Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine
Identifieur interne : 002A45 ( Main/Exploration ); précédent : 002A44; suivant : 002A46Quantifying the impact of community quarantine on SARS transmission in Ontario: estimation of secondary case count difference and number needed to quarantine
Auteurs : Susan J. Bondy [Canada] ; Margaret L. Russell [Canada] ; Julie Ml Laflèche [Canada] ; Elizabeth Rea [Canada]Source :
- BMC Public Health [ 1471-2458 ] ; 2009.
Abstract
Community quarantine is controversial, and the decision to use and prepare for it should be informed by specific quantitative evidence of benefit. Case-study reports on 2002-2004 SARS outbreaks have discussed the role of quarantine in the community in transmission. However, this literature has not yielded quantitative estimates of the reduction in secondary cases attributable to quarantine as would be seen in other areas of health policy and cost-effectiveness analysis.
Using data from the 2003 Ontario, Canada, SARS outbreak, two novel expressions for the impact of quarantine are presented. Secondary Case Count Difference (SCCD) reflects reduction in the average number of transmissions arising from a SARS case in quarantine, relative to not in quarantine, at onset of symptoms. SCCD was estimated using Poisson and negative binomial regression models (with identity link function) comparing the number of secondary cases to each index case for quarantine relative to non-quarantined index cases. The inverse of this statistic is proposed as the number needed to quarantine (NNQ) to prevent one additional secondary transmission.
Our estimated SCCD was 0.133 fewer secondary cases per quarantined versus non-quarantined index case; and a NNQ of 7.5 exposed individuals to be placed in community quarantine to prevent one additional case of transmission in the community. This analysis suggests quarantine can be an effective preventive measure, although these estimates lack statistical precision.
Relative to other health policy areas, literature on quarantine tends to lack in quantitative expressions of effectiveness, or agreement on how best to report differences in outcomes attributable to control measure. We hope to further this discussion through presentation of means to calculate and express the impact of population control measures. The study of quarantine effectiveness presents several methodological and statistical challenges. Further research and discussion are needed to understand the costs and benefits of enacting quarantine, and this includes a discussion of how quantitative benefit should be communicated to decision-makers and the public, and evaluated.
Url:
DOI: 10.1186/1471-2458-9-488
PubMed: 20034405
PubMed Central: 2808319
Affiliations:
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Bondy</name><affiliation wicri:level="4"><nlm:aff id="I1">Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Russell, Margaret L" sort="Russell, Margaret L" uniqKey="Russell M" first="Margaret L" last="Russell">Margaret L. 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Bondy</name><affiliation wicri:level="4"><nlm:aff id="I1">Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Russell, Margaret L" sort="Russell, Margaret L" uniqKey="Russell M" first="Margaret L" last="Russell">Margaret L. Russell</name><affiliation wicri:level="4"><nlm:aff id="I2">Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Community Health Sciences, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta, T2N 4Z6</wicri:regionArea><orgName type="university">Université de Calgary</orgName><placeName><settlement type="city">Calgary</settlement><region type="state">Alberta</region></placeName></affiliation></author><author><name sortKey="Lafleche, Julie Ml" sort="Lafleche, Julie Ml" uniqKey="Lafleche J" first="Julie Ml" last="Laflèche">Julie Ml Laflèche</name><affiliation wicri:level="1"><nlm:aff id="I3">Toronto Public Health, 277 Victoria St, Toronto, Ontario, M5B 1W2, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Public Health, 277 Victoria St, Toronto, Ontario, M5B 1W2</wicri:regionArea><wicri:noRegion>M5B 1W2</wicri:noRegion></affiliation></author><author><name sortKey="Rea, Elizabeth" sort="Rea, Elizabeth" uniqKey="Rea E" first="Elizabeth" last="Rea">Elizabeth Rea</name><affiliation wicri:level="4"><nlm:aff id="I1">Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, ON, MT5 3M7</wicri:regionArea><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="I3">Toronto Public Health, 277 Victoria St, Toronto, Ontario, M5B 1W2, Canada</nlm:aff><country xml:lang="fr">Canada</country><wicri:regionArea>Toronto Public Health, 277 Victoria St, Toronto, Ontario, M5B 1W2</wicri:regionArea><wicri:noRegion>M5B 1W2</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Community quarantine is controversial, and the decision to use and prepare for it should be informed by specific quantitative evidence of benefit. Case-study reports on 2002-2004 SARS outbreaks have discussed the role of quarantine in the community in transmission. However, this literature has not yielded quantitative estimates of the reduction in secondary cases attributable to quarantine as would be seen in other areas of health policy and cost-effectiveness analysis.