Estimating dengue under-reporting in Puerto Rico using a multiplier model.

Area of Science:

• Epidemiology
• Public Health
• Infectious Diseases

Background:

• Dengue is a significant mosquito-borne viral illness with a spectrum of severity.
• Passive Dengue Surveillance System (PDSS) in Puerto Rico has historically under-reported cases.
• Estimating true dengue burden is crucial for effective public health interventions.

Purpose of the Study:

• To quantify the under-reporting of dengue cases in Puerto Rico.
• To develop probability-based multiplier models for adjusting reported dengue data.
• To estimate the true incidence of medically attended dengue in Puerto Rico.

Main Methods:

• Utilized data from two surveillance systems: PDSS and the enhanced dengue surveillance system (EDSS).
• Developed separate inpatient and outpatient probability-based multiplier models.
• Adjusted for diagnostic test sensitivity, indeterminate results, and provider reporting differences.

Main Results:

• Under-reporting multipliers ranged from 5-9 for inpatients and 21-115 for outpatients.
• Estimated mean annual medically attended dengue rates (2005-2010) were 2.1/1,000 for inpatients and 7.8/1,000 for outpatients.
• Reported rates were significantly lower: 0.1/1,000 for inpatients and 0.4/1,000 for outpatients.

Conclusions:

• Dengue surveillance in Puerto Rico substantially under-reports actual cases.
• The developed multipliers provide a tool for public health officials to correct for under-reporting.
• Accurate dengue incidence data is essential for evaluating intervention strategies and resource allocation.