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American Journal of Epidemiology Vol. 131, No. 4: 693-701
Copyright © 1990 by The Johns Hopkins University School of Hygiene and Public Health

research-article

EPIDEMIC DENGUE 1 IN BRAZIL, 1986: EVALUATION OF A CLINICALLY BASED DENGUE SURVEILLANCE SYSTEM

VANCE J. DLETZ1,2,6, DUANE J. GUBLER1,5,, JOSÉ G. RIGAU-PÉREZ2, FRANCISCO PINHEIRO3, HERMAN G. SCHATZMAYR4, RAYMOND BAILEY5 and ROBERT A. GUNN2

1San Juan Laboratories, Dengue Branch, Division of Vector-borne Infectious Diseases, Center for Infectious Diseases, Centers for Disease Control San Juan, PR
2Epidemiology Program Office, Division of Field Services, Centers for Disease Control Atlanta, GA
3Division of Disease Prevention and Control, Pan Amencan Health Organization-World Health Organization Washington, DC
4Laboratorio de Virus, Fundaçäo Instituto Oswaldo Crux, Rio de Janeiro, Brazil
5Division of Vector-borne Infectious Diseases, Center for Infectious Diseases, Centers for Disease Control Fort Collins, CO
6Presently with Expanded Program on Immursization, Pan American Health Organization Mexico City, Mexico

Reprint requests to Dr. D. J. Gubler, Center for Infectious Diseases, Division of Vector-borne Infectious Diseases, Centers for Disease Control, P.O. Box 2087, Fort Collins, CO 80522-2087

In the last 15 years, dengue fever has emerged as a major health problem in tropical America. Prevention and control of epidemic disease are enhanced by the rapid identification of new or increased dengue activity. Most surveillance systems, however, identify cases by clinical case reports and, therefore, lack the sensitivity needed for early detection. During the 1986 dengue 1 epIdemicin Rio de Janeiro, Brazil, the authors evéluated the usefulness of a clinical case definition by comparing it with Laboratory-confirmed infection status of residents In two cities. The casedefinition had a sensitivity of 64% and a false-positive rate of 57%. Thus, for every 100 laboratory-confirmed dengue infectIons, 230 cases were reported. Both infected and noninfected residents who used medical services and who lived In the city with the highest transmission were more likely to meet the case definition. Thus, factors unrelated to actual infection influencedthe sensitivity. With the use of stepwise logistic regression, the authors analyzed combinations ofpatient symptoms and produced nine new hypothetical case definitions. However, none of the new definitions had a false-positive rate lower than 38%. This study emphasizes the need for laboratory-based dengue surveillance Systems.

dengue; enzyme-linked immunosorbent assay; hemorrhagic fever virus; epidemic; IgM; serology


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