Utilizing a capture–recapture strategy to accelerate infectious disease surveillance

Monitoring key elements of disease dynamics (e.g., prevalence, case counts) is of great importance in infectious disease prevention and control, as emphasized during the COVID-19 pandemic. To facilitate this effort, we propose a new capture-recapture (CRC) analysis strategy that adjusts for misclassification stemming from the use of easily administered but imperfect diagnostic test kits, such as rapid antigen test-kits or saliva tests. Our method is based on a recently proposed "anchor stream" design, whereby an existing voluntary surveillance data stream is augmented by a smaller and judiciously drawn random sample. It incorporates manufacturer-specified sensitivity and specificity parameters to account for imperfect diagnostic results in one or both data streams. For inference to accompany case count estimation, we improve upon traditional Wald-type confidence intervals by developing an adapted Bayesian credible interval for the CRC estimator that yields favorable frequentist coverage properties. When feasible, the proposed design and analytic strategy provides a more efficient solution than traditional CRC methods or random sampling-based bias-corrected estimation to monitor disease prevalence while accounting for misclassification. We demonstrate the benefits of this approach through simulation studies and a numerical example that underscore its potential utility in practice for economical disease monitoring among a registered closed population.