Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases.
Identifieur interne : 000794 ( PubMed/Checkpoint ); précédent : 000793; suivant : 000795Quantifying 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.
DOI: 10.1038/s41598-018-19406-x
PubMed: 29348656
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Vora</name><affiliation wicri:level="1"><nlm:affiliation>New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA.</nlm:affiliation><country xml:lang="fr">États-Unis</country><wicri:regionArea>New York City Department of Health and Mental Hygiene, New York, NY, 11101</wicri:regionArea><wicri:noRegion>11101</wicri:noRegion></affiliation></author></analytic><series><title level="j">Scientific reports</title><idno type="eISSN">2045-2322</idno><imprint><date when="2018" type="published">2018</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Communicable Diseases (epidemiology)</term><term>Costs and Cost Analysis</term><term>Epidemiological Monitoring</term><term>Humans</term><term>Infectious Disease Incubation Period</term><term>Models, Theoretical</term><term>Population Surveillance</term><term>Risk</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Coûts et analyse des coûts</term><term>Humains</term><term>Maladies transmissibles (épidémiologie)</term><term>Modèles théoriques</term><term>Période d'incubation de maladie infectieuse</term><term>Risque</term><term>Surveillance de la population</term><term>Épidémiosurveillance</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Communicable Diseases</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Maladies transmissibles</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Costs and Cost Analysis</term><term>Epidemiological Monitoring</term><term>Humans</term><term>Infectious Disease Incubation Period</term><term>Models, Theoretical</term><term>Population Surveillance</term><term>Risk</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Coûts et analyse des coûts</term><term>Humains</term><term>Modèles théoriques</term><term>Période d'incubation de maladie infectieuse</term><term>Risque</term><term>Surveillance de la population</term><term>Épidémiosurveillance</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">29348656</PMID><DateCompleted><Year>2018</Year><Month>11</Month><Day>27</Day></DateCompleted><DateRevised><Year>2019</Year><Month>01</Month><Day>18</Day></DateRevised><Article PubModel="Electronic"><Journal><ISSN IssnType="Electronic">2045-2322</ISSN><JournalIssue CitedMedium="Internet"><Volume>8</Volume><Issue>1</Issue><PubDate><Year>2018</Year><Month>01</Month><Day>18</Day></PubDate></JournalIssue><Title>Scientific reports</Title><ISOAbbreviation>Sci Rep</ISOAbbreviation></Journal><ArticleTitle>Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases.</ArticleTitle><Pagination><MedlinePgn>1093</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1038/s41598-018-19406-x</ELocationID><Abstract><AbstractText>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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Reich</LastName><ForeName>Nicholas G</ForeName><Initials>NG</Initials><Identifier Source="ORCID">http://orcid.org/0000-0003-3503-9899</Identifier><AffiliationInfo><Affiliation>University of Massachusetts-Amherst, Department of Biostatistics and Epidemiology, Amherst, MA, 01003, USA. nick@schoolph.umass.edu.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lessler</LastName><ForeName>Justin</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, 21205, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Varma</LastName><ForeName>Jay K</ForeName><Initials>JK</Initials><AffiliationInfo><Affiliation>New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vora</LastName><ForeName>Neil M</ForeName><Initials>NM</Initials><AffiliationInfo><Affiliation>New York City Department of Health and Mental Hygiene, New York, NY, 11101, USA.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>Centers for Disease Control and Prevention, Atlanta, GA, 30329, USA.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>R35 GM119582</GrantID><Acronym>GM</Acronym><Agency>NIGMS NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList><ArticleDate 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Massachusetts à Amherst</li></orgName></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="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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