Using a Bayesian Latent Class Model to Evaluate the Utility of Investigating Persons with Negative Polymerase Chain Reaction Results for Pertussis

• Published in: American journal of epidemiology Vol. 178; no. 2; pp. 309 - 318
• Main Authors: Tarr, Gillian A. M., Eickhoff, Jens C., Koepke, Ruth, Hopfensperger, Daniel J., Davis, Jeffrey P., Conway, James H.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15.07.2013; Oxford Publishing Limited (England)
• Subjects: Adolescent; Bacterial diseases; Bayes Theorem; Bayesian analysis; Biological and medical sciences; Bordetella pertussis - genetics; Bordetella pertussis - isolation & purification; Child; Child, Preschool; Data Interpretation, Statistical; DNA, Bacterial - analysis; Ent and stomatologic bacterial diseases; Epidemiology; False Negative Reactions; Female; Follow-Up Studies; General aspects; Human bacterial diseases; Humans; Infant; Infant, Newborn; Infectious diseases; Male; Medical sciences; Miscellaneous; Models, Statistical; Polymerase chain reaction; Population Surveillance - methods; Practice of Epidemiology; Predictive Value of Tests; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Real-Time Polymerase Chain Reaction; Reproducibility of Results; Sensitivity and Specificity; Whooping cough; Whooping Cough - diagnosis; Wisconsin; Wisconsin; Evaluation; Statistical analysis; Respiratory disease; predictive value of tests; Bordetella pertussis; Latent class analysis; Epidemiology; pertussis; Whooping cough; Result; Infection; Polymerase chain reaction; Sensitivity; Bacteriosis; Predictive value; public health surveillance; Bacteria; Models; Molecular biology; Sanitary surveillance; Bayesian analysis; Public health; whooping cough; sensitivity; polymerase chain reaction
• ISSN: 0002-9262; 1476-6256; 1476-6256
• DOI: 10.1093/aje/kws465

Pertussis remains difficult to control. Imperfect sensitivity of diagnostic tests and lack of specific guidance regarding interpretation of negative test results among patients with compatible symptoms may contribute to its spread. In this study, we examined whether additional pertussis cases could be identified if persons with negative pertussis test results were routinely investigated. We conducted interviews among 250 subjects aged ≤18 years with pertussis polymerase chain reaction (PCR) results reported from 2 reference laboratories in Wisconsin during July-September 2010 to determine whether their illnesses met the Centers for Disease Control and Prevention's clinical case definition (CCD) for pertussis. PCR validity measures were calculated using the CCD as the standard for pertussis disease. Two Bayesian latent class models were used to adjust the validity measures for pertussis detectable by 1) culture alone and 2) culture and/or more sensitive measures such as serology. Among 190 PCR-negative subjects, 54 (28%) had illnesses meeting the CCD. In adjusted analyses, PCR sensitivity and the negative predictive value were 1) 94% and 99% and 2) 43% and 87% in the 2 types of models, respectively. The models suggested that public health follow-up of reported pertussis patients with PCR-negative results leads to the detection of more true pertussis cases than follow-up of PCR-positive persons alone. The results also suggest a need for a more specific pertussis CCD.