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Volume 11, Number 2—February 2005

Perspective

Managing Febrile Respiratory Illnesses during Hypothetical SARS Outbreaks

Kamran Khan*Comments to Author , Peter Muennig†, Michael Gardam‡, and Joshua Graff Zivin†
Author affiliations: *St. Michael’s Hospital, Toronto, Ontario, Canada; †Columbia University, New York, New York, USA; ‡University Health Network, Toronto, Ontario, Canada

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Table 2

Selected probabilities in the decision-analysis model*

Selected probabilities Low Base High Source
Diagnostic tests
Sensitivity of influenza test 0.50 0.70 0.90 19
Specificity of influenza test 0.80 0.95 0.99 19
Sensitivity of multiplex† RT-PCR 0.70 0.85 0.95 20–22
Specificity of multiplex† RT-PCR 0.80 0.987 0.99 20–22
Sensitivity of SARS‡ RT-PCR 0.25 0.70 0.95 4,23
Specificity of SARS‡ RT-PCR 0.95 0.994 1.00 23,24
Morbidity and mortality
Hospitalization due to influenza 0.002 0.004 0.01 25
Death due to influenza 0.0 0.0012 0.01 25,26
Hospitalization due to FRI 0.010 0.015 0.02 Calculated
Death due to FRI 0.0 0.0009 0.01 Calculated
Death due to SARS 0.10 0.15 0.20 24
Miscellaneous probabilities
Probability of an FRI 0.10 0.33 0.50 27
Due to influenza 0.20 0.33 0.50 11,25,27,28
Due to multiplex† organisms other than influenza 0.20 0.33 0.50 29,30
Due to other causes§ 0.20 0.33 0.50 Calculated
Due to SARS 0.0 0.0001 0.01 Assigned
Influenza vaccine effectiveness 0.35 0.67 0.85 31
Annual probability of poor match between vaccine and circulating influenza strains 0.05 0.20 0.50 31
Probability of successful self-care management of an FRI at home 0.33 0.67 1.00 Assumption
Probability of receiving outpatient antimicrobial drugs for an FRI 0.33 0.67 1.00 32
Miscellaneous values
Patient time for outpatient medical visit (min) 30 50 90 Estimate
Influenza length of illness (d) 3 7 10 31
Other FRI¶ length of illness (d) 1 3 5 Estimate
Average duration of hospitalization, influenza (d) 5 10.2 15 14
Average duration of hospitalization, FRI¶ (d) 3 7.7 10 14
Average duration of hospitalization, SARS (d) 10 16 30 15
HRQL scores
SARS, hospitalized 0.05 0.160 0.50 HUI
SARS, outpatient 0.25 0.670 0.75 HUI
SARS, contact 0.50 0.785 0.95 HUI
FRI, hospitalized 0.25 0.511 0.75 HUI
FRI, outpatient 0.50 0.804 0.95 HUI
Reproductive number for SARS# 2 3 4 9,10
Contact investigations (per SARS case) 25 50 100 5

*RT-PCR, reverse transcriptase–polymerase chain reaction; SARS, severe acute respiratory syndrome; FRI, febrile respiratory illness; HRQL, health-related quality of life; HUI, Health Utilities Index.
†Refers to influenza viruses A and B, respiratory syncytial viruses A and B, parainfluenza viruses 1–3, human metapneumovirus, Legionella pneumophila, L. micdadei, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis.
‡Detects SARS-associated coronavirus and coronaviruses OC43 and 229E.
§Febrile respiratory illnesses not due to SARS, influenza viruses A and B, respiratory syncytial viruses A and B, parainfluenza viruses 1–3, human metapneumovirus, L. pneumophila, L. micdadei, M. pneumoniae, C. pneumoniae, and B. pertussis.
¶Febrile respiratory illnesses not due to SARS or influenza viruses A and B.
#In the absence of public health interventions.

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