Avaliação do valor preditivo positivo da suspeita clínica de dengue em períodos epidêmicos no Brasil, 2000 a 2010
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2012-02-24
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Universidade Federal de Goiás
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Introduction: the positive predictive value (PPV) is one of the quantitative attributes of
surveillance systems. The evaluation of this attribute is essential due to its usefulness in
routine dengue control activities and adequate clinical management of suspected cases.
Objective: to analyze the PPV of dengue reported cases with a focus on the epidemic periods.
Methods: we conducted an observational descriptive cross sectional study using secondary
data from the National Surveillance Information System. Cases reported from 2000 to 2010
with IgM ELISA test result from a blood sample collected between the 6th and 30th day after
the onset of symptoms were selected for the study. PPV was estimated as the proportion of
cases that were confirmed among the dengue suspected cases that were tested using the
serological test. Results: Globally, the PPV varied from 46% to 71% during epidemic periods
and from 27% to 47.5% during non-epidemic periods. No difference on the PPV according to
sex or population size of municipalities was observed. PPV increased with age, with a similar
pattern in all the years analyzed. Exanthema was the symptom with the highest PPV, ranging
from 66% to 83%. The PPV also increased with the number of symptoms presented by the
patients during all the study period, possibly reflecting a more specific diagnostic. The most
common clinical presentation included fever, arthralgia, headache, retro-orbital pain, myalgia
and prostration presented a low PPV. PPV was higher among patients with at least four
symptoms, usually including exanthema. Conclusions: the analysis of the PPV is essential to
understand the magnitude of dengue in the country. Our results highlight the need for
improvement in the routine notification of dengue suspected cases. These results should also
be used in the current discussion on the adoption of the new dengue case classification
proposed by the World Health Organization in Brazil, particularly in the revision and adoption
of new surveillance forms and other improvements in the disease surveillance system.
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ZARA, A. L. S. A. Avaliação do valor preditivo positivo da suspeita clínica de dengue em períodos epidêmicos no Brasil, 2000 a 2010. 2012. 82 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica) - Universidade Federal de Goiás, Goiânia, 2012.