Rob van Hest Capture-recapture Methods in Surveillance - RePub ...
Rob van Hest Capture-recapture Methods in Surveillance - RePub ...
Rob van Hest Capture-recapture Methods in Surveillance - RePub ...
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Chapter 1<br />
94% among AIDS patients with tuberculosis. 40,41 In France, local studies suggested undernotification<br />
of tuberculosis <strong>in</strong> the range of 30% to 63%. 42-44 The under-notification of<br />
tuberculosis <strong>in</strong> Italy has been estimated by the World Health Organization at 12%, but<br />
may reach between 30% and 54% <strong>in</strong> some areas of the country. 45-49 In Spa<strong>in</strong> undernotification<br />
of tuberculosis has been estimated at 50%. 50,51 In the Netherlands<br />
tuberculosis under-notification was estimated at 8% between 1994 and 1998 whilst<br />
accord<strong>in</strong>g to the World Health Organization 100% of the cases were notified <strong>in</strong> 2002. 26,52<br />
Under-notification obscures the true burden of tuberculosis, it frustrates proper<br />
plann<strong>in</strong>g of the human and f<strong>in</strong>ancial resources needed for adequate tuberculosis control,<br />
it h<strong>in</strong>ders mean<strong>in</strong>gful <strong>in</strong>terpretation of figures and trends for surveillance and identify<strong>in</strong>g<br />
priorities, it will compromise early signs of location and magnitude of outbreaks and it<br />
will also fail to reliably evaluate the effect of <strong>in</strong>terventions. Compared to noncommunicable<br />
diseases, for tuberculosis under-notification has an important additional<br />
consequence. The most serious public health aspect of tuberculosis under-notification,<br />
especially for culture-confirmed pulmonary tuberculosis patients, is that it prevents<br />
possibly <strong>in</strong>dicated contact <strong>in</strong>vestigations around potentially <strong>in</strong>fectious patients.<br />
<strong>Methods</strong> of estimat<strong>in</strong>g tuberculosis <strong>in</strong>cidence or prevalence<br />
Apart from (mandatory) notification different methods can be used to estimate the<br />
burden of disease of tuberculosis. As for other diseases a whole population can be<br />
exam<strong>in</strong>ed, but often this is not feasible, expensive and only representative for the area<br />
explored, 53 or the ascerta<strong>in</strong>ment of the number of tuberculosis patients can be achieved<br />
through exhaustive surveys. 54-58 A specific surrogate marker for the <strong>in</strong>cidence of<br />
pulmonary tuberculosis is the annual rate of tubercul<strong>in</strong> sk<strong>in</strong> test conversion. This method<br />
assumes that a one percent annual risk of <strong>in</strong>fection with Mycobacterium tuberculosis<br />
corresponds to an <strong>in</strong>cidence of approximately 50 smear-positive cases of pulmonary<br />
tuberculosis per 100 000 population. 59,60 However, these risks were orig<strong>in</strong>ally drawn from<br />
developed nations and, because of variations <strong>in</strong> the quality of <strong>in</strong>tervention and vary<strong>in</strong>g<br />
risks of progression from latent tuberculosis <strong>in</strong>fection to the active disease, it is unclear<br />
whether these figures can be reliably projected elsewhere. 61 Specific pharmacoepidemiological<br />
studies on anti-tuberculous drug use, especially daily def<strong>in</strong>ed doses of<br />
pyraz<strong>in</strong>amide, have been used to estimate tuberculosis <strong>in</strong>cidence. 51,52,62 One of the<br />
limitations of us<strong>in</strong>g drug prescriptions as a marker for tuberculosis <strong>in</strong>cidence is the<br />
difficulty to dist<strong>in</strong>guish between chemoprophylaxis and chemotherapy. 35 The general<br />
<strong>in</strong>direct estimation technique of record-l<strong>in</strong>kage has also been applied to tuberculosis.<br />
Through record-l<strong>in</strong>kage it is possible to assess the case-ascerta<strong>in</strong>ment and come closer to<br />
the true number of cases than by us<strong>in</strong>g one source only. 37,45,46,48,63 For tuberculosis and<br />
other <strong>in</strong>fectious diseases most often microbiology laboratory records or hospital episode<br />
registers are used to supplement notification data. However, proportions of miscoded<br />
(false-positive) tuberculosis patients <strong>in</strong> hospital episode registers of up to 62% and 27%<br />
have been reported <strong>in</strong> the USA and the United K<strong>in</strong>gdom respectively. 64-66 Pathology<br />
records compatible with tuberculosis have been mentioned as an alternative<br />
source. 32,33,36,67 Other options are pharmacy data, such as prescriptions, 30,35,38,67-69 death<br />
certificates, 28,30,33,34 AIDS registries 30,70 and bill<strong>in</strong>g records. 64<br />
12