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Previous studies about the predictability of influenza activity from clinical surveillance of ILI were mainly focused on the sensitivity and specificity of case definition for ILI to laboratory-confirmed influenza infection [7], [12] [14].
We analyzed data from four cohorts which underwent different surveillance methods for mild P. falciparum malaria, in order to describe the sensitivity and specificity of case definitions within cohorts and compare the specificity and incidences of the endpoints from active and passive surveillance.
A strength of the Morgen et al. study [ 7] is in the specificity of case selection.
One study for example [ 23] found that specificity of case finding dropped from 98.2% to 38.3% when negation terms were not included in the text search.
The broad initial screen for potential cases coupled with clinical adjudication addresses both the sensitivity and the specificity of case identification.
To improve the specificity of case detection (but potentially decrease the sensitivity), we used the probabilities of group membership to classify cases as into 'Work Activity'Probableble Work Activity'Probableble Other Activity' and 'Other Activity'.
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However, we expect a high specificity of cases both diagnosed and operated.
Therefore, a large number of severe cases would be excluded from this definition and in many situations only the most severe cases would be transferred, resulting indeed in an increase in the specificity of cases but at the cost of a reduction in sensitivity.
The previous work on integrated surveillance calculated the specificity of the case definition checking all the case's clinical files; they found that 20% of meningitis reported by the surveillance system was not confirmed by a panel of experts.
We included only laboratory confirmed cases of influenza A/H1N1 to increase the specificity of our case definition.
Possible explanations, other than differences in populations and methods, include the specificity of the case definitions we used, which might have excluded cases that would have been positive if other, more complacent diagnostic criteria were used.
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Justyna Jupowicz-Kozak
CEO of Professional Science Editing for Scientists @ prosciediting.com