We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Letters |

Modes of Transmission of Hemorrhagic Fever—Reply

Luciana Borio, MD
JAMA. 2002;288(5):571. doi:10.1001/jama.288.5.571.
Text Size: A A A
Published online


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.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.