{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T06:24:41Z","timestamp":1775543081473,"version":"3.50.1"},"reference-count":63,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T00:00:00Z","timestamp":1646265600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Leptospirosis is a globally disseminated zoonotic disease with no national surveillance systems. On the other hand, surveillance is crucial for improving population health, and surveillance systems produce data that motivates action. Unfortunately, like many other countries, Ecuador put in place a monitoring system that has never been tested. The goal of this study was to use scenario tree modeling to assess the sensitivity of Ecuador's current national surveillance system to human leptospirosis as the basis for an economic assessment of the system. We created a decision-tree model to analyze the current system's sensitivity. The inputs were described as probabilities distributions, and the model assessed the program's sensitivity as an output. The model also considers the geographical and weather variations across Ecuador's three continental regions: Andean, Amazonia, and the Coast. Several data sources were used to create the model, including leptospirosis records from Ecuador's Ministry of Public Health, national and international literature, and expert elicitation, all of which were incorporated in a Bayesian framework. We were able to determine the most critical parameters influencing each scenario's output (CSU) sensitivity through sensitivity analysis. The Coast region had the best sensitivity scenario, with a median of 0.85% (IC 95% 0.41\u20130.99), followed by the Amazonia with a median of 0.54% (CI 95% 0.18\u20130.99) and the Andes with a median of 0.29% (CI 95% 0.02\u20130.89). As per the sensitivity study, the most influential criteria on the system's sensitivity were \u201cAttendance or probability of going to a health center\u201d and \u201cprobability of having symptoms,\u201d notably for the Coast and Amazonia Regions.<\/jats:p>","DOI":"10.3389\/fpubh.2022.711938","type":"journal-article","created":{"date-parts":[[2022,3,3]],"date-time":"2022-03-03T06:08:59Z","timestamp":1646287739000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Assessment of the Current Surveillance System for Human Leptospirosis in Ecuador by Decision Analytic Modeling"],"prefix":"10.3389","volume":"10","author":[{"given":"Mar\u00eda Laura","family":"Calero","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gustavo","family":"Monti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,3,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1128\/CMR.14.2.296-326.2001","article-title":"Leptospirosis","volume":"14","author":"Levett","year":"2001","journal-title":"Clin Microbiol Rev."},{"key":"B2","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1016\/S0195-5616(03)00026-3","article-title":"Leptospirosis: a re-emerging zoonotic disease","volume":"33","author":"Langston","year":"2003","journal-title":"Vet Clin N Am Small."},{"key":"B3","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1007\/978-3-662-45059-8_2","article-title":"Systematics of leptospiraceae","volume":"387","author":"Levett","year":"2015","journal-title":"Curr Top Microbiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pntd.0007270","article-title":"Revisiting the taxonomy and evolution of pathogenicity of the genus Leptospira through the prism of genomics","volume":"13","author":"Vincent","year":"2019","journal-title":"PLoS Negl Trop Dis."},{"key":"B5","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1038\/nrmicro2017.5","article-title":"Virulence of the zoonotic agent of leptospirosis: still terra incognita?","volume":"15","author":"Picardeau","year":"2017","journal-title":"Nat Rev Microbiol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.ijid.2007.09.011","article-title":"The globalization of leptospirosis: worldwide incidence trends","volume":"1","author":"Pappas","year":"2007","journal-title":"Int J Inf Dis."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e81","DOI":"10.26633\/RPSP.2017.81","article-title":"Leptospirosis in Latin America: exploring the first set of regional data","volume":"41","author":"Schneider","year":"2017","journal-title":"Rev Panam Salud P\u00fablica."