TY - JOUR
T1 - Comparing insights from clinic-based versus community-based outbreak investigations
T2 - a case study of chikungunya in Bangladesh
AU - Paul, Kishor Kumar
AU - Salje, Henrik
AU - Rahman, Muhammad W.
AU - Rahman, Mahmudur
AU - Gurley, Emily S.
N1 - Funding Information:
This work was supported by Centers for Disease Control and Prevention (CDC), Atlanta, USA [cooperative agreement no: 5U01CI000628]. In addition, the Government of Bangladesh, Canada, Sweden and the UK provided core/unrestricted funding support for this work. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Publisher Copyright:
© 2020 The Author(s)
PY - 2020/8
Y1 - 2020/8
N2 - Background: Outbreak investigations typically focus their efforts on identifying cases that present at healthcare facilities. However, these cases rarely represent all cases in the wider community. In this context, community-based investigations may provide additional insight into key risk factors for infection, however, the benefits of these more laborious data collection strategies remains unclear. Methods: We used different subsets of the data from a comprehensive outbreak investigation to compare the inferences we make in alternative investigation strategies. Results: The outbreak investigation team interviewed 1,933 individuals from 460 homes. 364 (18%) of individuals had symptoms consistent with chikungunya. A theoretical clinic-based study would have identified 26% of the cases. Adding in community-based cases provided an overall estimate of the attack rate in the community. Comparison with controls from the same household revealed that those with at least secondary education had a reduced risk. Finally, enrolling residents from households across the community allowed us to characterize spatial heterogeneity of risk and identify the type of clothing usually worn and travel history as risk factors. This also revealed that household-level use of mosquito control was not associated with infection. Conclusions: These findings highlight that while clinic-based studies may be easier to conduct, they only provide limited insight into the burden and risk factors for disease. Enrolling people who escaped from infection, both in the household and in the community allows a step change in our understanding of the spread of a pathogen and maximizes opportunities for control.
AB - Background: Outbreak investigations typically focus their efforts on identifying cases that present at healthcare facilities. However, these cases rarely represent all cases in the wider community. In this context, community-based investigations may provide additional insight into key risk factors for infection, however, the benefits of these more laborious data collection strategies remains unclear. Methods: We used different subsets of the data from a comprehensive outbreak investigation to compare the inferences we make in alternative investigation strategies. Results: The outbreak investigation team interviewed 1,933 individuals from 460 homes. 364 (18%) of individuals had symptoms consistent with chikungunya. A theoretical clinic-based study would have identified 26% of the cases. Adding in community-based cases provided an overall estimate of the attack rate in the community. Comparison with controls from the same household revealed that those with at least secondary education had a reduced risk. Finally, enrolling residents from households across the community allowed us to characterize spatial heterogeneity of risk and identify the type of clothing usually worn and travel history as risk factors. This also revealed that household-level use of mosquito control was not associated with infection. Conclusions: These findings highlight that while clinic-based studies may be easier to conduct, they only provide limited insight into the burden and risk factors for disease. Enrolling people who escaped from infection, both in the household and in the community allows a step change in our understanding of the spread of a pathogen and maximizes opportunities for control.
KW - Chikungunya
KW - Community Controls
KW - Community-Based Investigation
KW - Hospital-Based Investigation
KW - Incidence of Chikungunya
KW - Outbreak Investigation
KW - Risk Factors of Chikungunya
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U2 - 10.1016/j.ijid.2020.05.111
DO - 10.1016/j.ijid.2020.05.111
M3 - Article
C2 - 32497797
AN - SCOPUS:85087431052
SN - 1201-9712
VL - 97
SP - 306
EP - 312
JO - International Journal of Infectious Diseases
JF - International Journal of Infectious Diseases
ER -