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Open AccessArticle

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

1
Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
2
Department of Environmental, Agricultural & Occupational Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
3
Department of Medicine, Division of Infectious Diseases, College of Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
*
Author to whom correspondence should be addressed.
The views expressed herein are those of the authors and do not necessarily reflect the position of the University of Nebraska or its component entities.
Viruses 2019, 11(9), 773; https://doi.org/10.3390/v11090773
Received: 9 July 2019 / Revised: 14 August 2019 / Accepted: 19 August 2019 / Published: 22 August 2019
(This article belongs to the Special Issue Medical Advances in Viral Hemorrhagic Fever Research)
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. View Full-Text
Keywords: high-level containment care; biocontainment; highly hazardous communicable disease; Ebola virus disease; infectivity; communicability high-level containment care; biocontainment; highly hazardous communicable disease; Ebola virus disease; infectivity; communicability
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Cieslak, T.J.; Herstein, J.J.; Kortepeter, M.G.; Hewlett, A.L. A Methodology for Determining Which Diseases Warrant Care in a High-Level Containment Care Unit. Viruses 2019, 11, 773.

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