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e0003898","DOI":"10.1371\/journal.pntd.0003898","article-title":"Morbidity and mortality of leptospirosis: a systematic review","volume":"9","author":"Costa","year":"2015","journal-title":"PLoS Negl Trop Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S1473-3099(03)00830-2","article-title":"Leptospirosis: a zoonotic disease of global importance","volume":"3","author":"Bharti","year":"2003","journal-title":"Lancet Infect Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"417","DOI":"10.1099\/00222615-48-5-417","article-title":"Leptospirosis: re-emerging or re-discovered disease?","volume":"48","author":"Levett","year":"1999","journal-title":"J Med Microbiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1016\/S0140-6736(99)80012-9","article-title":"Urban epidemic of severe leptospirosis in Brazil","volume":"354","author":"Ko","year":"1999","journal-title":"Lancet."},{"key":"B12","doi-asserted-by":"publisher","first-page":"36","DOI":"10.1016\/j.actatropica.2005.07.001","article-title":"Leptospirosis among patients presenting with dengue-like illness in Puerto Rico","volume":"96","author":"Bruce","year":"2005","journal-title":"Acta Trop."},{"key":"B13","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1016\/j.ijantimicag.2010.06.012","article-title":"Estimating the burden of human leptospirosis","volume":"36","author":"Abela-Ridder","year":"2010","journal-title":"Int J Antimicrob Agents."},{"key":"B14","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1590\/S0036-46652015000500014","article-title":"A new possibility for surveillance: do we identify all cases of leptospirosis?","volume":"57","author":"Fontes","year":"2015","journal-title":"Rev Inst Med Trop S\u00e3o Paulo."},{"key":"B15","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1590\/S0037-86822007000400012","article-title":"Anticorpos anti-Leptospira em pacientes de Mato Grosso do Sul com suspeita cl\u00ednica de dengue ou hepatite viral","volume":"40","author":"Souza","year":"2007","journal-title":"Rev Soc Bras Med Trop."},{"key":"B16","unstructured":"Leptospirosis: zoonosis emergente. Informe de un caso2447 MacedoJ Gonz\u00e1lezJ M\u00e1rquezMD Med Int Mex.232007"},{"key":"B17","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1146\/annurev-publhealth-031816-044348","article-title":"Public health surveillance systems: recent advances in their use and evaluation","volume":"38","author":"Groseclose","year":"2017","journal-title":"Annu Rev Publ Health."},{"key":"B18","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1056\/NEJM196301242680405","article-title":"The surveillance of communicable diseases of national importance","volume":"268","author":"Langmur","year":"1963","journal-title":"N Engl J Med."},{"key":"B19","first-page":"285","article-title":"Public health surveillance: historical origins, methods and evaluation","volume":"72","author":"Declich","year":"1994","journal-title":"Bull World Health Organ."},{"key":"B20","doi-asserted-by":"publisher","first-page":"184","DOI":"10.1097\/00124784-200505000-00002","article-title":"Design and operation of state and local infectious disease surveillance systems","volume":"11","author":"Hopkins","year":"2005","journal-title":"J Public Health Manag Pract."},{"key":"B21","doi-asserted-by":"publisher","first-page":"295","DOI":"10.4161\/viru.24041","article-title":"Mathematical modeling of infectious disease dynamics","volume":"4","author":"Siettos","year":"2013","journal-title":"Virulence."},{"key":"B22","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1023\/A:1014476916361","article-title":"The use of simulation models for the surveillance, justification and understanding of tobacco control policies","volume":"5","author":"Levy","year":"2002","journal-title":"Health Care Manage Sci."},{"key":"B23","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1080\/01621459.1995.10476529","article-title":"Inference from a deterministic population dynamics model for bowhead whales","volume":"90","author":"Raftery","year":"1995","journal-title":"J Amer Statist Ass."},{"key":"B24","volume-title":"Methods for the Economic Evaluation of Health Care Programmes.","author":"Drummond","year":"2015"},{"key":"B25","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1016\/j.prevetmed.2006.09.008","article-title":"Demonstrating freedom from disease using multiple complex data sources. 1: a new methodology based on scenario trees","volume":"79","author":"Martin","year":"2007","journal-title":"Prev Vet Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e0183126","DOI":"10.1371\/journal.pone.0183126","article-title":"Cost-effectiveness evaluation of bovine tuberculosis surveillance in wildlife in France (Sylvatub system) using scenario trees","volume":"12","author":"Rivi\u00e8re","year":"2015","journal-title":"PLoS ONE."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7275\/pdz9-th90","article-title":"The Delphi technique: making sense of consensus","volume":"12","author":"Hsu","year":"2007","journal-title":"Prac Assessment Res Evaluat."