Under-recognition and reporting of dengue in Cambodia: a capture-recapture analysis of the National Dengue Surveillance System

Epidemiol Infect. 2012 Mar;140(3):491-9. doi: 10.1017/S0950268811001191. Epub 2011 Jun 21.


Robust disease burden estimates are important for decision-making concerning introduction of new vaccines. Dengue is a major public health problem in the tropics but robust disease burden estimates are lacking. We conducted a two-sample, capture-recapture study in the largest province in Cambodia to determine disease under-recognition to the National Dengue Surveillance System (NDSS). During 2006-2008, community-based active surveillance for acute febrile illness was conducted in 0- to 19-year-olds in rural and urban areas combined with testing for dengue virus infection. Of 14 354 individuals under active surveillance (22 498 person-seasons), the annual incidence ranged from 13·4 to 57·8/1000 person-seasons. During the same period, NDSS incidence rates ranged from 1·1/1000 to 5·7/1000, which was 3·9- to 29·0-fold lower than found in the capture-recapture study. In hospitalized cases, the rate of under-recognition was 1·1- to 2·4-fold. This study shows the substantial degree of under-recognition/reporting of dengue and that reported hospitalized cases are not a good surrogate for estimating dengue disease burden.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Cambodia / epidemiology
  • Child
  • Child, Preschool
  • Dengue / epidemiology*
  • Epidemiologic Methods
  • Female
  • Health Services Research
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Male
  • Population Surveillance
  • Young Adult