Abstract
Since the World Health Organization declared the global outbreak of severe acute respiratory syndrome (SARS) contained in July 2003, new cases have periodically reemerged in Asia. This situation has placed hospitals and health officials worldwide on heightened alert. In a future outbreak, rapidly and accurately distinguishing SARS from other common febrile respiratory illnesses (FRIs) could be difficult. We constructed a decision-analysis model to identify the most efficient strategies for managing undifferentiated FRIs within a hypothetical SARS outbreak in New York City during the season of respiratory infections. If establishing reliable epidemiologic links were not possible, societal costs would exceed 2.0 billion US dollars per month. SARS testing with existing polymerase chain reaction assays would have harmful public health and economic consequences if SARS made up <0.1% of circulating FRIs. Increasing influenza vaccination rates among the general population before the onset of respiratory season would save both money and lives.
Highlights
Since the World Health Organization declared the global outbreak of severe acute respiratory syndrome (SARS) contained in July 2003, new cases have periodically reemerged in Asia
If SARS were to resurface during the 2004–2005 respiratory season and the timely establishment of epidemiologic links between SARS cases was not possible, our analysis estimates that the societal costs for New York City would exceed $2.0 billion for each month in which the SARS outbreak and respiratory season coincided
In our base-case analysis, we found the use of multiplex PCR assays to detect infections with a broad panel of common respiratory pathogens to be the dominant strategy, saving $79 million and resulting in the gain of 8,474 quality-adjusted life-years (QALYs) relative to a strategy of home isolation
Summary
Since the World Health Organization declared the global outbreak of severe acute respiratory syndrome (SARS) contained in July 2003, new cases have periodically reemerged in Asia. This reemergence of the SARS-associated coronavirus (SARS-CoV) has sparked international concern and has prompted heightened surveillance by hospitals and health officials worldwide Such concerns have been amplified by fears that a future SARS outbreak could coincide with respiratory infection season, when influenza infections and other febrile respiratory illnesses (FRIs) develop in large segments of the population. In 2003 and 2004, the emergence of SARS-CoV in China coincided with respiratory illness season, which suggests that the virus may resurface during winter months, like many other respiratory pathogens Should this seasonal pattern recur, rapidly and accurately differentiating SARS infections from other FRIs would become a critical component of any future outbreak containment efforts [2,3].
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