Week 15 - Outbreak Investigation

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Baseline

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64 Terms

1

Baseline

Amount of a disease that is usually present in a community; The observed but not necessarily the desired level; regarded as the expected level of disease

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Sporadic

A disease that occurs infrequently and irregularly.

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3

Endemic

The constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.

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4

Hyperendemic

The persistently high levels of disease occurrence.

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5

Epidemic

An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.

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6

Outbreak

Similar to an epidemic but is often used for a more limited geographic area.

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7

Cluster

An aggregation of cases grouped in a place and time that are suspected to be greater than the number expected, even though the expected number maybe unknown.

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8

Pandemic

An epidemic that has spread over several countries or continents, usually affecting a large number of people.

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9

Epidemic

Occurrence of disease cases of deaths; Limited to specified group of individuals during a short period of time; Excess of normal expectancy.

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10

👾 Agents and hosts are present in adequate number. 👾 Agent can be effectively conveyed from source to host.

How does epidemic occur?

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🦭 Recent increase in virulence of agent 🦭 Recent introduction of agent into a settling 🦭 Enhanced mode of transmission 🦭 Change in susceptibility 🦭 Increase host exposure 🦭 Introduction of agent through new portals entry

Factors which may trigger an epidemic:

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12

Prevention and Control

Primary Public Health reason for investigation; Principal considerations

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13

Prevent occurrence of additional cases

Main goal if cases are continuing to occur:

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14

To assess the extent of the outbreak, the size, and characteristics of the population at risk.

Main objective if cases are continuing to occur:

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15

Prevent similar outbreaks in the future.

Main goal if an outbreak appears to be almost over:

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16

To identify factors which contributed to the outbreak.

Main objective if an outbreak appears to be almost over:

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17

Gain additional knowledge/research

An opportunity to study the natural history of the disease in question; Field investigation provides an opportunity to define the natural history; Are able to characterize the populations at greater risk; Assessing impact of control measures.

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18

Training

Requires combination of diplomacy, logical thinking, problem-solving ability, quantitative skills, epidemiologic know-how and judgment; Improve with practice and experience; Seasoned epidemiologist with trainee/s.

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19

Public, Political, and Legal Concerns

Override scientific concerns in the decision to conduct investigation; Public has taken an interest in ‘disease clusters’ and potential environmental exposures.

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20

Program consideration

Targeted by a public health program; May reveal a weakness in that program and provide an opportunity to modify/strengthen the program’s efforts; May identify populations which may have been overlooked.

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21

🦈 Investigation 🦈 Administration 🦈 Consultation

Preparation can be grouped into:

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22

Investigation

Appropriate scientific knowledge, supplies, and equipment; consult regarding epidemic, laboratory specimen collection, storage, and transport.

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23

Administration

Travel arrangements and travel orders.

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24

Consultation

Specific roles and responsibilities.

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25

Verify the Diagnosis and Confirm Outbreak

Confirm laboratory testing; Rule out misdiagnoses or laboratory error.

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26

🐔 Regular analysis of surveillance data-detect unusual patterns 🐔 Calls from a health care provider who knows of several cases 🐔 Media reports

Knowledge/Awareness of an existence of an epidemic through:

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27

🫁 True outbreaks with a common cause 🫁 Sporadic and unrelated cases of the same disease 🫁 Unrelated cases of similar but unrelated disease

Initial investigation may turn out to be:

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28

🥖 Number of cases from the previous few weeks 🥖 Number of cases from a comparable period 🥖 Surveillance data if disease is a notifiable disease 🥖 Hospitals discharge record 🥖 Apply rates from neighboring areas 🥖 Conduct survey of the community

Comparison of the number of observed number of cases with the expected number which can be:

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🥼 Existence of a true outbreak 🥼 Changes in local reporting procedures 🥼 Changes in the case definition 🥼 Increased interest 🥼 Improvements in diagnostic procedures 🥼 Sudden increases in size of population

Factors which could explain excess cases:

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30

💨 Severity of the illness 💨 The potential for spread 💨 Political consideration 💨 Public relations 💨 Availability of resources

Factors influencing decision regarding investigation of the outbreak:

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🎃 Symptoms/Laboratory Results 🎃 Time period 🎃 Location

