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Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases

Nicholas G Reich, Justin Lessler, Jay K Varma, Neil M Vora
doi: https://doi.org/10.1101/156497
Nicholas G Reich
1University of Massachusetts, Amherst, Massachusetts, USA
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Justin Lessler
2Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Jay K Varma
3New York City Department of Health and Mental Hygiene, USA
4Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Neil M Vora
3New York City Department of Health and Mental Hygiene, USA
4Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Abstract

During outbreaks of deadly emerging pathogens (e.g., Ebola, MERS-CoV) and bioterror threats (e.g., smallpox), actively monitoring potentially infected individuals aims to limit disease transmission and morbidity. Guidance issued by CDC on active monitoring was a cornerstone of its response to the West Africa Ebola outbreak. There are limited data on how to balance the costs and performance of this important public health activity. We present a framework that estimates the risks and costs of specific durations of active monitoring for pathogens of significant public health concern. We analyze data from New York City’s Ebola active monitoring program over a 16-month period in 2014-2016. For monitored individuals, we identified unique durations of active monitoring that minimize expected costs for those at “low (but not zero) risk” and “some or high risk”: 21 and 31 days, respectively. Extending our analysis to smallpox and MERS-CoV, we found that the optimal length of active monitoring relative to the median incubation period was reduced compared to Ebola due to less variable incubation periods. Active monitoring can save lives but is expensive. Resources can be most effectively allocated by using exposure-risk categories to modify the duration or intensity of active monitoring.

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The copyright holder for this preprint is the author/funder, who has granted bioRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license.
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Posted June 28, 2017.
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Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases
Nicholas G Reich, Justin Lessler, Jay K Varma, Neil M Vora
bioRxiv 156497; doi: https://doi.org/10.1101/156497
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Quantifying the Risk and Cost of Active Monitoring for Infectious Diseases
Nicholas G Reich, Justin Lessler, Jay K Varma, Neil M Vora
bioRxiv 156497; doi: https://doi.org/10.1101/156497

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