Outbreak Investigations

What are the four purposes of outbreak investigation

1. identify the cause

2. identify the source

3. apply methods to control

4. identify measure to prevent

What is the primary aim of outbreak investigation

methods to control

What are the 10 outbreak investigation steps

1. prepare for field work

2. confirm existence of outbreak

3. verify Dx.

4. establish working case definition

5. identify causes

6. consider implementing control measures now

7. perform descriptive epidemiology

8. test hypothesis

9. implement control measures

10. communicate findings

what is testing hypotheses also known as

analytic epidemiology

what three things are involved in preparing for field work

1. investigation needs (supplies)

2. administrative needs (leader)

3. logistics and dynamics (where? who?)

how do you confirm the existence of an outbreak

know what is normal and use surveillence

_____ disease surveillance reports notifiable diseases submitted by physicians and diagnostic labs

passive

_____ disease surveillance involves visiting health facilities, talking with staff, reviewing medical records

active

what does sentinel surveillance focus on

animal groups where diseases or exposure are likely to be detected

what are three sentinel examples

1. flocks (WNV)

2. wild migratory waterfowl (Avian flu)

3. mosquitos (zoonotic agents)

what is syndromic surveillance

compilation of reports and signs/symptoms in patients (how data is obtained)

examples of syndromic surveillance

healthcare records or social media

what three things are included in verify diagnosis

1. ensure proper diagnosis

2. examine initial case patients

3. review medical records

what is a working case definition used for

to identify if someone is a case or not

what four components are in the working case definition

clinical presentation, who, where, when

what are the four modes of transmission

direct, indirect, foodborne, vector born

what disease showed a spike in cases when CDC changed case definiton

AIDS

what is the goal when identifying cases

determine extent of outbreak and identify cases of analytic study (case control)

how do you conduct systematic, comprehensive searched to identify cases

use multiple sources and list and organize cases

an index case the ____ _____ of disease outbreak

first case

what two things are notable about index cases

1. not always known

2. most commonly used in epidemiologic investigation

removing/eliminating from further exposure, isolation of exposed, quarantine sick, public health education/communication, and vector control are all examples of..

implementing control measures now

even without all the answers....

some control measures can usually be applied

summarize data, provide comprehensive characterization of outbreak, identify/infer population at risk are examples of

performing descriptive epidemiology

what does descriptive epidemiology include

person, place, time (epi curve)

Decriptive epidemiology can be turned into...

a testable hypothesis

what can knowing the causative agent of a disease tell you

the average incubation period

how do you determine when exposure occurs using epi curve

count back from peak of outbreak

how can you test the hypothesis (3)

1. review descriptive epidemiology

2. analytic epidemiology options (cohort or case control study)

3. additional analytic studies (environmental & labratory)

eliminate source (remove bad food), interrupting transmission (spray mosquitoes), and reducing susceptibility (vaccinate) are all ways to...

implement control measures

Why is it important to communicate findings

justify recommendations and legal purposes

what are some methods to communicate findings

trip report, peer-review journal, oral presentation

what does disease reporting allow authorities to do

monitor and provide early warning

what does the state vet do

works on zoonotic disease control and prevention

U.S. public health agency operates under the Department of Health & Human Services

Assists state & local health departments in all aspects of disease epidemiology

Promotes disease prevention & health promotion

Centers for disease control and preventions (CDC)

Responsible for oversight of movement/importation of animals

Food-producing animals up to the time of slaughter

Reportable diseases

Animal Plant Health Inspection Service (APHIS) (part of USDA)

Responsible for oversight of humane slaughter & food safety during processing

Food Safety Inspection Service (FSIS) (part of USDA)

Health agency within the United Nations

Mission:

Promote health care cooperation among nations

Carry out disease control & eradication programs

Preparedness, surveillance, & response

World Health Organization (WHO)

Mission:

Ensure transparency in global animal disease

Collect, analyze, & share veterinary information from around the globe

Ensure safety of internationally traded animals/products

Promote safety of food from animal origins

World Organization for Animal Health (OIE)

what is the similarity of human and animal disease outbreaks

approaches used for investigation

what are four nuanced differences in human and animal disease outbreaks

1. communication

2. control of movement

3. availability and protocol for testing

4. control measures

interdisciplinary teams, joint training, shared supplies, consistent messaging to stakeholders, streamline data, integrated analysis, joint interviewing of cases, and improved community acceptance are all ways that....

the one health approach is useful

the four types of surveillence

active, passive, sentinel, syndromatic

case definition includes

clinical signs, person, place, time