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Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring

  • T. O. YANG (a1), W.-T. HUANG (a2), M.-H. CHEN (a3) and P.-C. CHEN (a4) (a5) (a6)

Summary

The community burden of enterovirus is often monitored through syndromic monitoring systems based on reported cases of enterovirus-related infection (EVI) diagnoses. The extent to which this is affected by under- and over-diagnosis has not been reported. In Taiwan, children often make more than one healthcare visit during an episode of infection. We used change of diagnosis within an episode of infection as a guide of diagnostic uncertainty in a nationally representative cohort of Taiwanese children (n = 13 284) followed from birth to the 9th birthday through electronic health records. We conducted a nested case-control analysis and estimated cross-diagnosis ratios (CDRs) as the observed proportion of acute respiratory infection (ARI) diagnoses following an EVI diagnosis in excess of background ARI burdens. With 19 357 EVI diagnoses in this cohort, the CDR within 7 days was 1·51 (95% confidence interval 1·45–1·57), confirming a significant excess of ARI diagnoses within the week following an EVI diagnosis. We used age-specific CDRs to calibrate the weekly EVI burden in children aged 3–5 years in 2008, and the difference between observed and calibrated weekly EVI burdens was small. Therefore, there was evidence suggesting a small uncertainty in EVI diagnosis, but the observed EVI burdens through syndromic monitoring were not substantially affected by the small uncertainty.

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Copyright

Corresponding author

* Author for correspondence: T. O. Yang, MD, DPhil, Nuffield Department of Population Health, University of Oxford, Cancer Epidemiology Unit, Richard Doll Building, Old Road Campus, Oxford OX3 7LF, UK. (Email: tienyu.owen.yang@gmail.com )

References

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1. National Institute of Infectious Diseases (Japan). NESID Annual Surveillance Data Sentinel-Reporting Diseases 2012-2 (http://www.nih.go.jp/niid/en/all-surveillance/2085-idwr/ydata/4341-report-eb2012-2.html). Accessed 16 November 2014.
2. Taiwan Centers for Disease Control. Notifiable infectious diseases statistics system (herpangina and hand, foot, and mouth disease) (http://nidss.cdc.gov.tw/RODS_5.aspx). Accessed 16 November 2014.
3. Xing, W, et al. Hand, foot, and mouth disease in China, 2008–12: an epidemiological study. Lancet Infectious Diseases 2014; 14: 308318.
4. Samphutthanon, R, et al. Spatio-temporal distribution and hotspots of hand, foot and mouth disease (HFMD) in northern Thailand. International Journal of Environmental Research and Public Health 2014; 11: 312336.
5. Ooi, MH, et al. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurology 2010; 9: 10971105.
6. Cheng, HY, et al. The correlation between the presence of viremia and clinical severity in patients with enterovirus 71 infection: a multi-center cohort study. BMC Infectious Diseases 2014; 14: 417.
7. Christian, KA, et al. What we are watching – five top global infectious disease threats, 2012: a perspective from CDC's Global Disease Detection Operations Center. Emerging Health Threats Journal 2013; 6: 20632.
8. Mao, Q, et al. Coxsackievirus A16: epidemiology, diagnosis, and vaccine. Human Vaccines & Immunotherapeutics 2014; 10: 360367.
9. Hyeon, JY, et al. Accuracy of diagnostic methods and surveillance sensitivity for human enterovirus, South Korea, 1999–2011. Emerging Infectious Diseases 2013; 19: 12681275.
10. Stephenson, J. CDC tracking enterovirus D-68 outbreak causing severe respiratory illness in children in the Midwest. Journal of the American Medical Association 2014; 312: 1290.
11. Kadambari, S, et al. Enterovirus infections in England and Wales, 2000–2011: the impact of increased molecular diagnostics. Clinical Microbiology and Infection. Published online: 11 August 2014. doi: 10.1111/1469-0691.12753.
12. Lu, QB, et al. Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China. Journal of Medical Microbiology 2014; 63: 408414.
13. Yang, TYO, et al. Seasonal synchrony in incidences of common infectious diseases in early childhood among neighbouring regions. International Journal of Infectious Diseases. Published online: 11 October 2014. doi:10.1016/j.ijid.2014.06.015.
14. WHO Health Statistics and Information Systems. Metrics: population attributable fraction (PAF) (http://www.who.int/healthinfo/global_burden_disease/metrics_paf/en/). Accessed 16 November 2014.
15. Liu, WK, et al. Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study. PLoS ONE 2014; 9: e96674.
16. Monto, AS, et al. Frequency of acute respiratory illnesses and circulation of respiratory viruses in households with children over 3 surveillance seasons. Journal of Infectious Diseases. Published online: 6 June 2014. doi: 10.1093/infdis/jiu327.

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UNKNOWN
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Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring

  • T. O. YANG (a1), W.-T. HUANG (a2), M.-H. CHEN (a3) and P.-C. CHEN (a4) (a5) (a6)

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