Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring
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...
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Published in | Epidemiology and infection Vol. 144; no. 7; pp. 1512 - 1519 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
Cambridge, UK
Cambridge University Press
01.05.2016
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Abstract | 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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AbstractList | 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. 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. 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 theweekly 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. 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. 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. 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. |
Author | CHEN, M.-H. CHEN, P.-C. HUANG, W.-T. YANG, T. O. |
AuthorAffiliation | 1 Nuffield Department of Population Health , University of Oxford , Oxford , UK 4 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health , Taipei , Taiwan 3 Department of Pediatrics , National Taiwan University Hospital Yun-Lin Branch , YunLin , Taiwan 2 Office of Preventive Medicine , Taiwan Centers for Disease Control , Taipei , Taiwan 5 Department of Public Health , National Taiwan University College of Public Health , Taipei , Taiwan 6 Department of Environmental and Occupational Medicine , National Taiwan University College of Medicine and Hospital , Taipei , Taiwan |
AuthorAffiliation_xml | – name: 4 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health , Taipei , Taiwan – name: 3 Department of Pediatrics , National Taiwan University Hospital Yun-Lin Branch , YunLin , Taiwan – name: 1 Nuffield Department of Population Health , University of Oxford , Oxford , UK – name: 5 Department of Public Health , National Taiwan University College of Public Health , Taipei , Taiwan – name: 2 Office of Preventive Medicine , Taiwan Centers for Disease Control , Taipei , Taiwan – name: 6 Department of Environmental and Occupational Medicine , National Taiwan University College of Medicine and Hospital , Taipei , Taiwan |
Author_xml | – sequence: 1 givenname: T. O. surname: YANG fullname: YANG, T. O. email: tienyu.owen.yang@gmail.com organization: Nuffield Department of Population Health, University of Oxford, Oxford, UK – sequence: 2 givenname: W.-T. orcidid: 0000-0002-4344-9567 surname: HUANG fullname: HUANG, W.-T. organization: Office of Preventive Medicine, Taiwan Centers for Disease Control, Taipei, Taiwan – sequence: 3 givenname: M.-H. surname: CHEN fullname: CHEN, M.-H. organization: Department of Pediatrics, National Taiwan University Hospital Yun-Lin Branch, YunLin, Taiwan – sequence: 4 givenname: P.-C. surname: CHEN fullname: CHEN, P.-C. organization: Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan |
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References | Yang (13) 2014 Christian (7) 2013; 6 Mao (8) 2014; 10 Lu (12) 2014; 63 Samphutthanon (4) 2014; 11 Liu (15) 2014; 9 Monto (16) 2014 Cheng (6) 2014; 14 Hyeon (9) 2013; 19 Stephenson (10) 2014; 312 Xing (3) 2014; 14 Ooi (5) 2010; 9 Kadambari (11) 2014 Liu (S0950268815002988_ref15) 2014; 9 S0950268815002988_ref1 S0950268815002988_ref16 S0950268815002988_ref14 S0950268815002988_ref13 S0950268815002988_ref12 S0950268815002988_ref11 S0950268815002988_ref10 S0950268815002988_ref9 S0950268815002988_ref8 S0950268815002988_ref7 S0950268815002988_ref6 S0950268815002988_ref5 S0950268815002988_ref4 S0950268815002988_ref3 S0950268815002988_ref2 |
References_xml | – volume: 10 start-page: 360 year: 2014 end-page: 367 ident: 8 article-title: Coxsackievirus A16: epidemiology, diagnosis, and vaccine publication-title: Human Vaccines & Immunotherapeutics contributor: fullname: Mao – volume: 9 year: 2014 ident: 15 article-title: Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study publication-title: PLoS ONE contributor: fullname: Liu – year: 2014 ident: 11 article-title: Enterovirus infections in England and Wales, 2000–2011: the impact of increased molecular diagnostics publication-title: Clinical Microbiology and Infection contributor: fullname: Kadambari – year: 2014 ident: 16 article-title: Frequency of acute respiratory illnesses and circulation of respiratory viruses in households with children over 3 surveillance seasons publication-title: Journal of Infectious Diseases contributor: fullname: Monto – volume: 19 start-page: 1268 year: 2013 end-page: 1275 ident: 9 article-title: Accuracy of diagnostic methods and surveillance sensitivity for human enterovirus, South