Indonesian dengue burden estimates: review of evidence by an expert panel.
Indonesian dengue burden estimates: review of evidence by an expert panel.
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DOI：
10.1017/s0950268817001030
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发表时间：
2017-08
影响因子：
4.2
通讯作者：
Nadjib M
中科院分区：
文献类型：
--
作者：
Wahyono TYM;Nealon J;Beucher S;Prayitno A;Moureau A;Nawawi S;Thabrany H;Nadjib M
常规的被动监测系统往往低估了登革热等传染病的负担。当经验方法不可用时，可采用基于意见的互补或外推方法。在这里，德尔福专家小组估计了印度尼西亚监测系统捕获的登革热比例，以及相关的卫生系统参数。在介绍了医学和流行病学数据以及随后的讨论之后，专家小组进行了反复估算，并根据估算结果计算了扩展因子(EF)，即总病例与报告病例的比率。小组成员估计，在所有有症状的印度尼西亚登革热病例中，57.8%(95%可信区间46·6-59.8)进入医疗机构寻求治疗；39.3%(95%可信区间32·8-42.0)被诊断为登革热；20.3%(95%可信区间16.1-24.3%)随后在监测系统中报告。他们估计，大多数住院治疗发生在公共部门，而约55%的门诊病例是私人就诊的。这些估计得出的总体EF为5.00；住院EF为1.66；门诊EF为34.01，与被动监测数据相结合，相当于2006-2015年平均612 005例登革热病例和183 297例住院。这些估计低于其他地方发表的估计，可能是由于病例定义、当地的临床看法和寻求治疗的行为。这些发现补充了全球负担估计，支持卫生经济分析，并可用于为决策提供信息。
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.