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      Cost-effectiveness Analysis of Hospital Infection Control Response to an Epidemic Respiratory Virus Threat


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          Pandemic (H1N1) 2009 can be contained with less expensive measures than some other viruses.


          The outbreak of influenza A pandemic (H1N1) 2009 prompted many countries in Asia, previously strongly affected by severe acute respiratory syndrome (SARS), to respond with stringent measures, particularly in preventing outbreaks in hospitals. We studied actual direct costs and cost-effectiveness of different response measures from a hospital perspective in tertiary hospitals in Singapore by simulating outbreaks of SARS, pandemic (H1N1) 2009, and 1918 Spanish influenza. Protection measures targeting only infected patients yielded lowest incremental cost/death averted of $23,000 (US$) for pandemic (H1N1) 2009. Enforced protection in high-risk areas (Yellow Alert) and full protection throughout the hospital (Orange Alert) averted deaths but came at an incremental cost of up to $2.5 million/death averted. SARS and Spanish influenza favored more stringent measures. High case-fatality rates, virulence, and high proportion of atypical manifestations impacted cost-effectiveness the most. A calibrated approach in accordance with viral characteristics and community risks may help refine responses to future epidemics.

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          Most cited references17

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          Transmissibility of 1918 pandemic influenza

          The 1918 influenza pandemic killed 20–40 million people worldwide 1 , and is seen as a worst-case scenario for pandemic planning. Like other pandemic influenza strains, the 1918 A/H1N1 strain spread extremely rapidly. A measure of transmissibility and of the stringency of control measures required to stop an epidemic is the reproductive number, which is the number of secondary cases produced by each primary case 2 . Here we obtained an estimate of the reproductive number for 1918 influenza by fitting a deterministic SEIR (susceptible-exposed-infectious-recovered) model to pneumonia and influenza death epidemic curves from 45 US cities: the median value is less than three. The estimated proportion of the population with A/H1N1 immunity before September 1918 implies a median basic reproductive number of less than four. These results strongly suggest that the reproductive number for 1918 pandemic influenza is not large relative to many other infectious diseases 2 . In theory, a similar novel influenza subtype could be controlled. But because influenza is frequently transmitted before a specific diagnosis is possible and there is a dearth of global antiviral and vaccine stores, aggressive transmission reducing measures will probably be required. Supplementary information The online version of this article (doi:10.1038/nature03063) contains supplementary material, which is available to authorized users.
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            Severe Acute Respiratory Syndrome (SARS) in Singapore: Clinical Features of Index Patient and Initial Contacts

            Severe acute respiratory syndrome (SARS) is an emerging viral infectious disease. One of the largest outbreaks of SARS to date began in Singapore in March 2003. We describe the clinical, laboratory, and radiologic features of the index patient and the patient’s initial contacts affected with probable SARS.
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              Headaches and the N95 face‐mask amongst healthcare providers

              Background:  During the 2003 severe acute respiratory distress syndrome epidemic, healthcare workers mandatorily wore the protective N95 face‐mask. Methods:  We administered a survey to healthcare workers to determine risk factors associated with development of headaches (frequency, headache subtypes and duration of face‐mask wear) and the impact of headaches (sick days, headache frequency and use of abortive/preventive headache medications). Results:  In the survey, 212 (47 male, 165 female) healthcare workers of mean age 31 years (range, 21–58) participated. Of the 79 (37.3%) respondents who reported face‐mask‐associated headaches, 26 (32.9%) reported headache frequency exceeding six times per month. Six (7.6%) had taken sick leave from March 2003 to June 2004 (mean 2 days; range 1–4 days) and 47 (59.5%) required use of abortive analgesics because of headache. Four (2.1%) took preventive medications for headaches during this period. Multivariate logistic regression showed that pre‐existing headaches [P = 0.041, OR = 1.97 (95% CI 1.03–3.77)] and continuous use of the N95 face‐mask exceeding 4 h [P = 0.053, OR = 1.85 (95% CI 0.99–3.43)] were associated with development of headaches. Conclusions:  Healthcare providers may develop headaches following the use of the N95 face‐mask. Shorter duration of face‐mask wear may reduce the frequency and severity of these headaches.

                Author and article information

                Emerg Infect Dis
                Emerging Infect. Dis
                Emerging Infectious Diseases
                Centers for Disease Control and Prevention
                December 2009
                : 15
                : 12
                : 1909-1916
                [1]National University Health System, Singapore (Y.Y. Dan, P.A. Tambyah, J. Sim, L.Y. Hsu, D.A. Fisher, K.Y. Ho)
                [2]Singapore General Hospital, Singapore (J. Lim, W.L. Chow, Y.S. Wong)
                Author notes
                Address for correspondence: Paul A. Tambyah, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, 5 Lower Kent Ridge Rd, NUH Level 3, Singapore 119074; email: mdcpat@ 123456nus.edu.sg

                Infectious disease & Microbiology
                pandemic (h1n1) 2009,viruses,expedited,nosocomial infections,research,hospital infection control,pandemic,influenza,cost-effectiveness analysis


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