Sensitivity of the Dengue Surveillance System in Brazil for Detecting Hospitalized Cases.

We evaluated the sensitivity of the dengue surveillance system in detecting hospitalized cases in ten capital cities in Brazil from 2008 to 2013 using a probabilistic record linkage of two independent information systems hospitalization (SIH-SUS) adopted as the gold standard and surveillance (SINAN). Sensitivity was defined as the proportion of cases reported to the surveillance system amid the suspected hospitalized cases registered in SIH-SUS. Of the 48,174 hospitalizations registered in SIH-SUS, 24,469 (50.7%) were reported and registered in SINAN, indicating an overall sensitivity of 50.8% (95%CI 50.3-51.2). The observed sensitivity for each of the municipalities included in the study ranged from 22.0% to 99.1%. The combination of the two data sources identified 71,161 hospitalizations, an increase of 97.0% over SINAN itself. Our results allowed establishing the proportion of underreported dengue hospitalizations in the public health system in Brazil, highlighting the use of probabilistic record linkage as a valuable tool for evaluating surveillance systems

Probabilistic record linkage of hospitalized dengue cases in the Hospitalization Information System (SIH-SUS) and the reported dengue cases from the Notifiable Diseases Information System (SINAN) and in ten municipalities of the study, Brazil, 2008–2013.

<p>Probabilistic record linkage of hospitalized dengue cases in the Hospitalization Information System (SIH-SUS) and the reported dengue cases from the Notifiable Diseases Information System (SINAN) and in ten municipalities of the study, Brazil, 2008–2013.</p

Pairs identified by the probabilistic record linkage according to the initial clinical assessment in SIH-SUS and final case classification in SINAN in the 10 municipalities of the study, Brazil, 2008–2013.

<p>Pairs identified by the probabilistic record linkage according to the initial clinical assessment in SIH-SUS and final case classification in SINAN in the 10 municipalities of the study, Brazil, 2008–2013.</p

Sensitivity of the dengue surveillance system in detecting hospitalized dengue cases in ten municipalities in Brazil, 2008–2013.

<p>Sensitivity of the dengue surveillance system in detecting hospitalized dengue cases in ten municipalities in Brazil, 2008–2013.</p

Number of cases hospitalized in SINAN, SIH-SUS and the sensitivity of the dengue surveillance system in detecting hospitalized cases I n ten municipalities in Brazil, 2008–2013.

<p>Number of cases hospitalized in SINAN, SIH-SUS and the sensitivity of the dengue surveillance system in detecting hospitalized cases I n ten municipalities in Brazil, 2008–2013.</p

Hospitalizations recorded in the SINAN and SIH-SUS information systems by sex age and classification, in ten municipalities in Brazil, 2008–2013.

<p>Hospitalizations recorded in the SINAN and SIH-SUS information systems by sex age and classification, in ten municipalities in Brazil, 2008–2013.</p