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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 4

Threshold values from one-way sensitivity analyses*

SARS prevalence (%)† Appropriate strategy
Broad testing capabilities‡
<0.1% Multiplex§ RT-PCR testing alone is the most effective and least expensive (i.e., dominant) strategy.
0.1%–0.9% Combination of SARS and multiplex§ RT-PCR testing is the most effective strategy, while multiplex PCR testing alone is the least expensive strategy.
>0.9% Combination of SARS and multiplex‡ RT-PCR§ testing is the most effective strategy, while home isolation is the least expensive strategy.
Intermediate testing capabilities¶
<0.9% Multiplex§ RT-PCR testing alone is the most effective and least expensive (i.e., dominant) strategy.
>0.9% Multiplex§ RT-PCR testing alone is the most effective strategy, while home isolation is the least expensive strategy.
Minimal testing capabilities#
<1.9% Rapid influenza testing is more effective than home isolation.
Any Home isolation is less expensive than rapid influenza testing.
Influenza is >36% of FRIs Rapid influenza testing is the dominant strategy.

*SARS, severe acute respiratory syndrome; FRI, febrile respiratory illness; RT-PCR, reverse transcription–polymerase chain reaction.
†Prevalence or pretest probability of SARS among circulating FRIs.
‡Capable of performing rapid influenza antigen detection tests, multiplex polymerase chain reaction assays to detect influenza viruses A and B, respiratory syncytial viruses A and B, parainfluenza viruses 1–3, human metapneumovirus, Bordetella pertussis, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella pneumophila, and L. micdadei, and coronavirus assays to detect SARS-associated coronavirus and coronaviruses OC43 and 229E (with test turnaround times <24 hours).
§Refers to influenza viruses A and B, respiratory syncytial viruses A and B, parainfluenza viruses 1–3, human metapneumovirus, B. pertussis, C. pneumoniae, M. pneumoniae, L. pneumophila, and L. micdadei.
¶Capable of performing rapid influenza antigen detection tests, multiplex PCR assays to detect influenza viruses A and B, respiratory syncytial viruses A and B, parainfluenza viruses 1–3, human metapneumovirus, B. pertussis, C. pneumoniae, M. pneumoniae, L. pneumophila, and L. micdadei (with test turnaround times of <24 hours).
#Capable of performing rapid influenza antigen detection tests (with test turnaround times of <24 hours).

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