title: Using routine diagnostic data as a method of surveillance of arboviral infection in travellers: a comparative analysis with a focus on dengue.
abstract: BACKGROUND
  In a large part of the developing world, limited infectious disease surveillance is performed. In laboratory information management systems data on diagnostic requests is available and may be amenable to trend analyses. We explored this potential, using DENV diagnostic requests as a model.
  
  
  METHODS
  Test results and anonymised information provided by clinicians were received for 8942 patients from diagnostic centres in the Netherlands from January 2000 to May 2011. The data were evaluated for completeness of a predefined minimal dataset and trends in DENV positive results by travel destination. Population travel data were obtained from a commercial registry, and dengue case notification data by country from WHO DengueNet.
  
  
  RESULTS
  Vaccination history was rarely reported (0.4%); travel destination was completed for 42% of requests; trends in diagnostic requests and IgM positive tests for this subset correlated to the WHO DENV notifications for the three main travel destinations, with some discrepancies. Additionally, this approach may provide information on disease outbreaks with other pathogens causing diseases clinically similar to DENV. PCR data proved to be insufficient for trend monitoring by country.
  
  
  CONCLUSIONS
  This approach is not straightforward, but shows potential for use as a source of additional information for surveillance of disease.
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Diagnostics and Screening, A. van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Erasmus Medical Centre, Virology Department, 's Gravendijkwal 230, P.O. Box 2040, 3000 EA Rotterdam, The Netherlands. Electronic address: natalie.cleton@rivm.nl.
authors.forename: Natalie
authors.initials: N
authors.lastname: Cleton
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Diagnostics and Screening, A. van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands. Electronic address: chantal.reusken@rivm.nl.
authors.forename: Chantal
authors.initials: C
authors.lastname: Reusken
authors.affiliation: University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. Electronic address: j.murk@umcutrecht.nl.
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Murk
authors.affiliation: Academic Medical Centre, Department of Medical Microbiology, Meibergdreef 9, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands. Electronic address: m.d.dejong@amc.uva.nl.
authors.forename: Menno
authors.initials: M
authors.lastname: de Jong
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Diagnostics and Screening, A. van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Reimerink
authors.affiliation: Erasmus Medical Centre, Virology Department, 's Gravendijkwal 230, P.O. Box 2040, 3000 EA Rotterdam, The Netherlands. Electronic address: a.vandereijk@erasmusmc.nl.
authors.forename: Annemiek
authors.initials: A
authors.lastname: van der Eijk
authors.affiliation: National Institute for Public Health and the Environment, Centre for Infectious Disease Research, Diagnostics and Screening, A. van Leeuwenhoeklaan 9, P.O. Box 1, 3720 BA Bilthoven, The Netherlands; Erasmus Medical Centre, Virology Department, 's Gravendijkwal 230, P.O. Box 2040, 3000 EA Rotterdam, The Netherlands. Electronic address: marion.koopmans@rivm.nl.
authors.forename: Marion
authors.initials: M
authors.lastname: Koopmans
mesh_terms: D003715:Dengue / Q000175:diagnosis* / Q000453:epidemiology; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods; D057236:Travel Medicine / Q000379:methods*
keywords: Dengue; Diagnostics; Sentinels; Surveillance; Travellers