Research Article: Sensitivity and Specificity of a Novel Classifier for the Early Diagnosis of Dengue

Date Published: April 2, 2015

Publisher: Public Library of Science

Author(s): Nguyen Minh Tuan, Ho Thi Nhan, Nguyen Van Vinh Chau, Nguyen Thanh Hung, Ha Manh Tuan, Ta Van Tram, Nguyen Le Da Ha, Phan Loi, Han Khoi Quang, Duong Thi Hue Kien, Sonya Hubbard, Tran Nguyen Bich Chau, Bridget Wills, Marcel Wolbers, Cameron P. Simmons, Scott B Halstead.

Abstract: BackgroundDengue is the commonest arboviral disease of humans. An early and accurate diagnosis of dengue can support clinical management, surveillance and disease control and is central to achieving the World Health Organisation target of a 50% reduction in dengue case mortality by 2020.Methods5729 children with fever of <72hrs duration were enrolled into this multicenter prospective study in southern Vietnam between 2010-2012. A composite of gold standard diagnostic tests identified 1692 dengue cases. Using statistical methods, a novel Early Dengue Classifier (EDC) was developed that used patient age, white blood cell count and platelet count to discriminate dengue cases from non-dengue cases.ResultsThe EDC had a sensitivity of 74.8% (95%CI: 73.0-76.8%) and specificity of 76.3% (95%CI: 75.2-77.6%) for the diagnosis of dengue. As an adjunctive test alongside NS1 rapid testing, sensitivity of the composite test was 91.6% (95%CI: 90.4-92.9%).ConclusionsWe demonstrate that the early diagnosis of dengue can be enhanced beyond the current standard of care using a simple evidence-based algorithm. The results should support patient management and clinical trials of specific therapies.

Partial Text: Dengue is an acute, systemic viral infection and a public health problem in the tropical world [1]. The etiological agents of dengue are any of the four dengue viruses (DENV-1-4). In endemic countries it is common for all four DENV serotypes to co-circulate. Late-stage trials of a dengue vaccine with intermediate efficacy have recently been reported, offering hope of a public health intervention [2, 3].

The early and accurate diagnosis of dengue on the grounds of clinical signs and symptoms alone is problematic [9]. Physicians need better tools to assist in early diagnosis if the WHO ambition of a 50% reduction in global dengue mortality is to be achieved by 2020. This study characterized the performance of three diagnostic approaches; the NS1 rapid test, a stand-alone diagnostic classifier and the combination of NS1 rapid test and diagnostic classifier together. Our results highlight the utility of NS1 rapid tests for an early specific diagnosis, yet also remind that 2nd generation tests are needed with improved sensitivity. The diagnostic classifier described here could help guide diagnosis in endemic settings, or be used as an adjunct to help exclude dengue in patients returning a negative NS1 rapid test result.



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