katharine" uniqKey="Sturm Ramirez K" first="Katharine" last="Sturm-Ramirez">Katharine Sturm-Ramirez</name></noRegion><name sortKey="Gurley, Emily S" sort="Gurley, Emily S" uniqKey="Gurley E" first="Emily S." last="Gurley">Emily S. Gurley</name><name sortKey="Homaira, Nusrat" sort="Homaira, Nusrat" uniqKey="Homaira N" first="Nusrat" last="Homaira">Nusrat Homaira</name><name sortKey="Paul, Repon C" sort="Paul, Repon C" uniqKey="Paul R" first="Repon C." last="Paul">Repon C. Paul</name><name sortKey="Rahman, Mahmudur" sort="Rahman, Mahmudur" uniqKey="Rahman M" first="Mahmudur" last="Rahman">Mahmudur Rahman</name></country><country name="Australie"><noRegion><name sortKey="Homaira, Nusrat" sort="Homaira, Nusrat" uniqKey="Homaira N" first="Nusrat" last="Homaira">Nusrat Homaira</name></noRegion><name sortKey="Paul, Repon C" sort="Paul, Repon C" uniqKey="Paul R" first="Repon C." last="Paul">Repon C. Paul</name></country><country name="Gambie"><noRegion><name sortKey="Hossain, M Jahangir" sort="Hossain, M Jahangir" uniqKey="Hossain M" first="M. Jahangir" last="Hossain">M. Jahangir Hossain</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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