Develop a specific case definition using:

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32

🥶 Existing surveillance 🥶 Active surveillance

Conduct surveillance using case definition:

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33

Case Definition

Allows a simple, uniform way to identify cases; “Standardizes” the investigation; Unique to outbreak; Objective Criteria

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34

Confirmed Probable Suspected

Categories of Cases

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35

Confirmed

Symptoms characteristics of the agent; Lab test; Epidemiologic link

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36

Probable

Symptoms confirmed; No lab or epidemiologic link

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37

Suspected

Symptoms are reported but not confirmed; No lab or epidemiologic link

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38

Tabulate and Orient Data

Create a line listing of identified cases.

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39

Epidemic Curve

Graphical depiction of the number of cases of illness by the date of illness onset; Can provide information on the following characteristics of an outbreak.

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40

Pattern of spread Magnitude Outliers Time trend Exposure/Incubation Period

Characteristics of an outbreak:

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41

Common Source Propagated Mixed

Types of Outbreak

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42

Common Space

People are exposed continuously or intermittently; Exposure maybe brief or long; Exposure often results in an epi curve with irregular peaks

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43

Common Source - Common Point Source

Cases were all exposed to the same source during a brief period; Sharp upward slope and a gradual downward slope; All cases occur within one incubation period.

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44

Common Source - Continuous Exposure

Continuous exposure will often cause cases to rise gradually.

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45

Common Source - Intermittent

Brief, sporadic exposure period; Irregular peaks reflect timing and extent of exposure.

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46

Propagated Epidemic

Spread is from person-to-person; Can last longer than source outbreaks; Agent may replicate in a susceptible host; May have multiple waves

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47

👾 Acute food poisoning; Staphylococci toxins, C. perfringens 👾 Heavy metal exposure: cadmium, copper, zinc 👾 Other poisonings: MSG, mushroom, shellfish poisoning

Time Frame (Incubation Period): Hours

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👾 Some food poisonings: Salmonella (1-2 days), V. cholerae, C. jejuni 👾 Bacterial infections: Legionnaire’s disease, Mycoplasma pneumoniae 👾 Viral infections: influenza (1-3 days), adenovirus (1-5 days), enteroviral infections (5-6 days)

Time Frame (Incubation Period): Days

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49

🎃 Common childhood disease: measles, mumps, rubella (2-3 weeks) 🎃 Hepatitis A (2-6 weeks)

Time Frame (Incubation Period): Weeks

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🌷 Hepatitis B (2-6 weeks) 🌷 Rabies (0.5-12 months)

Time Frame (Incubation Period): Months

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51

🦭 Radiation induced leukemia 🦭 Kuru (1-27 years)

Time Frame (Incubation Period): Years

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52

Mixed Pandemic

Both a single, common exposure to an infectious agent and secondary propagative spread to other individuals; Either same disease introduced separately or different diseases with different incubation periods.

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53

Number of susceptible persons The period of time The minimum and maximum incubation periods

Factors Affecting Duration of an Epidemic

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54

Attack Rate

Special cumulative incidence that measures the proportion of persons in an population who experience an acute health event during a limited time.

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55

Attack Rate

Number of new cases of a health problem during an outbreak divided by the size of a population at the beginning of the period who are at risk of the event.

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56

Secondary Attack Rate

Frequency of new cases of a disease among the contacts of known patients; The ratio of the number cases among contacts occurring within the acceptable incubation period.

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57

Outbreak Magnitude Outbreak Time Trend Outbreak Outliers

Epidemic Curve:

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58

Outbreak Outliers

Outliers are cases at the very beginning and end that may not appear to be related to the rest of the cases.

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59

Outbreak Magnitude

Can provide a sense of the magnitude of an outbreak Additional information can be obtained by stratifying the epi curve

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60

Communicate Findings

8th Step in Outbreak Investigation

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61

Implement and Evaluate Control Measures

7th Step in Outbreak Investigation

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62

Institute Immediate Control Measures

4th Step in Outbreak Investigation

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63

Formulate and Test Hypothesis

5th Step in Outbreak Investigation

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64

Plan and Execute Additional Studies

6th Step in Outbreak Investigation

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