Identifying the most sensitive and specific sign and symptom combinations for cholera: results from an analysis of laboratory-based surveillance data from Haiti, 2012-2013.
Since October 2010, over 700,000 cholera cases have been reported in Haiti. We used data from laboratory-based surveillance for diarrhea in Haiti to evaluate the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the cholera case definitions recommended by the World Health Organization (WHO). From April 2012 to May 2013, we tested 1,878 samples from hospitalized patients with acute watery diarrhea; 1,178 (62.7%) yielded Vibrio cholerae O1. The sensitivity and specificity of the WHO case definition for cholera in an epidemic setting were 91.3% and 43.1%, respectively, and the PPV and NPV were 72.8% and 74.8%, respectively. The WHO case definition for cholera in an area where cholera is not known to be present had lower sensitivity (63.1%) and NPV (55.1%) but higher specificity (74.2%) and PPV (80.0%). When laboratory diagnostic testing is not immediately available, clinicians can evaluate signs and symptoms to more accurately identify cholera patients.
Mentor Ali Ber
MAB
Lucien
Nicolas
N
Schaad
Maria W
MW
Steenland
Eric D
ED
Mintz
Rossignol
R
Emmanuel
Nicole
N
Freeman
Jacques
J
Boncy
Paul
P
Adrien
Gerard A
GA
Joseph
Mark A
MA
Katz
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002771:Cholera / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D019411:Clinical Laboratory Techniques; D003955:Diagnostic Tests, Routine; D003967:Diarrhea / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D058872:Epidemics; D005243:Feces / Q000382:microbiology; D005260:Female; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D018571:Sentinel Surveillance; D063189:Symptom Assessment / Q000592:standards*; D041241:Vibrio cholerae O1 / Q000502:physiology*; D055815:Young Adult