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Modes of Transmission of Hemorrhagic Fever—Reply

Luciana Borio, MD
JAMA. 2002;288(5):571. doi:10.1001/jama.288.5.571.
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In Reply: We agree with Dr Rigau-Pérez that transmission of dengue by needlestick injury and bone marrow transplantation is possible. We excluded dengue from our analysis for reasons we discussed in our article. Although cases of nosocomial transmission of yellow fever have not been reported, it would be prudent to assume that exposure to a viremic patient through needlestick injury or bone marrow transplantation could transmit infection.

In response to Dr Morse, we stated that all of the viruses we reviewed are "highly infectious in the laboratory setting and may be transmitted via small-particle aerosol," as exemplified by his own unfortunate experience. This is why these viruses are routinely handled only in biosafety level 4 laboratories. Such infectivity poses great problems for patient care in the event of an outbreak. We favor the use of point-of-care analyzers to process clinical specimens of patients at the bedside, thereby precluding the need for aerosol-generating procedures and exposure of laboratory workers. In the event that point-of-care analyzers are not available or feasible, we suggest additional precautions to reduce the risk of accidental infection of laboratory workers.

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