A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit
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 o...
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| Format: | Article |
| Language: | English |
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MDPI AG
2019-08-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/11/9/773 |
| _version_ | 1828874686544478208 |
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| author | Theodore J. Cieslak Jocelyn J. Herstein Mark G. Kortepeter Angela L. Hewlett |
| author_facet | Theodore J. Cieslak Jocelyn J. Herstein Mark G. Kortepeter Angela L. Hewlett |
| author_sort | Theodore J. Cieslak |
| collection | DOAJ |
| description | 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 (ID<sub>50</sub>)), communicability (as measured by the reproductive number (R<sub>0</sub>)), 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. |
| first_indexed | 2024-12-13T07:43:20Z |
| format | Article |
| id | doaj.art-a11f47997e4e4c1f93d4e103a8563ee5 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-12-13T07:43:20Z |
| publishDate | 2019-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Viruses |
| spelling | doaj.art-a11f47997e4e4c1f93d4e103a8563ee52022-12-21T23:54:55ZengMDPI AGViruses1999-49152019-08-0111977310.3390/v11090773v11090773A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care UnitTheodore J. Cieslak0Jocelyn J. Herstein1Mark G. Kortepeter2Angela L. Hewlett3Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USADepartment of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USADepartment of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USADepartment of Medicine, Division of Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USAAlthough 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 (ID<sub>50</sub>)), communicability (as measured by the reproductive number (R<sub>0</sub>)), 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.https://www.mdpi.com/1999-4915/11/9/773high-level containment carebiocontainmenthighly hazardous communicable diseaseEbola virus diseaseinfectivitycommunicability |
| spellingShingle | Theodore J. Cieslak Jocelyn J. Herstein Mark G. Kortepeter Angela L. Hewlett A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit Viruses high-level containment care biocontainment highly hazardous communicable disease Ebola virus disease infectivity communicability |
| title | A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit |
| title_full | A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit |
| title_fullStr | A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit |
| title_full_unstemmed | A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit |
| title_short | A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit |
| title_sort | methodology for determining which diseases warrant care in a high level containment care unit |
| topic | high-level containment care biocontainment highly hazardous communicable disease Ebola virus disease infectivity communicability |
| url | https://www.mdpi.com/1999-4915/11/9/773 |
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