Korea, 1999–2011 publication-title: Emerging Infectious Diseases contributor: fullname: Hyeon – volume: 9 start-page: 1097 year: 2010 end-page: 1105 ident: 5 article-title: Clinical features, diagnosis, and management of enterovirus 71 publication-title: Lancet Neurology contributor: fullname: Ooi – volume: 11 start-page: 312 year: 2014 end-page: 336 ident: 4 article-title: Spatio-temporal distribution and hotspots of hand, foot and mouth disease (HFMD) in northern Thailand publication-title: International Journal of Environmental Research and Public Health contributor: fullname: Samphutthanon – year: 2014 ident: 13 article-title: Seasonal synchrony in incidences of common infectious diseases in early childhood among neighbouring regions publication-title: International Journal of Infectious Diseases contributor: fullname: Yang – volume: 14 start-page: 308 year: 2014 end-page: 318 ident: 3 article-title: Hand, foot, and mouth disease in China, 2008–12: an epidemiological study publication-title: Lancet Infectious Diseases contributor: fullname: Xing – volume: 63 start-page: 408 year: 2014 end-page: 414 ident: 12 article-title: Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China publication-title: Journal of Medical Microbiology contributor: fullname: Lu – volume: 312 start-page: 1290 year: 2014 ident: 10 article-title: CDC tracking enterovirus D-68 outbreak causing severe respiratory illness in children in the Midwest publication-title: Journal of the American Medical Association contributor: fullname: Stephenson – volume: 6 start-page: 20632 year: 2013 ident: 7 article-title: What we are watching – five top global infectious disease threats, 2012: a perspective from CDC's Global Disease Detection Operations Center publication-title: Emerging Health Threats Journal contributor: fullname: Christian – volume: 14 start-page: 417 year: 2014 ident: 6 article-title: The correlation between the presence of viremia and clinical severity in patients with enterovirus 71 infection: a multi-center cohort study publication-title: BMC Infectious Diseases contributor: fullname: Cheng – ident: S0950268815002988_ref7 doi: 10.3402/ehtj.v6i0.20632 – ident: S0950268815002988_ref12 doi: 10.1099/jmm.0.068247-0 – volume: 9 year: 2014 ident: S0950268815002988_ref15 article-title: Epidemiology of acute respiratory infections in children in Guangzhou: a three-year study publication-title: PLoS ONE contributor: fullname: Liu – ident: S0950268815002988_ref9 doi: 10.3201/eid1908.130496 – ident: S0950268815002988_ref14 – ident: S0950268815002988_ref16 doi: 10.1093/infdis/jiu327 – ident: S0950268815002988_ref2 – ident: S0950268815002988_ref13 doi: 10.1016/j.ijid.2014.06.015 – ident: S0950268815002988_ref1 – ident: S0950268815002988_ref4 doi: 10.3390/ijerph110100312 – ident: S0950268815002988_ref10 doi: 10.1001/jama.2014.13256 – ident: S0950268815002988_ref6 doi: 10.1186/1471-2334-14-417 – ident: S0950268815002988_ref11 doi: 10.1111/1469-0691.12753 – ident: S0950268815002988_ref3 doi: 10.1016/S1473-3099(13)70342-6 – ident: S0950268815002988_ref8 doi: 10.4161/hv.27087 – ident: S0950268815002988_ref5 doi: 10.1016/S1474-4422(10)70209-X |
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Snippet | The community burden of enterovirus is often monitored through syndromic monitoring systems based on reported cases of enterovirus-related infection (EVI)... SUMMARY The community burden of enterovirus is often monitored through syndromic monitoring systems based on reported cases of enterovirus-related infection... SUMMARY The community burden of enterovirus is often monitored through syndromic monitoring systems based on reported cases of enterovirus-related infection... |
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SubjectTerms | Acute Disease Age Ambulatory care Birthdays Case-Control Studies Child Child, Preschool Children & youth Cohort Studies Datasets Enterovirus Enterovirus - physiology Female Hand, Foot and Mouth Disease - diagnosis Hand, Foot and Mouth Disease - epidemiology Hand, Foot and Mouth Disease - virology Hand, Foot, and Mouth Disease Health care Herpangina - diagnosis Herpangina - epidemiology Herpangina - virology Humans Incidence Infant Infant, Newborn Infections Male Monitoring systems National health insurance Original Papers Population Surveillance Respiratory Tract Infections - diagnosis Respiratory Tract Infections - virology Syndrome Taiwan - epidemiology Uncertainty |
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Title | Diagnostic uncertainty of herpangina and hand-foot-and-mouth disease and its impact on national enterovirus syndromic monitoring |
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