Robust disease burden estimates are important for decision-making concerning introduction of
new vaccines. Dengue is a major public health problem in the tropics but robust disease burden
estimates are lacking. We conducted a two-sample, capture–recapture study in the largest
province in Cambodia to determine disease under-recognition to the National Dengue
Surveillance System (NDSS). During 2006–2008, community-based active surveillance for acute
febrile illness was conducted in 0- to 19-year-olds in rural and urban areas combined with testing
for dengue virus infection. Of 14 354 individuals under active surveillance (22 498 person-seasons),
the annual incidence ranged from 13.
4 to 57.
8/1000 person-seasons. During the same period,
NDSS incidence rates ranged from 1.
1/1000 to 5.
7/1000, which was 3.
9- to 29.
0-fold lower than
found in the capture–recapture study. In hospitalized cases, the rate of under-recognition was
1.
1- to 2.
4-fold. This study shows the substantial degree of under-recognition/reporting of dengue
and that reported hospitalized cases are not a good surrogate for estimating dengue disease
burden.