Epidemiology and Infection

Other viruses

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

S. VONGa1 c1, S. GOYETa1, S. LYa1, C. NGANa2, R. HUYa2, V. DUONGa1, O. WICHMANNa3, G. W. LETSONa3, H. S. MARGOLISa3 and P. BUCHYa1

a1 Institut Pasteur in Cambodia, Réseau International des Instituts Pasteur, Phnom Penh, Cambodia

a2 National Dengue Control Programme, Ministry of Health, Phnom Penh, Cambodia

a3 Pediatric Dengue Vaccine Initiative, International Vaccine Institute, Seoul, Korea


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.

(Accepted May 27 2011)

(Online publication June 21 2011)


c1 Author for correspondence: S. Vong, M.D., Head, Epidemiology and Public Health Unit, Institut Pasteur in Cambodia, 5 Bld Monivong, POB 983, Phnom Penh, Cambodia. (Email: svong@pasteur-kh.org or sirenda.vong@gmail.com)