Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.

<h4>Introduction</h4>Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (...

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Main Authors: Fred Nsubuga, Immaculate Ampaire, Simon Kasasa, Henry Luzze, Annet Kisakye
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2017-01-01
Series:PLoS ONE
Online Access:https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184549&type=printable
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author Fred Nsubuga
Immaculate Ampaire
Simon Kasasa
Henry Luzze
Annet Kisakye
author_facet Fred Nsubuga
Immaculate Ampaire
Simon Kasasa
Henry Luzze
Annet Kisakye
author_sort Fred Nsubuga
collection DOAJ
description <h4>Introduction</h4>Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice.<h4>Methods</h4>An IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012-2015.<h4>Results</h4>A total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%.<h4>Conclusion</h4>In conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.
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spelling doaj-art-60bb4e23fa85487590484f3e861c91da2025-08-20T02:03:51ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018454910.1371/journal.pone.0184549Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.Fred NsubugaImmaculate AmpaireSimon KasasaHenry LuzzeAnnet Kisakye<h4>Introduction</h4>Disease surveillance is a critical component in the control and elimination of vaccine preventable diseases. The Uganda National Expanded Program on Immunization strives to have a sensitive surveillance system within the Integrated Disease Surveillance and Response (IDSR) framework. We analyzed measles surveillance data to determine the effectiveness of the measles case-based surveillance system and estimate its positive predictive value in order to inform policy and practice.<h4>Methods</h4>An IDSR alert was defined as ≥1 suspected measles case reported by a district in a week, through the electronic Health Management Information System. We defined an alert in the measles case-based surveillance system (CBS) as ≥1 suspected measles case with a blood sample collected for confirmation during the corresponding week in a particular district. Effectiveness of CBS was defined as having ≥80% of IDSR alerts with a blood sample collected for laboratory confirmation. Positive predictive value was defined as the proportion of measles case-patients who also had a positive measles serological result (IgM +). We reviewed case-based surveillance data with laboratory confirmation and measles surveillance data from the electronic Health Management Information System from 2012-2015.<h4>Results</h4>A total of 6,974 suspected measles case-persons were investigated by the measles case-based surveillance between 2012 and 2015. Of these, 943 (14%) were measles specific IgM positive. The median age of measles case-persons between 2013 and 2015 was 4.0 years. Between 2013 and 2015, 72% of the IDSR alerts reported in the electronic Health Management Information System, had blood samples collected for laboratory confirmation. This was however less than the WHO recommended standard of ≥80%. The PPV of CBS between 2013 and 2015 was 8.6%.<h4>Conclusion</h4>In conclusion, the effectiveness of measles case-based surveillance was sub-optimal, while the PPV showed that true measles cases have significantly reduced in Uganda. We recommended strengthening of case-based surveillance to ensure that all suspected measles cases have blood samples collected for laboratory confirmation to improve detection and ensure elimination by 2020.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184549&type=printable
spellingShingle Fred Nsubuga
Immaculate Ampaire
Simon Kasasa
Henry Luzze
Annet Kisakye
Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
PLoS ONE
title Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
title_full Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
title_fullStr Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
title_full_unstemmed Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
title_short Positive predictive value and effectiveness of measles case-based surveillance in Uganda, 2012-2015.
title_sort positive predictive value and effectiveness of measles case based surveillance in uganda 2012 2015
url https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184549&type=printable
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