A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit.

Theodore J Cieslak,Jocelyn J Herstein,Angela L Hewlett,Mark G Kortepeter

doi:10.3390/v11090773

Theodore J Cieslak, Jocelyn J Herstein + Show 2 more

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https://doi.org/10.3390/v11090773

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Journal: Viruses	Publication Date: Aug 22, 2019
Citations: 12	License type: CC BY 4.0

Affiliation: University of Nebraska Medical Center

Abstract

Although the concept of high-level containment care (HLCC or ‘biocontainment’), dates back to 1969, the 2014–2016 outbreak of Ebola virus disease (EVD) brought with it a renewed emphasis on the use of specialized HLCC units in the care of patients with EVD. Employment of these units in the United States and Western Europe resulted in a significant decrease in mortality compared to traditional management in field settings. Moreover, this employment appeared to significantly lessen the risk of nosocomial transmission of disease; no secondary cases occurred among healthcare workers in these units. While many now accept the wisdom of utilizing HLCC units and principles in the management of EVD (and, presumably, of other transmissible and highly hazardous viral hemorrhagic fevers, such as those caused by Marburg and Lassa viruses), no consensus exists regarding additional diseases that might warrant HLCC. We propose here a construct designed to make such determinations for existing and newly discovered diseases. The construct examines infectivity (as measured by the infectious dose needed to infect 50% of a given population (ID50)), communicability (as measured by the reproductive number (R0)), and hazard (as measured by morbidity and mortality). Diseases fulfilling all three criteria (i.e., those that are highly infectious, communicable, and highly hazardous) are considered candidates for HLCC management if they also meet a fourth criterion, namely that they lack effective and available licensed countermeasures.

Highlights

High-level containment care (HLCC, known as ‘biocontainment’) units are highly specialized patient care facilities that employ a number of engineering and administrative controls exceeding those found in more conventional infection control patient care environments (such as airborne infection isolation rooms (AIIRs))
No secondary cases or evidence of nosocomial transmission occurred within these units. While these seeming improvements are based upon a very small number of patients (27 persons were managed in HLCC units in the US and Europe during that outbreak), it lends support to the notion that such units, or at least the provision of critical care and enhanced medical capabilities provided within these units compared with what was available in the field environment, may prove beneficial in Ebola virus disease (EVD) case management and in reducing the risk of nosocomial transmission [3]
China developed an entire specialized containment facility for managing patients with Severe Acute Respiratory Syndrome (SARS) during the 2003 outbreak of that disease [4], and multiple other facilities have managed patients infected with SARS and Middle East Respiratory Syndrome (MERS) under HLCC conditions