},{"key":"B28","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1046\/j.1365-2648.2000.t01-1-01567.x","article-title":"Research guidelines for the Delphi survey technique","volume":"32","author":"Hasson","year":"2000","journal-title":"J Adv Nurs."},{"key":"B29","first-page":"620","volume-title":"The Delphi Method: Techniques and Applications","author":"Linstone","year":"2002"},{"key":"B30","doi-asserted-by":"publisher","first-page":"e1003583","DOI":"10.1371\/journal.pmed.1003583","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"18","author":"Page","year":"2021","journal-title":"PLoS Med."},{"key":"B31","unstructured":"OakleyJ SHELF: Tools to Support the Sheffield Elicitation Framework2021"},{"key":"B32","unstructured":"R: A Language Environment for Statistical ComputingViennaR Foundation Computing2016"},{"key":"B33","doi-asserted-by":"crossref","DOI":"10.1201\/9780429258480","volume-title":"Bayesian Data Analysis.","author":"Gelman","year":"2003"},{"key":"B34","first-page":"290","article-title":"Applying Bayesian approach to decision tree","volume-title":"Computational Intelligence. ICIC 2006. Lecture Notes in Computer Science","author":"Zhou","year":"2006"},{"key":"B35","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1890\/07-0744.1","article-title":"Accounting for uncertainty in ecological analysis: the strengths and limitations of hierarchical statistical modeling","volume":"19","author":"Cressie","year":"2009","journal-title":"Ecol Appl."},{"key":"B36","first-page":"237","article-title":"Decision modelling for health economic evaluation","volume-title":"Handbooks in Health Economic Evaluation","author":"Briggs","year":"2006"},{"key":"B37","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1111\/j.1461-0248.2010.01477.x","article-title":"A guide to eliciting and using expert knowledge in Bayesian ecological models","volume":"13","author":"Kuhnert","year":"2010","journal-title":"Ecol Lett."},{"key":"B38","doi-asserted-by":"crossref","DOI":"10.1201\/9781439894798","volume-title":"Bayesian Ideas and Data Analysis: An Introduction for Scientists and Statisticians","author":"Christensen","year":"2010"},{"key":"B39","unstructured":"StevensonM SergeantE epiR: Tools for the Analysis of Epidemiological Data2021"},{"key":"B40","doi-asserted-by":"publisher","first-page":"22","DOI":"10.18637\/jss.v042.i09","article-title":"MCMCpack: Markov Chain Monte Carlo in R","volume":"42","author":"Martin","year":"2011","journal-title":"J Stat Softw."},{"key":"B41","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.prevetmed.2009.05.012","article-title":"Probability of freedom from disease after the first detection and eradication of PRRS in Sweden: scenario-tree modelling of the surveillance system","volume":"91","author":"Fr\u00f6ssling","year":"2009","journal-title":"Prev Vet Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"e0183037","DOI":"10.1371\/journal.pone.0183037","article-title":"Evaluation of the cost-effectiveness of bovine brucellosis surveillance in a disease-free country using stochastic scenario tree modelling","volume":"12","author":"H\u00e9naux","year":"2017","journal-title":"PLoS ONE."},{"key":"B43","article-title":"The comparison of existing and alternative surveillance strategies to prove freedom of BHV1 in dairy farms: a case study within the risksur project","volume-title":"Stendaler Symposium 2017","author":"Veldhuis","year":"2016"},{"key":"B44","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1186\/s12917-017-1091-7","article-title":"Development of a stochastic agent-based model to evaluate surveillance strategies for detection of emergent porcine reproductive and respiratory syndrome Strains","volume":"13","author":"Arruda","year":"2017","journal-title":"Vet Res."},{"key":"B45","doi-asserted-by":"publisher","first-page":"2532","DOI":"10.1111\/tbed.13598","article-title":"2020. Quantification of the sensitivity of early detection surveillance","volume":"67","author":"Cameron","year":"2020","journal-title":"Transbound Emerg Dis."},{"key":"B46","first-page":"1","article-title":"Guidelines for evaluating surveillance systems","volume":"37","author":"Klaucke","year":"1988","journal-title":"Morbidity Mortality Weekly Rep."},{"key":"B47","first-page":"1","article-title":"Updated guidelines for evaluating public health surveillance systems: recommendations from the guidelines working group","volume":"50","year":"2001","journal-title":"Morb Mortal Wkly Rep Recomm Rep"},{"key":"B48","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1111\/avj.12648","article-title":"Evaluation of Australian surveillance for freedom from bovine tuberculosis","volume":"95","author":"Sergeant","year":"2017","journal-title":"Aust Vet J."