Fig 1.
Schematic of model to estimate multipliers to correct for under-reporting of outpatient and hospitalized dengue cases.
Notes; Multiplier D (only) is used for the inpatient module. Multiplier D and Multiplier E are used for the outpatient module. See text for further details. PDSS = Passive dengue surveillance system. EDSS = Enhanced dengue surveillance system. CDC-DB = U.S. Centers for Disease Control and Prevention, Dengue Branch (stationed in San Juan, Puerto Rico).
Table 1.
Input parameters to estimate multipliers to correct for under-reporting in Puerto Rico (2005–2010).
Fig 2.
Reported and estimated number of clincial dengue cases in Puerto Rico, 2005–2010 (with 95% CI).
Panel A: Reported and Estimated Dengue Inpatients; Panel B: Reported and Estimated Dengue Outpatients. Notes: MA = Medically Attended patient classification sub-model which includes all patients who either had a completed Dengue Case Information Form (DCIF), or had some indication in their medical records (such as specimens sent to a laboratory for dengue testing) as potentially having a clinical case of dengue. DO = In this patient classification sub-model, labeled “DCIF Only (DO),” we included only those patients (in or out) definitively recorded as potential dengue case on a DCIF. See text for further details. The 95% CI (confidence interval) is the range between the 2.5% and 97.5% confidence estimates.
Table 2.
Estimates of dengue overall multiplier for inpatients in Puerto Rico: 2005 to 2010a.
Table 3.
Estimates of dengue overall multiplier for outpatients in Puerto Rico: 2005 to 2010.
Table 4.
Reported and estimated rate of medically attended dengue per 1,000 general population in Puerto Rico (2005 to 2010).
Fig 3.
Sensitivity analysis: Relative importance of individual multipliers in calculating the overall multiplier for reported dengue inpatients: Puerto Rico, 2010.
Notes: a: Graph plots relative importance of the individual multipliers used to calculate the overall multiplier. The wider the plotted range (i.e., bar), the greater the change in the overall multiplier. b: Results calculated for MA = Medically Attended patient classification sub-model which includes all patients who either had a completed Dengue Case Information Form (DCIF), or had some indication in their medical records (such as specimens sent to a laboratory for dengue testing) as potentially having a clinical case of dengue. PDSS = Passive dengue surveillance system. EDSS = Enhance dengue surveillance system. IgM = Immunoglobulin M. Test indicates presence of dengue IgM antibodies using an antibody capture enzyme-linked immunosorbent assay. PCR = Polymerase chain reaction. Test indicates evidence of dengue RNA using by a Reverse transcription polymerase chain reaction (RT-PCR) test. See main text for detailed description of individual multipliers and how they are used to calculate the overall multiplier.