Reply to Hugonnet et al
Identifieur interne : 000668 ( Istex/Corpus ); précédent : 000667; suivant : 000669Reply to Hugonnet et al
Auteurs : Ignatius T. S. Yu ; Joseph J. Y. SungSource :
- Clinical Infectious Diseases [ 1058-4838 ] ; 2007.
Url:
DOI: 10.1086/523724
Links to Exploration step
ISTEX:640614197D0690C16082AC4BF9659F4684DA8F5ELe document en format XML
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<front>
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<journal-title>Clinical Infectious Diseases</journal-title>
<abbrev-journal-title>Clinical Infectious Diseases</abbrev-journal-title>
<issn pub-type="ppub">1058-4838</issn>
<issn pub-type="epub">1537-6591</issn>
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<publisher-name>The University of Chicago Press</publisher-name>
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<subject>Correspondence</subject>
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<title-group>
<article-title>Reply to Hugonnet et al</article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Yu</surname>
<given-names>Ignatius T. S.</given-names>
</name>
<xref rid="aff1" ref-type="aff">1</xref>
<xref rid="aff2" ref-type="aff">2</xref>
</contrib>
<contrib contrib-type="author" corresp="yes">
<name>
<surname>Sung</surname>
<given-names>Joseph J. Y.</given-names>
</name>
<xref rid="aff1" ref-type="aff">1</xref>
</contrib>
<aff id="aff1"><label>1</label><institution>Centre for Emerging Infectious Disease and Department of Community and Family Medicine, The Chinese University of Hong Kong</institution>, <addr-line>Hong Kong, China</addr-line></aff>
<aff id="aff2"><label>2</label><institution>Department of Community and Family Medicine, The Chinese University of Hong Kong</institution>, <addr-line>Hong Kong, China</addr-line></aff>
</contrib-group>
<author-notes>
<corresp id="cor1">Reprints or correspondence: Dr. Joseph J. Y. Sung, Dept. of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong (<email>joesung@cuhk.edu.hk</email>).</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>15</day>
<month>12</month>
<year>2007</year>
</pub-date>
<volume>45</volume>
<issue>12</issue>
<fpage>1652</fpage>
<lpage>1652</lpage>
<copyright-statement>© 2007 Infectious Diseases Society of America</copyright-statement>
<copyright-year>2007</copyright-year>
</article-meta>
</front>
<body>
<p>To The Editor—Thank you for giving us the opportunity to respond to the comments raised by Hugonnet et al. [<xref rid="ref1" ref-type="bibr">1</xref>] regarding our article [<xref rid="ref2" ref-type="bibr">2</xref>]. No researcher could be absolutely sure that all transmissions within an individual “superspreading” event were nosocomial and were related to the putative index case, unless fingerprinting of the virus for all cases was done. This also applies to “transmission chains,” which are frequently adopted to describe infectious disease transmissions inside hospitals by infection control units. We actually included all nosocomial outbreaks of severe acute respiratory syndrome (SARS) documented by the infection control units, and thus, we identified index patients in some wards. For the analysis of host factors, as well as the combined analysis of environmental and administrative factors and host factors, only case wards with documented nosocomial outbreaks of SARS (with identified index patients) were used [<xref rid="ref2" ref-type="bibr">2</xref>].</p>
<p>We admit that recall inaccuracies (not necessarily leading to bias) might exist in some exposure measures because of the time lag. We made every effort to minimize the possible biases and discussed the details in our article [<xref rid="ref2" ref-type="bibr">2</xref>]. We do not agree that some exposure measures were ecological, because we were looking at the outbreak of SARS at the ward level and were not reporting risk factors for individual patients. For environmental and administrative factors, the reported information during the 10-day study period referred to the average (usual) situation. Unless drastic changes were introduced (none documented in any ward) within these 10 days, the information collected should reflect the situation before the infection transmission events.</p>
<p>It was possible that some wards experienced >1 outbreak, but any ward with at least 1 outbreak already qualified as a case ward, and no selection bias was present. Wards admitting several patients with SARS would have been designated as “SARS wards” and excluded from our study.</p>
