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Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar
During outbreaks, the lack of diagnostic “gold standard” can mask the true burden of infection in the population and hamper the allocation of resources required for control. Here, we present an analytical framework to evaluate and optimize the use of diagnostics when multiple yet imperfect diagnosti...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410560/ https://www.ncbi.nlm.nih.gov/pubmed/35969599 http://dx.doi.org/10.1371/journal.pbio.3001736 |
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author | ten Bosch, Quirine Andrianaivoarimanana, Voahangy Ramasindrazana, Beza Mikaty, Guillain Rakotonanahary, Rado J. L. Nikolay, Birgit Rahajandraibe, Soloandry Feher, Maxence Grassin, Quentin Paireau, Juliette Rahelinirina, Soanandrasana Randremanana, Rindra Rakotoarimanana, Feno Melocco, Marie Rasolofo, Voahangy Pizarro-Cerdá, Javier Le Guern, Anne-Sophie Bertherat, Eric Ratsitorahina, Maherisoa Spiegel, André Baril, Laurence Rajerison, Minoarisoa Cauchemez, Simon |
author_facet | ten Bosch, Quirine Andrianaivoarimanana, Voahangy Ramasindrazana, Beza Mikaty, Guillain Rakotonanahary, Rado J. L. Nikolay, Birgit Rahajandraibe, Soloandry Feher, Maxence Grassin, Quentin Paireau, Juliette Rahelinirina, Soanandrasana Randremanana, Rindra Rakotoarimanana, Feno Melocco, Marie Rasolofo, Voahangy Pizarro-Cerdá, Javier Le Guern, Anne-Sophie Bertherat, Eric Ratsitorahina, Maherisoa Spiegel, André Baril, Laurence Rajerison, Minoarisoa Cauchemez, Simon |
author_sort | ten Bosch, Quirine |
collection | PubMed |
description | During outbreaks, the lack of diagnostic “gold standard” can mask the true burden of infection in the population and hamper the allocation of resources required for control. Here, we present an analytical framework to evaluate and optimize the use of diagnostics when multiple yet imperfect diagnostic tests are available. We apply it to laboratory results of 2,136 samples, analyzed with 3 diagnostic tests (based on up to 7 diagnostic outcomes), collected during the 2017 pneumonic (PP) and bubonic plague (BP) outbreak in Madagascar, which was unprecedented both in the number of notified cases, clinical presentation, and spatial distribution. The extent of these outbreaks has however remained unclear due to nonoptimal assays. Using latent class methods, we estimate that 7% to 15% of notified cases were Yersinia pestis-infected. Overreporting was highest during the peak of the outbreak and lowest in the rural settings endemic to Y. pestis. Molecular biology methods offered the best compromise between sensitivity and specificity. The specificity of the rapid diagnostic test was relatively low (PP: 82%, BP: 85%), particularly for use in contexts with large quantities of misclassified cases. Comparison with data from a subsequent seasonal Y. pestis outbreak in 2018 reveal better test performance (BP: specificity 99%, sensitivity: 91%), indicating that factors related to the response to a large, explosive outbreak may well have affected test performance. We used our framework to optimize the case classification and derive consolidated epidemic trends. Our approach may help reduce uncertainties in other outbreaks where diagnostics are imperfect. |
format | Online Article Text |
id | pubmed-9410560 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-94105602022-08-26 Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar ten Bosch, Quirine Andrianaivoarimanana, Voahangy Ramasindrazana, Beza Mikaty, Guillain Rakotonanahary, Rado J. L. Nikolay, Birgit Rahajandraibe, Soloandry Feher, Maxence Grassin, Quentin Paireau, Juliette Rahelinirina, Soanandrasana Randremanana, Rindra Rakotoarimanana, Feno Melocco, Marie Rasolofo, Voahangy Pizarro-Cerdá, Javier Le Guern, Anne-Sophie Bertherat, Eric Ratsitorahina, Maherisoa Spiegel, André Baril, Laurence Rajerison, Minoarisoa Cauchemez, Simon PLoS Biol Research Article During outbreaks, the lack of diagnostic “gold standard” can mask the true burden of infection in the population and hamper the allocation of resources required for control. Here, we present an analytical framework to evaluate and optimize the use of diagnostics when multiple yet imperfect diagnostic tests are available. We apply it to laboratory results of 2,136 samples, analyzed with 3 diagnostic tests (based on up to 7 diagnostic outcomes), collected during the 2017 pneumonic (PP) and bubonic plague (BP) outbreak in Madagascar, which was unprecedented both in the number of notified cases, clinical presentation, and spatial distribution. The extent of these outbreaks has however remained unclear due to nonoptimal assays. Using latent class methods, we estimate that 7% to 15% of notified cases were Yersinia pestis-infected. Overreporting was highest during the peak of the outbreak and lowest in the rural settings endemic to Y. pestis. Molecular biology methods offered the best compromise between sensitivity and specificity. The specificity of the rapid diagnostic test was relatively low (PP: 82%, BP: 85%), particularly for use in contexts with large quantities of misclassified cases. Comparison with data from a subsequent seasonal Y. pestis outbreak in 2018 reveal better test performance (BP: specificity 99%, sensitivity: 91%), indicating that factors related to the response to a large, explosive outbreak may well have affected test performance. We used our framework to optimize the case classification and derive consolidated epidemic trends. Our approach may help reduce uncertainties in other outbreaks where diagnostics are imperfect. Public Library of Science 2022-08-15 /pmc/articles/PMC9410560/ /pubmed/35969599 http://dx.doi.org/10.1371/journal.pbio.3001736 Text en © 2022 ten Bosch et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article ten Bosch, Quirine Andrianaivoarimanana, Voahangy Ramasindrazana, Beza Mikaty, Guillain Rakotonanahary, Rado J. L. Nikolay, Birgit Rahajandraibe, Soloandry Feher, Maxence Grassin, Quentin Paireau, Juliette Rahelinirina, Soanandrasana Randremanana, Rindra Rakotoarimanana, Feno Melocco, Marie Rasolofo, Voahangy Pizarro-Cerdá, Javier Le Guern, Anne-Sophie Bertherat, Eric Ratsitorahina, Maherisoa Spiegel, André Baril, Laurence Rajerison, Minoarisoa Cauchemez, Simon Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title | Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title_full | Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title_fullStr | Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title_full_unstemmed | Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title_short | Analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: Application to the 2017 plague epidemic in Madagascar |
title_sort | analytical framework to evaluate and optimize the use of imperfect diagnostics to inform outbreak response: application to the 2017 plague epidemic in madagascar |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410560/ https://www.ncbi.nlm.nih.gov/pubmed/35969599 http://dx.doi.org/10.1371/journal.pbio.3001736 |
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