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Volume 23, Number 4—April 2017

Dispatch

Assessing Sensitivity and Specificity of Surveillance Case Definitions for Zika Virus Disease

Angela ChowComments to Author , Hanley Ho, Mar-Kyaw Win, and Yee-Sin Leo
Author affiliations: Tan Tock Seng Hospital, Singapore

Main Article

Table 1

Clinical characteristics of an adult cohort with suspected Zika virus disease, Singapore, August 26–September 5, 2016*

Characteristic Zika virus positive, n = 149 Zika virus negative, n = 210
Demographic data
Mean age, y (SD) 38.1 (14.2) 34.2 (12.1)
Sex
M 92 (61.7) 129 (61.4)
F 57 (38.3) 81 (38.6)
Ethnicity
Chinese 109 (73.2) 122 (58.1)
Malay 15 (10.1) 17 (8.1)
Indian 9 (6.0) 24 (11.4)
Other 16 (10.7) 47 (22.4)
Singapore residents
113 (75.8)
131 (62.4)
Signs and symptoms at presentation
Rash 139 (93.3) 94 (44.8)
Fever 118 (79.2) 181 (86.2)
Myalgia 63 (42.3) 124 (59.1)
Headache 35 (23.5) 75 (35.7)
Conjunctivitis 35 (23.5) 32 (15.2)
Arthralgia 34 (22.8) 50 (23.8)
Pruritis 17 (11.4) 17 (8.1)
Any gastrointestinal symptom†
10 (6.7)
25 (11.9)
Fulfilled case definition
United States‡ 149 (100.0) 206 (98.1)
World Health Organization§ 57 (38.3) 64 (30.5)
PAHO¶ 73 (49.0) 50 (23.8)
ECDC# 83 (55.7) 55 (26.2)
Singapore Ministry of Health** 81 (54.4) 51 (24.3)

*Values are no. (%) except as indicated. ECDC, European Centre for Disease Prevention and Control; PAHO, Pan American Health Organization.
†Nausea, vomiting, diarrhea, or abdominal pain.
‡Definition used in the United States (interim, February 2016; confirmed, June 2016) states that clinical criteria for noncongenital Zika virus disease are defined as >1 of the following: acute onset of fever, maculopapular rash, arthralgia, and conjunctivitis.
§Interim case definition (February 12, 2016) includes rash or fever and >1 of the following signs or symptoms: arthralgia or arthritis, or conjunctivitis (nonpurulent/hyperemic).
¶Interim case definition (April 1, 2016) includes rash with >2 of the following signs or symptoms: fever, conjunctivitis (nonpurulent/hyperemic), arthralgia, myalgia, or periarticular edema.
#Interim case definition (March 17, 2016) includes rash with or without fever and >1 of the following signs or symptoms: arthralgia, myalgia, or conjunctivitis (nonpurulent/hyperemic).
**Case definition (August 2016) includes fever and rash and >1 of the following symptoms: headache, myalgia, arthralgia, or nonpurulent conjunctivitis.

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