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      Under-reporting of pertussis in Ontario: A Canadian Immunization Research Network (CIRN) study using capture-recapture

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          Abstract

          Introduction

          Under-reporting of pertussis cases is a longstanding challenge. We estimated the true number of pertussis cases in Ontario using multiple data sources, and evaluated the completeness of each source.

          Methods

          We linked data from multiple sources for the period 2009 to 2015: public health reportable disease surveillance data, public health laboratory data, and health administrative data (hospitalizations, emergency department visits, and physician office visits). To estimate the total number of pertussis cases in Ontario, we used a three-source capture-recapture analysis stratified by age (infants, or aged one year and older) and adjusting for dependency between sources. We used the Bayesian Information Criterion to compare models.

          Results

          Using probable and confirmed reported cases, laboratory data, and combined hospitalizations/emergency department visits, the estimated total number of cases during the six-year period amongst infants was 924, compared with 545 unique observed cases from all sources. Using the same sources, the estimated total for those aged 1 year and older was 12,883, compared with 3,304 observed cases from all sources. Only 37% of infants and 11% for those aged 1 year and over admitted to hospital or seen in an emergency department for pertussis were reported to public health. Public health reporting sensitivity varied from 2% to 68% depending on age group and the combination of data sources included. Sensitivity of combined hospitalizations and emergency department visits varied from 37% to 49% and of laboratory data from 1% to 50%.

          Conclusions

          All data sources contribute cases and are complementary, suggesting that the incidence of pertussis is substantially higher than suggested by routine reports. The sensitivity of different data sources varies. Better case identification is required to improve pertussis control in Ontario.

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          Most cited references25

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          Capture-Recapture Methods in Epidemiology: Methods and Limitations

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            Capture-recapture methods in epidemiology: methods and limitations.

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              How best to estimate the global burden of pertussis?

              In most countries, pertussis surveillance is inadequate for accurately estimating numbers of cases or deaths. Good estimates are needed to help set priorities for vaccination programmes. We aimed to develop a simple, reliable, and explicit method for estimating pertussis cases and deaths for children under 15 years to calculate the global disease burden in 1999. We estimated the proportion of susceptible children becoming infected in countries with poor vaccination coverage ( or =70%) at 10% by 1 year, 60% by 5 years, and 100% by 15 years. Vaccine efficacy was estimated at 80% for preventing infection and 95% for preventing deaths. We used UN population estimates and vaccination coverage reported to WHO (adjusted for specific survey data if available). Case fatality ratios for countries with high and low child mortality were derived from published and unpublished work. For some countries with good vital events registration we used reported deaths adjusted for underascertainment. In 1999 there were an estimated 48.5 million pertussis cases in children worldwide. Deaths from pertussis were estimated at 390000 and at 295000 after adjustment for local data sources. Based on this approach, disability-adjusted life years from pertussis (12.7 million) in 2000 exceeded those of other preventable diseases such as lung cancer (11.4 million) and meningitis (5.8 million). This simple approach yields estimates that can be used for setting vaccination programme priorities. Better data are needed on the public health importance of pertussis in high mortality countries, the benefits of incomplete vaccination, and the harm from delayed vaccination.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Project administrationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: Writing – review & editing
                Role: Formal analysisRole: MethodologyRole: SoftwareRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 May 2018
                2018
                : 13
                : 5
                : e0195984
                Affiliations
                [1 ] Public Health Ontario, Toronto, ON, Canada
                [2 ] Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
                [3 ] Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
                [4 ] ProvLab Alberta, Edmonton, AB, Canada
                [5 ] Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
                [6 ] Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
                [7 ] Alberta Health, Edmonton, AB, Canada
                [8 ] Division of Preventive Medicine, University of Alberta, Edmonton, AB, Canada
                [9 ] School of Public Health, University of Alberta, Edmonton, AB, Canada
                [10 ] Community Health Sciences, University of Calgary, Calgary, AB, Canada
                [11 ] Vaccine and Drug Evaluation Centre, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
                [12 ] Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
                [13 ] Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
                Universidad Nacional de la Plata, ARGENTINA
                Author notes

                Competing Interests: Dr. Salah Mahmud (SMM) has received unrestricted research grants from GlaxoSmithKline, Sanofi Pasteur, Pfizer, Merck and Roche for unrelated studies. This does not alter the authors’ adherence to PLOS ONE policies on sharing data and materials.

                Article
                PONE-D-17-36410
                10.1371/journal.pone.0195984
                5931792
                29718945
                440c797f-3bc9-4e44-8abc-cabc79704484
                © 2018 Crowcroft 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.

                History
                : 10 October 2017
                : 3 April 2018
                Page count
                Figures: 2, Tables: 4, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award ID: 137470
                Award Recipient :
                This study was funded by the Canadian Institutes of Health Research grant #137470 (Canadian Immunization Research Network sub grant #PC01 ON24), received by NSC. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Infectious Diseases
                Bacterial Diseases
                Pertussis
                People and places
                Geographical locations
                North America
                Canada
                Ontario
                Medicine and Health Sciences
                Public and Occupational Health
                People and Places
                Population Groupings
                Age Groups
                Medicine and Health Sciences
                Critical Care and Emergency Medicine
                People and Places
                Population Groupings
                Professions
                Medical Personnel
                Medical Doctors
                Physicians
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medical Doctors
                Physicians
                Biology and Life Sciences
                Physiology
                Physiological Processes
                Coughing
                Medicine and Health Sciences
                Physiology
                Physiological Processes
                Coughing
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Coughing
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Coughing
                Medicine and Health Sciences
                Epidemiology
                Disease Surveillance
                Custom metadata
                Unfortunately, Public Health Ontario (PHO) cannot disclose the underlying data. Doing so would compromise individual privacy contrary to PHO’s ethical and legal obligations. Restricted access to the data may be available under conditions prescribed by the Ontario Personal Health Information Protection Act, 2004, the Ontario Freedom of Information and Protection of Privacy Act, the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans (TCPS 2 (2014)), and PHO privacy and ethics policies. Data are available for researchers who meet PHO’s criteria for access to confidential data, by filling in a Data Access Request Form, which can be found at: https://www.publichealthontario.ca/en/About/Documents/PHO_Data_Request_Form_2017.pdf.

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