India ICEMR Fever Surveillance

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Background: Fever is frequently reported by patients using general medicine outpatient departments in Indian hospitals. However, even when additional clinical symptoms are collected for diagnosis and treatment, those symptoms are often nonspecific. Delays or inaccuracies in arriving at a clinical diagnosis can lead to inappropriate treatment that may result in fatalities. To establish a specific diagnosis and provide the appropriate treatment regimen, diagnoses of febrile illnesses should be confirmed by laboratory tests.

Objectives: This study describes a pilot project to determine whether chikungunya, dengue, and scrub typhus were common among patients presenting with acute febrile illness who had been triaged for malaria in an outpatient department (OPD) at Ispat General Hospital, Rourkela, in the state of Odisha, India. A second aim of the study was to undertake a comparative assessment of the performance of several standard, commercially available diagnostic tests for these three febrile illnesses. A third aim was to determine if malaria cases were missed during the initial malaria triage by the OPD.

Methodology:

Geographic Location/Study Sites: Ispat General Hospital in Rourkela, Sundargarh District, in the state of Odisha, India

Dates of Data Collection: January 2016-January 2017

Study Design: Health center surveillance study

Eligibility Criteria: The participants must have met the following criteria

Inclusion criteria:

Aged 12 months to 70 years (children categorized as ≤15 years and adults as ≥16 years)
Report of fever up to 48 hours prior to enrollment or febrile on the day of enrollment (body temperature ≥37.5°C)

Exclusion criteria:

Probable malaria cases identified based on presence of high fever, chills, and rigor during triage in the OPD
Individuals with symptoms of influenza
Pregnant women

Data Collection: 954 OPD patients were enrolled who had already been through triage for malaria in the OPD, where probable malaria cases were identified based on presence of high fever, chills, and rigor. Written consent or assent was obtained from each enrolled patient prior to a physical examination and administration of a detailed clinical questionnaire, and each patient provided a blood sample. All 954 enrollees were tested for malaria by at least one diagnostic test; a subset of enrollees (293/954) from whom a larger volume of blood was collected was also tested for dengue, chikungunya, and scrub typhus by either RDT, ELISA, or both tests.

Study Documentation:

Codebooks:

Enrollment codebook - Used to enroll participants in the study and collect participant and observation level data
Malaria microscopy codebook - Used for Plasmodium microscopy results
Malaria PCR codebook - Used for Plasmodium PCR results
Chikungunya ELISA codebookUsed for Chikungunya ELISA results
Chikungunya and Dengue RDT codebook - Used for Chikungunya and Dengue RDT results
Dengue IgM ELISA codebook - Used for Dengue IgM ELISA results
Dengue NS1 ELISA codebook - Used for Dengue NS1 ELISA results
Salmonella typhi PCR codebookUsed for Salmonella typhi PCR results
Scrub typhus ELISA codebook - Used for Scrub typhus ELISA results
All codebooks - Download all codebook PDFs in .zip format

Data Dictionaries:

Malaria microscopy data dictionary
Malaria PCR data dictionary
Chikungunya ELISA data dictionary
Chikungunya and Dengue RDT data dictionary
Dengue IgM ELISA data dictionary
Dengue NS1 ELISA data dictionary
Salmonella typhi PCR data dictionary
Scrub typhus ELISA data dictionary
All data dictionaries - Download all data dictionary CSV files in .zip format

ClinEpiDB Data Integration: Data files were provided to ClinEpiDB as flat, csv files. These datasets were merged by unique ID and redundant or administrative columns were dropped from presentation on ClinEpiDB.org. All dates were obfuscated per participant through the application of a random number algorithm that shifted dates no more than seven days to comply with the ethical conduct of human subjects research.

Acknowledgements: We thank the people of Rourkela, Sundargarh District, Odisha, and the staff and doctors of Ispat General Hospital.

Financial Support: Research was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number U19AI089676 as part of the International Centers for Excellence in Malaria Research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Ethics Statement: Ethical approval to conduct this study was obtained from the Ethics Committees of Ispat General Hospital, India, and the Institutional Review Board of New York University. All project staff completed Protection of Human Research Subjects training prior to beginning the study, and clinical samples were collected after informed consent was obtained from participants.

Last updated: April 16, 2019
A health center-based surveillance study was conducted to identify non-malarial causes of acute febrile illness. Patients from 1-70 years old who were febrile or reported a fever in the previous 48 hours and who had been triaged and found negative for malaria were enrolled. Participant observations were assessed at enrollment, and a few participants had 2 follow-up visits each.