<p>That transmission was more intense at the beginning of the SARS epidemic, probably because of the poor preventive and infection-control measures adopted [<xref rid="ref3" ref-type="bibr">3</xref>]. There was no evidence to show that the natural virulence of the SARS coronavirus decreased towards the end of the epidemic. Moreover, we did include wards with nosocomial outbreaks that occurred towards the end of the epidemic, as well as control wards identified early in the epidemic.</p>
<p>Hugonnet et al. [<xref rid="ref1" ref-type="bibr">1</xref>] did not challenge our findings of some “accepted” risk factors (i.e., distance between beds, resuscitation procedures, staff washing or changing facilities, and staff working while experiencing symptoms) but focused their concerns on the several respiratory-support techniques adopted for patients with SARS as risk factors, possibly because these contradicted their understanding of the transmission mechanisms of SARS. Actually, the information related to respiratory support was retrieved from medical records and, thus, should be objective.</p>
<p>Postoutbreak self-reports of compliance with standard infection-control measures and use of personal protective equipment are notorious for introducing recall bias. Such information was also not applicable to non–health care workers, who constituted a majority of the secondary cases involved in the nosocomial outbreaks of SARS being studied.</p>
<p>We cannot agree with the allegation that the so-called methodological flaws would invalidate our results. We feel that a type of “a priori bias” has been happening among certain groups of the infection control community: any findings not in line with the a priori hypothesis or belief get rejected. It all reverts to the droplet and/or contact versus aerosol (airborne) spread debate. “The clinical implications of airborne transmission are particularly important for infection control in hospitals” [<xref rid="ref4" ref-type="bibr">4</xref>, p. 1711]. The deep-rooted biased view of how SARS and other similar respiratory infections could be transmitted could have resulted in the loss of golden opportunities for effective control of such outbreaks. Will the infection-control community learn the lesson?</p>
</body>
<back>
<ack>
<title>Acknowledgments</title>
<p><bold><italic>Potential conflicts of interest.</italic></bold>I.T.S.Y. and J.J.Y.S.: no conflicts.</p>
</ack>
<ref-list>
<title>References</title>
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</ref-list>
</back>
</article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Reply to Hugonnet et al</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Reply to Hugonnet et al</title></titleInfo><name type="personal"><namePart type="given">Ignatius T. S.</namePart><namePart type="family">Yu</namePart><affiliation>Centre for Emerging Infectious Disease and Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong, China</affiliation><affiliation>Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong, China</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal" displayLabel="corresp"><namePart type="given">Joseph J. Y.</namePart><namePart type="family">Sung</namePart><affiliation>Centre for Emerging Infectious Disease and Department of Community and Family Medicine, The Chinese University of Hong Kong, Hong Kong, China</affiliation><affiliation>E-mail: joesung@cuhk.edu.hk</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="reply" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>The University of Chicago Press</publisher><dateIssued encoding="w3cdtf">2007-12-15</dateIssued><copyrightDate encoding="w3cdtf">2007</copyrightDate></originInfo><relatedItem type="host"><titleInfo><title>Clinical Infectious Diseases</title></titleInfo><titleInfo type="abbreviated"><title>Clinical Infectious Diseases</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><identifier type="ISSN">1058-4838</identifier><identifier type="eISSN">1537-6591</identifier><identifier type="PublisherID">cid</identifier><identifier type="PublisherID-hwp">cid</identifier><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>45</number></detail><detail type="issue"><caption>no.