Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases.
Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases.
复制标题
量化传染病主动监测的风险和成本。
DOI：
10.1038/s41598-018-19406-x
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发表时间：
2018
影响因子：
4.6
通讯作者：
Vora,NeilM
中科院分区：
文献类型：
--
作者：
Reich,NicholasG;Lessler,Justin;Varma,JayK;Vora,NeilM
在致命的新出现病原体爆发期间（例如，埃博拉、中东呼吸综合征冠状病毒）和生物恐怖威胁（例如，天花），积极监测潜在感染者，旨在限制疾病传播和发病率。疾病预防控制中心发布的关于积极监测的指导是其应对西非埃博拉疫情的基石。关于如何平衡这一重要公共卫生活动的成本和绩效的数据有限。我们提出了一个框架，估计风险和成本的特定持续时间的积极监测病原体的重大公共卫生问题。我们分析了2014-2016年16个月期间纽约市埃博拉病毒主动监测计划的数据。对于受监测的个体，我们确定了主动监测的独特持续时间，以最大限度地减少“低（但不是零）风险”和“一些或高风险”的预期成本：分别为21天和31天。将我们的分析扩展到天花和MERS-CoV，我们发现，与埃博拉病毒相比，由于潜伏期变化较小，相对于中位潜伏期的主动监测的最佳长度减少了。主动监测可以挽救生命，但费用昂贵。通过使用确定风险类别来修改主动监测的持续时间或强度，可以最有效地分配资源。
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.