Mass Fever Screening | CDC EID

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Volume 16, Number 11–November 2010
Research
Comparison of 3 Infrared Thermal Detection Systems and Self-Report for Mass Fever Screening

An V. Nguyen, Nicole J. Cohen, Comments to Author Harvey Lipman,1 Clive M. Brown, Noelle-Angelique Molinari, William L. Jackson, Hannah Kirking, Paige Szymanowski, Todd W. Wilson, Bisan A. Salhi, Rebecca R. Roberts, David W. Stryker, and Daniel B. Fishbein
Author affiliations: Centers for Disease Control and Prevention, Atlanta, Georgia, USA (A.V. Nguyen, N.J. Cohen, H. Lipman, C.M. Brown, N.A. Molinari, W.L. Jackson, H. Kirking, P. Szymanowski, T.W. Wilson, D.B. Fishbein); Council of State and Territorial Epidemiologists, Atlanta (A.V. Nguyen); Emory University, Atlanta (P. Szymanowski, B.A. Salhi); John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois, USA (R.R. Roberts); and Presbyterian Healthcare Services, Albuquerque, New Mexico, USA (D.W. Stryker)

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Abstract
Despite limited evidence regarding their utility, infrared thermal detection systems (ITDS) are increasingly being used for mass fever detection. We compared temperature measurements for 3 ITDS (FLIR ThermoVision A20M [FLIR Systems Inc., Boston, MA, USA], OptoTherm Thermoscreen [OptoTherm Thermal Imaging Systems and Infrared Cameras Inc., Sewickley, PA, USA], and Wahl Fever Alert Imager HSI2000S [Wahl Instruments Inc., Asheville, NC, USA]) with oral temperatures (>100°F = confirmed fever) and self-reported fever. Of 2,873 patients enrolled, 476 (16.6%) reported a fever, and 64 (2.2%) had a confirmed fever. Self-reported fever had a sensitivity of 75.0%, specificity 84.7%, and positive predictive value 10.1%. At optimal cutoff values for detecting fever, temperature measurements by OptoTherm and FLIR had greater sensitivity (91.0% and 90.0%, respectively) and specificity (86.0% and 80.0%, respectively) than did self-reports. Correlations between ITDS and oral temperatures were similar for OptoTherm (ρ = 0.43) and FLIR (ρ = 0.42) but significantly lower for Wahl (ρ = 0.14; p<0.001). When compared with oral temperatures, 2 systems (OptoTherm and FLIR) were reasonably accurate for detecting fever and predicted fever better than self-reports. Advancements in transportation coupled with the growth and movement of human populations enable efficient transport of infectious diseases almost anywhere in the world within 24 hours (1). This recognition has prompted the evaluation of rapid mass screening methods to delay the importation of infection into healthcare settings, communities, and countries (1–4). Because fever is a common indicator of many infectious diseases, the rapid identification of fever is a major component of screening efforts. Such screening was used by many countries during the severe acute respiratory syndrome outbreak in 2003 and the influenza A pandemic (H1N1) 2009 outbreak (2,3,5–8). Despite widespread implementation of fever screening, its value for detecting highly communicable diseases has mainly been established through mathematical modeling rather than through studies in humans (9,10). One approach to fever screening is to simply ask persons if they have a fever. In healthcare settings, this information is routinely obtained in the chief complaint or review of symptoms and in some situations by querying persons as they enter the facility (11). In travel settings, many countries have used a written health declaration to screen travelers arriving at international ports of entry (2). However, limited information exists on the accuracy of self-reported fever, which is biased by its subjective nature and reliance on travelers' awareness of fever status and willingness to report (12,13). Indeed, a clinical trial suggested that traditional thermometry is superior to self-reported fever for identifying patients with seasonal influenza (14). However, traditional thermometry methods are time-consuming and require close contact with potentially infectious patients. Infrared thermal detection systems (ITDS) offer a potentially useful alternative to contact thermometry. This technology was used for fever screening at hospitals, airports, and other mass transit sites during the severe acute respiratory syndrome and influenza A pandemic (H1N1) 2009 outbreaks (2,3,5–8,15). ITDS appeared to enable early detection of febrile persons entering healthcare facilities, where the undetected introduction of communicable diseases can lead to outbreaks among patients and staff (5,16–18). Although ITDS have the potential to serve as rapid, noninvasive screening tools for detecting febrile persons, previous studies provide conflicting information about their utility for mass fever screening (15,16,19–25). In addition, there are few published comparisons of the efficacy of different ITDS and their suitability for mass fever screening (19). Finally, no studies on the relative accuracy of self-reported fever and ITDS for fever screening or the value of combining these 2 methods have been published. These questions and the potential need to rapidly screen for fever during an emerging pandemic prompted us to conduct this study to validate different ITDS temperatures and self-reported fevers with oral temperatures. full-text: Mass Fever Screening | CDC EID

Suggested Citation for this Article

Nguyen AV, Cohen NJ, Lipman H, Brown CM, Molinari N-A, Jackson WL, et al. Comparison of 3 infrared thermal detection systems and self-report for mass fever screening. Emerg Infect Dis [serial on the Internet]. 2010 Nov [date cited]. http://www.cdc.gov/EID/content/16/11/1710.htm

DOI: 10.3201/eid1611.100703