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Open Access Highly Accessed Research article

Evaluation of an influenza-like illness case definition in the diagnosis of influenza among patients with acute febrile illness in cambodia

Matthew R Kasper1*, Thomas F Wierzba2, Ly Sovann3, Patrick J Blair1 and Shannon D Putnam1

Author Affiliations

1 U.S. Naval Medical Research Unit 2, Jakarta, Indonesia

2 U.S. Naval Medical Research Unit No. 2, Phnom Penh, Cambodia

3 Communicable Diseases Control Department, Kingdom of Cambodia Ministry of Health, Phnom Penh, Kingdom of Cambodia

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BMC Infectious Diseases 2010, 10:320  doi:10.1186/1471-2334-10-320

Published: 7 November 2010



Influenza-like illness (ILI) is often defined as fever (>38.0°C) with cough or sore throat. In this study, we tested the sensitivity, specificity, and positive and negative predictive values of this case definition in a Cambodia patient population.


Passive clinic-based surveillance was established at nine healthcare centers to identify the causes of acute undifferentiated fever in patients aged two years and older seeking treatment. Fever was defined as tympanic membrane temperature >38°C lasting more than 24 hours and less than 10 days. Influenza virus infections were identified by polymerase chain reaction.


From July 2008 to December 2008, 2,639 patients were enrolled. From 884 (33%) patients positive for influenza, 652 presented with ILI and 232 acute fever patients presented without ILI. Analysis by age group identified no significant differences between influenza positive patients from the two groups. Positive predictive values (PPVs) varied during the course of the influenza season and among age groups.


The ILI case definition can be used to identify a significant percentage of patients with influenza infection during the influenza season in Cambodia, assisting healthcare providers in its diagnosis and treatment. However, testing samples based on the criteria of fever alone increased our case detection by 34%.