},{"key":"B49","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1016\/j.prevetmed.2016.10.012","article-title":"Assessing the sensitivity of bovine tuberculosis surveillance in Canada's cattle population, 2009-2013","volume":"134","author":"Allaki","year":"2016","journal-title":"Prev Vet Med."},{"key":"B50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3201\/eid1601.081467","article-title":"Public health threat of new, reemerging, and neglected zoonoses in the industrialized world","volume":"16","author":"Cutler","year":"2010","journal-title":"Emerg Infect Dis."},{"key":"B51","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.biologicals.2013.06.010","article-title":"Leptospirosis: public health perspectives","volume":"41","author":"Guerra","year":"2013","journal-title":"Biologicals."},{"key":"B52","doi-asserted-by":"publisher","first-page":"105183","DOI":"10.1016\/j.actatropica.2019.105183","article-title":"Leptospirosis: increasing importance in developing countries","volume":"201","author":"Soo","year":"2019","journal-title":"Acta Trop"},{"key":"B53","doi-asserted-by":"publisher","first-page":"105046","DOI":"10.1016\/j.actatropica.2019.105046","article-title":"Misunderstanding of leptospirosis","volume":"197","author":"Teh","year":"2019","journal-title":"Acta Trop."},{"key":"B54","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.trstmh.2011.02.002","article-title":"\u2018Zoonoses? Not sure what that is...' An assessment of knowledge of zoonoses among medical students in India","volume":"105","author":"Kakkar","year":"2011","journal-title":"Trans R Soc Trop Med Hyg."},{"key":"B55","doi-asserted-by":"publisher","first-page":"3942672","DOI":"10.1155\/2016\/3942672","article-title":"Health care providers' knowledge and practice gap towards joint zoonotic disease surveillance system: challenges and opportunities, gomma district, southwest Ethiopia","volume":"2016","author":"Gemeda","year":"2016","journal-title":"Biomed Res Int."},{"key":"B56","doi-asserted-by":"publisher","first-page":"e0004476","DOI":"10.1371\/journal.pntd.0004476","article-title":"Mixed methods survey of zoonotic disease awareness and practice among animal and human healthcare providers in Moshi, Tanzania","volume":"10","author":"Zhang","year":"2016","journal-title":"PLoS Negl Trop Dis."},{"key":"B57","doi-asserted-by":"publisher","first-page":"760","DOI":"10.4269\/ajtmh.14-0220","article-title":"Case report: case series of fatal leptospira spp","volume":"91","author":"P\u00e9rez Rodr\u00edguez","year":"2014","journal-title":"Am J Trop Med Hyg."},{"key":"B58","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/j.idcr.2016.06.003","article-title":"Fatal leptospirosis and chikungunya co-infection: do not forget leptospirosis during chikungunya outbreaks","volume":"5","author":"Nhan","year":"2016","journal-title":"IDCases."},{"key":"B59","doi-asserted-by":"publisher","first-page":"e82019","DOI":"10.1371\/journal.pone.0082019","article-title":"System approaches to animal disease surveillance and resource allocation: methodological frameworks for behavioral analysis","volume":"8","author":"Rich","year":"2013","journal-title":"PLoS ONE."},{"key":"B60","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.prevetmed.2010.09.002","article-title":"Assessment of different surveillance systems for avian influenza in commercial poultry in Catalonia (North-Eastern Spain)","volume":"97","author":"Alba","year":"2010","journal-title":"Prev Vet Med."},{"key":"B61","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1016\/j.prevetmed.2012.11.002","article-title":"Epidemiologic and economic evaluation of risk-based meat inspection for bovine cysticercosis in Danish cattle","volume":"108","author":"Calvo-Artavia","year":"2013","journal-title":"Prev Vet Med."},{"key":"B62","first-page":"57","article-title":"Evaluation and optimization of surveillance systems for rare and emerging infectious diseases","volume-title":"Vet Res.","author":"Hadorn","year":"2008"},{"key":"B63","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1017\/S0950268811002160","article-title":"Evaluation of animal and public health surveillance systems: a systematic review","volume":"140","author":"Drewe","year":"2012","journal-title":"Epidemiol Infect."}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.711938\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,18]],"date-time":"2023-11-18T09:49:04Z","timestamp":1700300944000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2022.711938\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,3]]},"references-count":63,"alternative-id":["10.3389\/fpubh.2022.711938"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2022.711938","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,3]]},"article-number":"711938"}}