Journal article
Diagnostic accuracy of the WHO clinical definitions for dengue and implications for surveillance: A systematic review and meta-analysis
- Abstract:
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Background
Dengue is the world’s most common mosquito-borne virus but remains diagnostically challenging due to its nonspecific presentation. Access to laboratory confirmation is limited and thus most reported figures are based on clinical diagnosis alone, the accuracy of which is uncertain. This systematic review assesses the diagnostic accuracy of the traditional (1997) and revised (2009) WHO clinical case definitions for dengue fever, the basis for most national guidelines.
Methodology/Principal findings
PubMed, EMBASE, Scopus, OpenGrey, and the annual Dengue Bulletin were searched for studies assessing the diagnostic accuracy of the unmodified clinical criteria. Two reviewers (NR/SL) independently assessed eligibility, extracted data, and evaluated risk of bias using a modified QUADAS-2. Additional records were found by citation network analysis. A meta-analysis was done using a bivariate mixed-effects regression model. Studies that modified criteria were analysed separately. This systematic review protocol was registered on PROSPERO (CRD42020165998). We identified 11 and 12 datasets assessing the 1997 and 2009 definition, respectively, and 6 using modified criteria. Sensitivity was 93% (95% CI: 77–98) and 93% (95% CI: 86–96) for the 1997 and 2009 definitions, respectively. Specificity was 29% (95% CI: 8–65) and 31% (95% CI: 18–48) for the 1997 and 2009 definitions, respectively. Diagnostic performance suffered at the extremes of age. No modification significantly improved accuracy.
Conclusions/Significance
Diagnostic accuracy of clinical criteria is poor, with significant implications for surveillance and public health responses for dengue control. As the basis for most reported figures, this has relevance to policymakers planning resource allocation and researchers modelling transmission, particularly during COVID-19.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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- Files:
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(Preview, Version of record, 2.3MB, Terms of use)
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- Publisher copy:
- 10.1371/journal.pntd.0009359
Authors
- Publisher:
- Public Library of Science
- Journal:
- PLoS Neglected Tropical Diseases More from this journal
- Volume:
- 15
- Issue:
- 4
- Article number:
- e0009359
- Place of publication:
- United States
- Publication date:
- 2021-04-26
- Acceptance date:
- 2021-04-02
- DOI:
- EISSN:
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1935-2735
- ISSN:
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1935-2727
- Pmid:
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33901191
- Language:
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English
- Keywords:
- Pubs id:
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1174548
- Local pid:
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pubs:1174548
- Deposit date:
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2021-12-08
Terms of use
- Copyright holder:
- Raafat et al.
- Copyright date:
- 2021
- Rights statement:
- ©2021 Raafat et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
- Licence:
- CC Attribution (CC BY)
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