Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases
Identifieur interne : 000840 ( Main/Exploration ); précédent : 000839; suivant : 000841Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases
Auteurs : Nicholas G. Reich [États-Unis] ; Justin Lessler [États-Unis] ; Jay K. Varma [États-Unis] ; Neil M. Vora [États-Unis]Source :
- Scientific Reports [ 2045-2322 ] ; 2018.
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Abstract
During outbreaks of deadly emerging pathogens (e.g., Ebola, MERS-CoV) and bioterror threats (e.g., smallpox), actively monitoring potentially infected individuals aims to limit disease transmission and morbidity. Guidance issued by CDC on active monitoring was a cornerstone of its response to the West Africa Ebola outbreak. There are limited data on how to balance the costs and performance of this important public health activity. We present a framework that estimates the risks and costs of specific durations of active monitoring for pathogens of significant public health concern. We analyze data from New York City’s Ebola active monitoring program over a 16-month period in 2014–2016. For monitored individuals, we identified unique durations of active monitoring that minimize expected costs for those at “low (but not zero) risk” and “some or high risk”: 21 and 31 days, respectively. Extending our analysis to smallpox and MERS-CoV, we found that the optimal length of active monitoring relative to the median incubation period was reduced compared to Ebola due to less variable incubation periods. Active monitoring can save lives but is expensive. Resources can be most effectively allocated by using exposure-risk categories to modify the duration or intensity of active monitoring.
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DOI: 10.1038/s41598-018-19406-x
PubMed: 29348656
PubMed Central: 5773605
Affiliations:
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Guidance issued by CDC on active monitoring was a cornerstone of its response to the West Africa Ebola outbreak. There are limited data on how to balance the costs and performance of this important public health activity. We present a framework that estimates the risks and costs of specific durations of active monitoring for pathogens of significant public health concern. We analyze data from New York City’s Ebola active monitoring program over a 16-month period in 2014–2016. For monitored individuals, we identified unique durations of active monitoring that minimize expected costs for those at “low (but not zero) risk” and “some or high risk”: 21 and 31 days, respectively. Extending our analysis to smallpox and MERS-CoV, we found that the optimal length of active monitoring relative to the median incubation period was reduced compared to Ebola due to less variable incubation periods. Active monitoring can save lives but is expensive. Resources can be most effectively allocated by using exposure-risk categories to modify the duration or intensity of active monitoring.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Stehling Ariza, T" uniqKey="Stehling Ariza T">T Stehling-Ariza</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Peak, Cm" uniqKey="Peak C">CM Peak</name></author><author><name sortKey="Childs, Lm" uniqKey="Childs L">LM Childs</name></author><author><name sortKey="Grad, Yh" uniqKey="Grad Y">YH Grad</name></author><author><name sortKey="Buckee, Co" uniqKey="Buckee C">CO Buckee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name></author><author><name sortKey="Riley, S" uniqKey="Riley S">S Riley</name></author><author><name sortKey="Anderson, Rm" uniqKey="Anderson R">RM Anderson</name></author><author><name sortKey="Ferguson, Nm" uniqKey="Ferguson N">NM Ferguson</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Reich, Ng" uniqKey="Reich N">NG Reich</name></author><author><name sortKey="Lessler, J" uniqKey="Lessler J">J Lessler</name></author><author><name sortKey="Cummings, Dat" uniqKey="Cummings D">DAT Cummings</name></author><author><name sortKey="Brookmeyer, R" uniqKey="Brookmeyer R">R Brookmeyer</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lessler, J" uniqKey="Lessler J">J Lessler</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Faye, O" uniqKey="Faye O">O Faye</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Mack, Tm" uniqKey="Mack T">TM Mack</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nishiura, H" uniqKey="Nishiura H">H Nishiura</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Velasquez, Ge" uniqKey="Velasquez G">GE Velásquez</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cowling, Bj" uniqKey="Cowling B">BJ Cowling</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Chowell, G" uniqKey="Chowell G">G Chowell</name></author><author><name sortKey="Hengartner, Nw" uniqKey="Hengartner N">NW Hengartner</name></author><author><name sortKey="Castillo Chavez, C" uniqKey="Castillo Chavez C">C Castillo-Chavez</name></author><author><name sortKey="Fenimore, Pw" uniqKey="Fenimore P">PW Fenimore</name></author><author><name sortKey="Hyman, Jm" uniqKey="Hyman J">JM Hyman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Millman, Aj" uniqKey="Millman A">AJ Millman</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Yacisin, K" uniqKey="Yacisin K">K Yacisin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Drazen, Jm" uniqKey="Drazen J">JM Drazen</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Brookmeyer, R" uniqKey="Brookmeyer R">R Brookmeyer</name></author><author><name sortKey="Blades, N" uniqKey="Blades N">N Blades</name></author><author><name sortKey="Hugh Jones, M" uniqKey="Hugh Jones M">M Hugh-Jones</name></author><author><name sortKey="Henderson, Da" uniqKey="Henderson D">DA Henderson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nishiura, H" uniqKey="Nishiura H">H Nishiura</name></author><author><name sortKey="Inaba, H" uniqKey="Inaba H">H Inaba</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ezeoke, I" uniqKey="Ezeoke I">I Ezeoke</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Parham, M" uniqKey="Parham M">M Parham</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Géorgie (États-Unis)</li><li>Maryland</li><li>Massachusetts</li><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="Massachusetts"><name sortKey="Reich, Nicholas G" sort="Reich, Nicholas G" uniqKey="Reich N" first="Nicholas G." last="Reich">Nicholas G. Reich</name></region><name sortKey="Lessler, Justin" sort="Lessler, Justin" uniqKey="Lessler J" first="Justin" last="Lessler">Justin Lessler</name><name sortKey="Varma, Jay K" sort="Varma, Jay K" uniqKey="Varma J" first="Jay K." last="Varma">Jay K. Varma</name><name sortKey="Varma, Jay K" sort="Varma, Jay K" uniqKey="Varma J" first="Jay K." last="Varma">Jay K. Varma</name><name sortKey="Vora, Neil M" sort="Vora, Neil M" uniqKey="Vora N" first="Neil M." last="Vora">Neil M. Vora</name><name sortKey="Vora, Neil M" sort="Vora, Neil M" uniqKey="Vora N" first="Neil M." last="Vora">Neil M. Vora</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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