Statistical analyses in disease surveillance systems.

The performance of disease surveillance systems is evaluated and monitored using a diverse set of statistical analyses throughout each stage of surveillance implementation. An overview of their main elements is presented, with a specific emphasis on syndromic surveillance directed to outbreak detection in resource-limited settings. Statistical analyses are proposed for three implementation stages: planning, early implementation, and consolidation. Data sources and collection procedures are described for each analysis.During the planning and pilot stages, we propose to estimate the average data collection, data entry and data distribution time. This information can be collected by surveillance systems themselves or through specially designed surveys. During the initial implementation stage, epidemiologists should study the completeness and timeliness of the reporting, and describe thoroughly the population surveyed and the epidemiology of the health events recorded. Additional data collection processes or external data streams are often necessary to assess reporting completeness and other indicators. Once data collection processes are operating in a timely and stable manner, analyses of surveillance data should expand to establish baseline rates and detect aberrations. External investigations can be used to evaluate whether abnormally increased case frequency corresponds to a true outbreak, and thereby establish the sensitivity and specificity of aberration detection algorithms.Statistical methods for disease surveillance have focused mainly on the performance of outbreak detection algorithms without sufficient attention to the data quality and representativeness, two factors that are especially important in developing countries. It is important to assess data quality at each state of implementation using a diverse mix of data sources and analytical methods. Careful, close monitoring of selected indicators is needed to evaluate whether systems are reaching their proposed goals at each stage.

Application of dipstick dye immunoassay (DDIA) kit for the diagnosis of schistosomiasis mekongi.

The dipstick dye immunoassay (DDIA), developed in China for the detection of antibodies against Schistosoma japonicum, relies on soluble egg antigen (SEA) labelled with a colloidal dye. This assay is not only rapid, simple and inexpensive, but also particularly useful for screening in the field. In order to determine whether S. japonicum antigens are sufficiently cross-reactive to make the assay applicable for the diagnosis also of S. mekongi a DDIA approach based on the S. japonicum SEA was tried in cohorts of healthy and infected people living in areas non-endemic and endemic with regard to schistosomiasis mekongi in Cambodia and Laos. A sensitivity of 97.1% was recorded when testing Cambodian subjects, correctly diagnosing 33 out of 34 infected people. When the assay was applied in Laos, a sensitivity of 98.6% (69/70) was found. None of 114 residents living in a non-endemic area in Cambodia tested positive. A cross-reaction of 18.3% was found in patients infected with Opisthorchis viverrini. The results support the notion that the DDIA using S. japonicum SEA antigens can safely be implemented for the diagnosis of schistosomiasis mekongi, but care is needed in the interpretation of results obtained from areas that are co-endemic for O. viverrini.

The importance of leptospirosis in Southeast Asia.

The importance of leptospirosis in Southeast Asia was assessed in conjunction with other studies supported by the U.S. Naval Medical Research Unit No. 2 (US NAMRU-2), Jakarta, Republic of Indonesia. These included studies of hospital-based, acute clinical jaundice in Indonesia, Lao PDR, and Socialist Republic of Vietnam; nonmalarial fever in Indonesia; and hemorrhagic fever in Cambodia. Background prevalence estimates of leptospiral infection were obtained by a cross-sectional, community-based study in Lao PDR. Laboratory testing methods involved serology, microscopic agglutination test, and reverse-transcriptase polymerase chain reaction. Suggestive evidence of recent leptospiral infections was detected in 17%, 13%, and 3% of patients selected on the basis of non-hepatitis A through E jaundice, nonmalarial fever, and hemorrhagic fever (in the absence of acute, dengue viral infections). Leptospiral IgG antibody, reflective of prior infections, was detected in 37% of human sera, collected in Lao PDR. The predominant leptospiral serogroups identified from cases with clinical jaundice were Hurstbridge, Bataviae, and Icterohaemorrhagiae tonkini LT 96 69. Among the nonmalarial febrile cases, Bataviae was the most frequently recognized serogroup. Pyrogenes and Hurstbridge were the principal serogroups among the hemorrhagic fever case subjects. These findings further attest to the relative importance of clinical leptospirosis in Southeast Asia. The wide spectrum of clinical signs and symptoms associated with probable, acute, leptospiral infections contributes to the potential of significant underreporting.