Fever Incidence Is Much Lower in the Morning than the Evening: Boston and US National Triage Data

So, what's best? Accuracy and acceptance of thermometers in triage and inpatients in a low-resource tropical setting - The MaTe study

Objectives

We searched for the most-suitable thermometry method in the low-resource, tropical setting of Sierra Leone, both in terms of accuracy and also patient and user acceptance.

Methods

We conducted a prospective comparative study of different methods of body temperature measurement. Each participant had their temperature taken by four different methods: non-contact infrared temperature (NCIT), axillary, tympanic membrane and rectal measurements. Rectal temperature was considered clinical gold standard. Primary outcome was predicted sensitivity and specificity of thermometry methods in detecting fever (rectal temperature ≥38.0 °C). Questionnaires were used to explore patient and healthcare worker attitudes towards different methods of temperature-taking.

Results

824 rectal body temperature readings were taken from 562 participants. The mean rectal temperature was 37.4 °C (IQR 37 °C to 37.7 °C), with a minimum reading of 35.2 °C and maximum of 41.0 °C. Tympanic membrane thermometry showed the highest sensitivity of fever detection using the Genius3 TM thermometer (sensitivity 70.8 %, 95 % CI 60.2%-79.9 %; specificity 97.2 %, 95 % CI 95.5-98.4 %); and Braun TM (sensitivity 51.5 %, 95 % CI 42.6%-62.0 %; specificity 98.8 %, 95 % CI 97.7-99.5). NCIT thermometry sensitivity was low (36.8 %-41.4 % for the two devices used). Axillary thermometry sensitivity was 40.6 %. Participants ranked NCIT as the most and rectal as the least preferred method. Questionnaires from 32 participating nurses showed agreeability to using NCIT, TM and axillary methods routinely, but less so for rectal thermometry.

Conclusions

When combining the accuracy of different thermometry methods in detecting fever with user and patient acceptability, tympanic membrane thermometry appears most suitable but also has limitations.

Diurnal Temperature Variation: Addressing Once-Daily Nighttime Fevers in the Era of COVID-19

Pediatric patients with "once-daily" fevers are often referred to pediatric infectious disease specialists for evaluation. Often, these fevers occur at nighttime in the absence of additional symptoms and come to the caregiver's attention after a viral illness. It is crucial for caregivers and providers to be able to define and measure fever accurately when trying to ascertain the true etiology of this clinical picture. Fever education is critical in providing reassurance to parents, and fever diaries should be encouraged. In a well-appearing child without any additional symptoms, at least a percentage of these fevers can be explained by normal diurnal variation of temperature. [Pediatr Ann. 2022;51(5):e202-e205.].

Spatio-temporal Differentiation in the Incidence of Influenza and Its Relationship with Air Pollution in China from 2004 to 2017

The Healthy China Initiative is a major health strategy being pursued by the country. To prevent and control different types of diseases as well as their complex variants, research on the spatio-temporal differentiation among and mechanisms of influence of epidemic diseases is growing worldwide. This study analyzed monthly data on the incidence of influenza by using different methods, including Moran's I, the hotspot analysis model, concentration analysis, and correlation analysis, to determine the characteristics of spatio-temporal differentiation in the incidence of influenza across prefecture-level cities in China from 2004 to 2017, and to examine its relationship with air pollution. According to the results, the overall incidence of influenza in China exhibited a trend of increase from 2004 to 2017, with small peaks in 2009 and 2014. More cases of influenza were recorded in the first and fourth quarters of each year. Regions with higher incidences of influenza were concentrated in northwestern and northern China, and in the coastal areas of southeastern China. Over time, the distribution of regions with a higher incidence of influenza has shifted from the west to the east of the country. A significant relationship was observed between the incidence of influenza and factors related to air pollution. The contents of five air pollutants (PM2.5, PM10, SO2, NO2, and CO) were significantly positively correlated with the incidence of influenza, with a decreasing order of contribution to it of SO2 > CO > NO2 > PM2.5 > PM10. The content of O3 in the air was negatively correlated with the incidence of influenza. The influence of air pollution-related factors on the incidence of influenza in different regions and seasons showed minor differences. The large-scale empirical results provided here can supply a scientific basis for governmental disease control authorities to formulate strategies for regional prevention and control.

Feasibility and effectiveness of daily temperature screening to detect COVID-19 in a prospective cohort at a large public university

BACKGROUND

Many persons with active SARS-CoV-2 infection experience mild or no symptoms, presenting barriers to COVID-19 prevention. Regular temperature screening is nonetheless used in some settings, including university campuses, to reduce transmission potential. We evaluated the potential impact of this strategy using a prospective university-affiliated cohort.

METHODS

Between June and August 2020, 2912 participants were enrolled and tested for SARS-CoV-2 by PCR at least once (median: 3, range: 1-9). Participants reported temperature and symptoms daily via electronic survey using a previously owned or study-provided thermometer. We assessed feasibility and acceptability of daily temperature monitoring, calculated sensitivity and specificity of various fever-based strategies for restricting campus access to reduce transmission, and estimated the association between measured temperature and SARS-CoV-2 test positivity using a longitudinal binomial mixed model.

RESULTS

Most participants (70.2%) did not initially have a thermometer for taking their temperature daily. Across 5481 total person months, the average daily completion rate of temperature values was 61.6% (median: 67.6%, IQR: 41.8-86.2%). Sensitivity for SARS-CoV-2 ranged from 0% (95% CI 0-9.7%) to 40.5% (95% CI 25.6-56.7%) across all strategies for self-report of possible COVID-19 symptoms on day of specimen collection, with corresponding specificity of 99.9% (95% CI 99.8-100%) to 95.3% (95% CI 94.7-95.9%). An increase of 0.1 °F in individual mean body temperature on the same day as specimen collection was associated with 1.11 increased odds of SARS-CoV-2 positivity (95% CI 1.06-1.17).

CONCLUSIONS

Our study is the first, to our knowledge, that examines the feasibility, acceptability, and effectiveness of daily temperature screening in a prospective cohort during an infectious disease outbreak, and the only study to assess these strategies in a university population. Daily temperature monitoring was feasible and acceptable; however, the majority of potentially infectious individuals were not detected by temperature monitoring, suggesting that temperature screening is insufficient as a primary means of detection to reduce transmission of SARS-CoV-2.