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Identifying the Probable Timing and Setting of Respiratory Virus Infections

Published online by Cambridge University Press:  02 January 2015

Justin Lessler ,
Ron Brookmeyer ,
Nicholas G. Reich ,
Kenrad E. Nelson ,
Derek A. T. Cummings  and
Trish M. Perl
Justin Lessler*
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, Maryland
Ron Brookmeyer
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, Maryland
Nicholas G. Reich
Affiliation:
Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, Maryland
Kenrad E. Nelson
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, Maryland
Derek A. T. Cummings
Affiliation:
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Hospital, Baltimore, Maryland
Trish M. Perl
Affiliation:
Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, Maryland
*
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, E6545, Baltimore, MD 21205 (jlessler@jhsph.edu)
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Abstract

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Objective.

Show how detailed incubation period estimates can be used to identify and investigate potential healthcare-associated infections and dangerous diseases.

Methods.

We used the incubation period of 9 respiratory viruses to derive decision rules for distinguishing between community- and hospital-acquired infection. We developed a method, implemented in a simple spreadsheet, that can be used to investigate the exposure history of an individual patient and more specifically to identify the probable time and location of infection. Illustrative examples are used to explain and evaluate this technique.

Results.

If the risks of hospital and community infection are equal, 95% of patients who develop symptoms of adenovirus infection within 5 days of hospital admission will have been infected in the community, as will 95% of patients who develop symptoms within 3 days for human-coronavirus infection, 2.5 days for severe acute respiratory syndrome, 1 day for influenza A, 0.5 day for influenza B, 12 days for measles, 2 days for parainfluenza, 4 days for respiratory syncytial virus infection, and 1.5 days for rhinovirus infection. Sources of infection suggested by analysis of the symptom onset times of individual patients are consistent with those from detailed investigations.

Conclusions.

This work shows how a detailed understanding of the incubation period can be an effective tool for identifying the source of infection, ultimately ensuring patient safety.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 8 , August 2010 , pp. 809 - 815
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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