Sensitivity, Specificity, and Public-Health Utility of Clinical Case Definitions Based on the Signs and Symptoms of Cholera in Africa

During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case d...

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Bibliographic Details
Published in:The American journal of tropical medicine and hygiene 2018-01, Vol.98 (4), p.1021-1030
Main Authors: Nadri, Johara, Sauvageot, Delphine, Njanpop-Lafourcade, Berthe-Marie, Baltazar, Cynthia S, Banla Kere, Abiba, Bwire, Godfrey, Coulibaly, Daouda, Kacou N'Douba, Adele, Kagirita, Atek, Keita, Sakoba, Koivogui, Lamine, Landoh, Dadja E, Langa, Jose P, Miwanda, Berthe N, Mutombo Ndongala, Guy, Mwakapeje, Elibariki R, Mwambeta, Jacob L, Mengel, Martin A, Gessner, Bradford D
Format: Article
Language:English
Subjects:
Adolescent
Adult
Africa - epidemiology
Child
Child, Preschool
Cholera
Cholera - diagnosis
Cholera - epidemiology
Cholera - microbiology
Diarrhea - diagnosis
Diarrhea - epidemiology
Diarrhea - microbiology
Disease Outbreaks
Epidemiological Monitoring
Feces - microbiology
Female
Humans
Infant
Male
Middle Aged
Public Health
Sensitivity and Specificity
Symptom Assessment
Vibrio cholerae - isolation & purification
Young Adult
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Summary:During 2014, Africa reported more than half of the global suspected cholera cases. Based on the data collected from seven countries in the African Cholera Surveillance Network (Africhol), we assessed the sensitivity, specificity, and positive and negative predictive values of clinical cholera case definitions, including that recommended by the World Health Organization (WHO) using culture confirmation as the gold standard. The study was designed to assess results in real-world field situations in settings with recent cholera outbreaks or endemicity. From June 2011 to July 2015, a total of 5,084 persons with suspected cholera were tested for in seven different countries of which 35.7% had culture confirmation. For all countries combined, the WHO case definition had a sensitivity = 92.7%, specificity = 8.1%, positive predictive value = 36.1%, and negative predictive value = 66.6%. Adding dehydration, vomiting, or rice water stools to the case definition could increase the specificity without a substantial decrease in sensitivity. Future studies could further refine our findings primarily by using more sensitive methods for cholera confirmation.
ISSN:0002-9637
1476-1645
DOI:10.4269/ajtmh.16-0523