</p></sec><sec><title>Methods</title><p>Using data from the 2003 Ontario, Canada, SARS outbreak, two novel expressions for the impact of quarantine are presented. Secondary Case Count Difference (SCCD) reflects reduction in the average number of transmissions arising from a SARS case in quarantine, relative to not in quarantine, at onset of symptoms. SCCD was estimated using Poisson and negative binomial regression models (with identity link function) comparing the number of secondary cases to each index case for quarantine relative to non-quarantined index cases. The inverse of this statistic is proposed as the number needed to quarantine (NNQ) to prevent one additional secondary transmission.</p></sec><sec><title>Results</title><p>Our estimated SCCD was 0.133 fewer secondary cases per quarantined versus non-quarantined index case; and a NNQ of 7.5 exposed individuals to be placed in community quarantine to prevent one additional case of transmission in the community. This analysis suggests quarantine can be an effective preventive measure, although these estimates lack statistical precision.</p></sec><sec><title>Conclusions</title><p>Relative to other health policy areas, literature on quarantine tends to lack in quantitative expressions of effectiveness, or agreement on how best to report differences in outcomes attributable to control measure. We hope to further this discussion through presentation of means to calculate and express the impact of population control measures. The study of quarantine effectiveness presents several methodological and statistical challenges. Further research and discussion are needed to understand the costs and benefits of enacting quarantine, and this includes a discussion of how quantitative benefit should be communicated to decision-makers and the public, and evaluated.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Heymann, D" uniqKey="Heymann D">D Heymann</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barbera, J" uniqKey="Barbera J">J Barbera</name></author><author><name sortKey="Macintyre, A" uniqKey="Macintyre A">A Macintyre</name></author><author><name sortKey="Gostin, L" uniqKey="Gostin L">L Gostin</name></author><author><name sortKey="Inglesby, T" uniqKey="Inglesby T">T Inglesby</name></author><author><name sortKey="O Toole, T" uniqKey="O Toole T">T O'Toole</name></author><author><name sortKey="Deatley, C" uniqKey="Deatley C">C DeAtley</name></author><author><name sortKey="Tonat, K" uniqKey="Tonat K">K 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Sinclair</name></author><author><name sortKey="Cook, Rj" uniqKey="Cook R">RJ Cook</name></author><author><name sortKey="Guyatt, Gh" uniqKey="Guyatt G">GH Guyatt</name></author><author><name sortKey="Pauker, Sg" uniqKey="Pauker S">SG Pauker</name></author><author><name sortKey="Cook, Dj" uniqKey="Cook D">DJ Cook</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Gostin, L" uniqKey="Gostin L">L Gostin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ferguson, Nm" uniqKey="Ferguson N">NM Ferguson</name></author><author><name sortKey="Cummings, Dat" uniqKey="Cummings D">DAT Cummings</name></author><author><name sortKey="Fraser, C" uniqKey="Fraser C">C Fraser</name></author><author><name sortKey="Cajka, Jc" uniqKey="Cajka J">JC Cajka</name></author><author><name sortKey="Cooley, Pc" uniqKey="Cooley P">PC Cooley</name></author><author><name sortKey="Burke, Ds" uniqKey="Burke D">DS Burke</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Canada</li></country><region><li>Alberta</li><li>Ontario</li></region><settlement><li>Calgary</li><li>Toronto</li></settlement><orgName><li>Université de Calgary</li><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Bondy, Susan J" sort="Bondy, Susan J" uniqKey="Bondy S" first="Susan J" last="Bondy">Susan J. Bondy</name></region><name sortKey="Lafleche, Julie Ml" sort="Lafleche, Julie Ml" uniqKey="Lafleche J" first="Julie Ml" last="Laflèche">Julie Ml Laflèche</name><name sortKey="Rea, Elizabeth" sort="Rea, Elizabeth" uniqKey="Rea E" first="Elizabeth" last="Rea">Elizabeth Rea</name><name sortKey="Rea, Elizabeth" sort="Rea, Elizabeth" uniqKey="Rea E" first="Elizabeth" last="Rea">Elizabeth Rea</name><name sortKey="Russell, Margaret L" sort="Russell, Margaret L" uniqKey="Russell M" first="Margaret L" last="Russell">Margaret L. Russell</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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