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Title: Laboratory-Enhanced Dengue Sentinel Surveillance in Colombo District, Sri Lanka: 2012-2014
Authors: Tissera, Hasitha
Amarasinghe, Ananda
Gunasena, Sunethra
DeSilva, Aruna Dharshan
Yee, Leong Wei
Sessions, October
Muthukuda, Chanaka
Palihawadana, Paba
Lohr, Wolfgang
Byass, Peter
Gubler, Duane J.
Wilder-Smith, Annelies
Keywords: Sri Langka
Infectious disease surveillance
Diagnostic medicine
Government Laboratories
Clinical laboratories
Disease surveillance
Dengue fever
Research laboratories
Issue Date: 2016
Source: Tissera, H., Amarasinghe, A., Gunasena, S., DeSilva, A. D., Yee, L. W., Sessions, O., et al. (2016). Laboratory-Enhanced Dengue Sentinel Surveillance in Colombo District, Sri Lanka: 2012-2014. PLOS Neglected Tropical Diseases, 10(2), e0004477-.
Series/Report no.: PLOS Neglected Tropical Diseases
Abstract: Introduction: Dengue has emerged as a significant public health problem in Sri Lanka. Historically surveillance was passive, with mandatory dengue notifications based on clinical diagnosis with only limited laboratory confirmation. To obtain more accurate data on the disease burden of dengue, we set up a laboratory-based enhanced sentinel surveillance system in Colombo District. Here we describe the study design and report our findings of enhanced surveillance in the years 2012–2014. Methods: Three outpatient clinics and three government hospitals in Colombo District that covered most of the Colombo metropolitan area were selected for the sentinel surveillance system. Up to 60 patients per week presenting with an undifferentiated fever were enrolled. Acute blood samples from each patient were tested by dengue specific PCR, NS1 ELISA and IgM ELISA. A sub-set of samples was sent to Duke-NUS Singapore for quality assurance, virus isolation and serotyping. Trained medical research assistants used a standardized case report form to record clinical and epidemiological data. Clinical diagnoses by the clinicians-in-charge were recorded for hospitalized cases. Results: Of 3,127 febrile cases, 43.6% were PCR and/or NS1 positive for dengue. A high proportion of lab confirmed dengue was observed from inpatients (IPD) (53.9%) compared to outpatient (clinics in hospitals and general practice) (7.6%). Dengue hemorrhagic fever (DHF) was diagnosed in 11% of patients at the time of first contact, and the median day of illness at time of presentation to the sentinel sites was 4. Dengue serotype 1 was responsible for 85% of the cases and serotype 4 for 15%. The sensitivity and specificity of the clinicians’ presumptive diagnosis of dengue was 84% and 34%, respectively. Conclusion: DENV-1, and to a lesser degree DENV-4, infection were responsible for a high proportion of febrile illnesses in Colombo in the years 2012 to 2014. Clinicians’ diagnoses were associated with high sensitivity, but laboratory confirmation is required to enhance specificity.
ISSN: 1935-2727
DOI: 10.1371/journal.pntd.0004477
Schools: Lee Kong Chian School of Medicine (LKCMedicine) 
Rights: © 2016 Tissera et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Fulltext Permission: open
Fulltext Availability: With Fulltext
Appears in Collections:LKCMedicine Journal Articles

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