Index case

For the band, see Index Case (band).

The index case, primary case, or patient zero is the initial patient in the population of an epidemiological investigation,[1][2] or more generally, the first case of a condition or syndrome (not necessarily contagious) to be described in the medical literature, whether or not the patient is thought to be the first person affected. An index case will sometimes achieve the status of a "classic" case in the literature, as did Phineas Gage.

The index case may indicate the source of the disease, the possible spread, and which reservoir holds the disease in between outbreaks. The index case is the first patient that indicates the existence of an outbreak. Earlier cases may be found and are labeled primary, secondary, tertiary, etc.[3] The term primary case can only apply to infectious diseases that spread from human to human, and refers to the person who first brings a disease into a group of people.[4]

"Patient Zero" was used to refer to the supposed[5] index case in the spread of HIV in North America.[6]

In genetics, the index case is the case of the original patient (propositus or proband) that stimulates investigation of other members of the family to discover a possible genetic factor.[7]

Gaëtan Dugas case ("Patient Zero")

Main article: Gaëtan Dugas
A now disproven 1984 paper[8] linked 40 AIDS patients by sexual contact. Of those patients, Dugas was supposedly the first to experience an onset of symptoms of AIDS. In the above graph, Dugas is represented by the circle highlighted in red.

In the early years of the AIDS epidemic, a “patient zero” transmission scenario was compiled by Dr. William Darrow and colleagues at the U.S. Centers for Disease Control and Prevention (CDC).[9] This epidemiological study showed how “patient zero” had infected multiple partners with HIV, and they, in turn, transmitted it to others and rapidly spread the virus to locations all over the world (Auerbach et al., 1984). The CDC identified Gaëtan Dugas as a carrier of the virus from Europe to the United States and spreading it to other men he encountered at gay bathhouses.[10]

Journalist Randy Shilts subsequently wrote about Patient Zero, based on Darrow's findings,[9] in his 1987 book And the Band Played On, which identified Patient Zero as Gaëtan Dugas.[11] Dugas was a flight attendant who was sexually promiscuous in several North American cities, according to Shilts' book. He was vilified for several years as a "mass spreader" of HIV, and seen as the original source of the HIV epidemic among homosexual men. Four years later, Darrow repudiated the study's methodology and how Shilts had represented its conclusions.[9]

A 2007 study published in the Proceedings of the National Academy of Sciences of the United States by Michael Worobey and Dr. Arthur Pitchenik claimed that, based on the results of genetic analysis, current North American strains of HIV probably moved from Africa to Haiti and then entered the United States around 1969,[12] probably through a single immigrant. However, Robert Rayford died in St. Louis, Missouri, of complications from AIDS in 1969, and most likely became infected before 1966, so there were prior carriers of HIV strains in North America.[13][14]

The phrase "patient zero" is now used in the media to refer to the index case for infectious disease outbreaks, as well as for computer virus outbreaks, and, more broadly, as the source of ideas or actions that have far-reaching consequences.[15][16][17][18][19]

David Heymann, infectious-disease epidemiologist at the London School of Hygiene & Tropical Medicine, has questioned the importance of finding patient zero and has said: “Finding patient zero may be important in some instances, but only if they are still alive and spreading the disease. And more often than not, especially in large disease outbreaks, they’re not."[20]

Other index patients

In the media

In journalism and documentaries

The thirteenth season of the WNYC radio series Radiolab included an hour-long segment on patients zero.[28]

In fiction

See also

References

  1. "Diseases - Activity 1 - Glossary, page 3 of 5". science.education.nih.gov. Retrieved 2010-11-03.
  2. "WordNet Search - 3.0". Princeton University, wordnetweb.princeton.edu. Retrieved 3 November 2010.
  3. "Sporadic STEC O157 Infection: Secondary Household Transmission in Wales". Centers for Disease Control and Prevention, USA, www.cdc.gov. 1 January 1994. Retrieved 3 November 2010.
  4. Giesecke, Johan. "Primary and index cases". The Lancet. 384 (9959). doi:10.1016/s0140-6736(14)62331-x.
  5. https://www.theguardian.com/science/2016/oct/26/patient-zero-gaetan-dugas-not-source-of-hivaids-outbreak-study-proves
  6. "Patient Zero - definition of Patient Zero in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia". medical-dictionary.thefreedictionary.com. Retrieved 3 November 2010.
  7. "Definition of index case". The free medical dictionary by farlex.
  8. Auerbach, D.M.; W.W. Darrow; H.W. Jaffe; J.W. Curran (1984). "Cluster of cases of the acquired immune deficiency syndrome. Patients linked by sexual contact". The American Journal of Medicine. 76 (3): 487–92. doi:10.1016/0002-9343(84)90668-5. PMID 6608269.
  9. 1 2 3 "The Origin of HIV and the First Cases of AIDS". AVERT, www.avert.org. Retrieved 2010-11-03.
  10. Pence, G. E. (2008). Preventing the Global Spread of AIDS. In Medical Ethics Accounts of the Cases That Shaped and Define Medical Ethics (p. 331). New York, USA, McGraw-Hill.
  11. Matt & Andrej Koymasky - Famous GLTB - Gaëtan Dugas Archived December 14, 2005, at the Wayback Machine.
  12. Bowdler, Neil (2007-10-30). "Key HIV strain 'came from Haiti'". BBC News. Retrieved 2010-05-05.
  13. Patient-Zero Not to Blame The Scientist
  14. Worobey, Michael et al "1970s and ‘Patient 0’ HIV-1 genomes illuminate early HIV/AIDS history in North America" Nature (2016) doi:10.1038/nature19827
  15. "Have Doctors Found Swine "Patient Zero?"". CBS News. 2009-04-29.
  16. "Researchers trawl for Conficker's 'Patient Zero' - Techworld.com". news.techworld.com. Retrieved 2010-11-03.
  17. "Patient Zero". TV.com. 2006-03-20. Retrieved 2010-11-03.
  18. Lemos, Robert. "Witty worm traced to 'Patient Zero'". The Register.
  19. "That Man in the White House". The Weekly Standard. 28 November 2003. Retrieved 3 November 2010.
  20. Mohammadi, Dara (2015-01-15). "Finding patient zero". The Pharmaceutical Journal. 294 (7845). Retrieved 2015-01-16.
  21. "NOVA | The Most Dangerous Woman in America | In Her Own Words". PBS. 1938-11-11. Retrieved 2010-11-03.
  22. "How SARS changed the world in less than six months" (PDF). Bulletin of the World Health Organization. 81 (8). 2003.
  23. Laurance, Jeremy (2003-04-24). "One family went on holiday – and made Toronto a global pariah". The Independent. London. Retrieved 2010-05-05.
  24. "Molecular Interventions - CLOCKSS" (PDF). Retrieved 14 October 2014.
  25. "Have Doctors Found Swine "Patient Zero?"". CBS News. 2009-04-29. Retrieved 2010-11-03.
  26. "Statue erected of first boy in world who caught swine flu". Mirror, www.mirror.co.uk. Retrieved 2009-04-25.
  27. "Finding Ebola's 'patient zero'". The Guardian. Retrieved 28 November 2014.
  28. "Patient Zero - Updated". Radiolab. Season 13, Episode 3. Retrieved November 15, 2015.
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