Abstract
Background
In Taiwan, around 1,500 cases of dengue fever are reported annually and incidence has been increasing over time. A national web-based Notifiable Diseases Surveillance System (NDSS) has been in operation since 1997 to monitor incidence and trends and support case and outbreak management. We present the findings of an evaluation of the NDSS to ascertain the extent to which dengue fever surveillance objectives are being achieved.
Methodology
We extracted the NDSS data on all laboratory-confirmed dengue fever cases reported during 1 January 2010 to 31 December 2012 to assess and describe key system attributes based on the Centers for Disease Control and Prevention surveillance evaluation guidelines. The system’s structure and processes were delineated and operational staff interviewed using a semi-structured questionnaire. Crude and age-adjusted incidence rates were calculated and key demographic variables were summarised to describe reporting activity. Data completeness and validity were described across several variables.
Principal Findings
Of 5,072 laboratory-confirmed dengue fever cases reported during 2010–2012, 4,740 (93%) were reported during July to December. The system was judged to be simple due to its minimal reporting steps. Data collected on key variables were correctly formatted and usable in > 90% of cases, demonstrating good data completeness and validity. The information collected was considered relevant by users with high acceptability. Adherence to guidelines for 24-hour reporting was 99%. Of 720 cases (14%) recorded as travel-related, 111 (15%) had an onset >14 days after return, highlighting the potential for misclassification. Information on hospitalization was missing for 22% of cases. The calculated PVP was 43%.
Conclusions/Significance
The NDSS for dengue fever surveillance is a robust, well maintained and acceptable system that supports the collection of complete and valid data needed to achieve the surveillance objectives. The simplicity of the system engenders compliance leading to timely and accurate reporting. Completeness of hospitalization information could be further improved to allow assessment of severity of illness. To minimize misclassification, an algorithm to accurately classify travel cases should be established.
In Taiwan, around 1,500 cases of dengue fever are reported annually. Surveillance and outbreak preparedness are important activities aimed at reducing the burden of dengue fever worldwide. A national web-based Notifiable Diseases Surveillance System (NDSS) for dengue fever has been established since 1997 in Taiwan to monitor trends, and support case and outbreak management. We evaluated this surveillance system based on the Centers for Disease Control and Prevention guidelines and operational staff interviews to ascertain the extent to which stated objectives are being achieved. The results indicate that the NDSS for dengue fever surveillance works well, is easy to use, and can be used to accurately identify cases. The findings have informed recommendations to improve surveillance and its use in outbreak response, including efforts to improve data completeness. Comprehensive surveillance exemplified by the NDSS for dengue fever in Taiwan is necessary for establishing a clear picture of the local burden and distribution of dengue fever to effectively support public health response.
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