</caption><number>12</number></detail><extent unit="pages"><start>1652</start><end>1652</end></extent></part></relatedItem><relatedItem type="references" displayLabel="b1"><titleInfo><title>Nosocomial transmission of severe acute respiratory syndrome: better quality of evidence is needed</title></titleInfo><name type="personal"><namePart type="given">S</namePart><namePart type="family">Hugonnet</namePart></name><name type="personal"><namePart type="given">D</namePart><namePart type="family">Legros</namePart></name><name type="personal"><namePart type="given">C</namePart><namePart type="family">Roth</namePart></name><name type="personal"><namePart type="given">CL</namePart><namePart type="family">Pessoa-Silva</namePart></name><genre>journal</genre><note>(in this issue)</note><note>Hugonnet S Legros D Roth C Pessoa-Silva CL Nosocomial transmission of severe acute respiratory syndrome: better quality of evidence is needed Clin Infect Dis 2007 45 1651 0000 (in this issue)</note><relatedItem type="host"><titleInfo><title>Clin Infect Dis</title></titleInfo><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>45</number></detail><extent unit="pages"><start>1651</start><end>0000</end><list>1651-0000</list></extent></part></relatedItem></relatedItem><relatedItem type="references" displayLabel="b2"><titleInfo><title>Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others?</title></titleInfo><name type="personal"><namePart type="given">IT</namePart><namePart type="family">Yu</namePart></name><name type="personal"><namePart type="given">ZH</namePart><namePart type="family">Xie</namePart></name><name type="personal"><namePart type="given">KK</namePart><namePart type="family">Tsoi</namePart></name><genre>journal</genre><note>Yu IT Xie ZH Tsoi KK Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others? Clin Infect Dis 2007 44 1017 25</note><relatedItem type="host"><titleInfo><title>Clin Infect Dis</title></titleInfo><part><date>2007</date><detail type="volume"><caption>vol.</caption><number>44</number></detail><extent unit="pages"><start>1017</start><end>25</end><list>1017-25</list></extent></part></relatedItem></relatedItem><relatedItem type="references" displayLabel="b3"><titleInfo><title>Severe acute respiratory syndrome (SARS)—multi-country outbreak: update 30: status of diagnostic test, significance of “super spreaders,” situation in China. 15 April 2003</title></titleInfo><genre>other</genre><note>Available at: http://www.who.int/csr/don/2003_04_15/en/. Accessed 22 June 2006</note><note>World Health Organization Severe acute respiratory syndrome (SARS)—multi-country outbreak: update 30: status of diagnostic test, significance of “super spreaders,” situation in China. 15 April 2003 Available at: http://www.who.int/csr/don/2003_04_15/en/. Accessed 22 June 2006</note></relatedItem><relatedItem type="references" displayLabel="b4"><titleInfo><title>Airborne transmission of communicable infection—the elusive pathway</title></titleInfo><name type="personal"><namePart type="given">CJ</namePart><namePart type="family">Roy</namePart></name><name type="personal"><namePart type="given">DK</namePart><namePart type="family">Milton</namePart></name><genre>journal</genre><note>Roy CJ Milton DK Airborne transmission of communicable infection—the elusive pathway N Engl J Med 2004 350 1710 2</note><relatedItem type="host"><titleInfo><title>N Engl J Med</title></titleInfo><part><date>2004</date><detail type="volume"><caption>vol.</caption><number>350</number></detail><extent unit="pages"><start>1710</start><end>2</end><list>1710-2</list></extent></part></relatedItem></relatedItem><identifier type="istex">640614197D0690C16082AC4BF9659F4684DA8F5E</identifier><identifier type="ark">ark:/67375/HXZ-JH0RVFZG-9</identifier><identifier type="DOI">10.1086/523724</identifier><accessCondition type="use and reproduction" contentType="copyright">© 2007 Infectious Diseases Society of America</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-GTWS0RDP-M">oup</recordContentSource><recordOrigin>Converted from (version 1.2.10) to MODS version 3.6.</recordOrigin><recordCreationDate encoding="w3cdtf">2020-04-17</recordCreationDate></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-JH0RVFZG-9/record.json</uri></json:item></metadata><covers><json:item><extension>tiff</extension><original>true</original><mimetype>image/tiff</mimetype><uri>https://api.istex.fr/document/640614197D0690C16082AC4BF9659F4684DA8F5E/covers/tiff</uri></json:item><json:item><extension>html</extension><original>true</original><mimetype>text/html</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-JH0RVFZG-9/covers.html</uri></json:item></covers><annexes><json:item><extension>gif</extension><original>true</original><mimetype>image/gif</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-JH0RVFZG-9/annexes.gif</uri></json:item><json:item><extension>jpeg</extension><original>true</original><mimetype>image/jpeg</mimetype><uri>https://api.istex.fr/ark:/67375/HXZ-JH0RVFZG-9/annexes.jpeg</uri></json:item></annexes><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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