Invasive Pneumococcal Disease in Tuscany Region, Italy, 2016–2017: Integrating Multiple Data Sources to Investigate Underreporting
Open Access
- 19 October 2020
- journal article
- research article
- Published by MDPI AG in International Journal of Environmental Research and Public Health
- Vol. 17 (20), 7581
- https://doi.org/10.3390/ijerph17207581
Abstract
Invasive pneumococcal disease (IPD) is a vaccine-preventable disease characterized by the presence of Streptococcus pneumoniae in normally sterile sites. Since 2007, Italy has implemented an IPD national surveillance system (IPD-NSS). This system suffers from high rates of underreporting. To estimate the level of underreporting of IPD in 2016–2017 in Tuscany (Italy), we integrated data from IPD-NSS and two other regional data sources, i.e., Tuscany regional microbiological surveillance (Microbiological Surveillance and Antibiotic Resistance in Tuscany, SMART) and hospitalization discharge records (HDRs). We collected (1) notifications to IPD-NSS, (2) SMART records positive for S. pneumoniae from normally sterile sites, and (3) hospitalization records with IPD-related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9) codes in discharge diagnoses. We performed data linkage of the three sources to obtain a combined surveillance system (CSS). Using the CSS, we calculated the completeness of the three sources and performed a three-source log-linear capture–recapture analysis to estimate total IPD underreporting. In total, 127 IPD cases were identified from IPD-NSS, 320 were identified from SMART, and 658 were identified from HDRs. After data linkage, a total of 904 unique cases were detected. The average yearly CSS notification rate was 12.1/100,000 inhabitants. Completeness was 14.0% for IPD-NSS, 35.4% for SMART, and 72.8% for HDRs. The capture–recapture analysis suggested a total estimate of 3419 cases of IPD (95% confidence interval (CI): 1364–5474), corresponding to an underreporting rate of 73.7% (95% CI: 34.0–83.6) for CSS. This study shows substantial underreporting in the Tuscany IPD surveillance system. Integration of available data sources may be a useful approach to complement notification-based surveillance and provide decision-makers with better information to plan effective control strategies against IPD.This publication has 32 references indexed in Scilit:
- Measuring underreporting and under-ascertainment in infectious disease datasets: a comparison of methodsBMC Public Health, 2014
- A three-source capture-recapture estimate of the number of new HIV diagnoses in children in France from 2003–2006 with multiple imputation of a variable of heterogeneous catchabilityBMC Infectious Diseases, 2012
- Understanding the burden of pneumococcal disease in adultsClinical Microbiology & Infection, 2012
- Etiology of Illness in Patients with Severe Sepsis Admitted to the Hospital from the Emergency DepartmentClinical Infectious Diseases, 2010
- Molecular detection methods and serotyping performed directly on clinical samples improve diagnostic sensitivity and reveal increased incidence of invasive disease by Streptococcus pneumoniae in Italian childrenJournal of Medical Microbiology, 2008
- Invasive pneumococcal disease in Victoria: a better measurement of the true incidenceEpidemiology and Infection, 2007
- Completeness of notification of tuberculosis in The Netherlands: how reliable is record-linkage and capture–recapture analysis?Epidemiology and Infection, 2006
- Capture–recapture analysis to estimate the incidence of invasive meningococcal disease in Germany, 2003Epidemiology and Infection, 2006
- Underreporting of Meningococcal Disease Incidence in the Netherlands: Results from a Capture–Recapture Analysis Based on Three Registration Sources with Correction for False Positive DiagnosesEuropean Journal of Epidemiology, 2006
- Capture-recapture methods—useful or misleading?International Journal of Epidemiology, 2001