CD - outbreak mgmt

Question 1

what is a general framework for conducting outbreak investigations (MICC) (4)

Answer 1

1- Manage
2- Investigate
3- control
4- communicate

Question 2

what are the 10 steps of outbreak investigations (these fit inside MICC) - VC TDD HP SCE (10)

Answer 2

1- verify existence of outbreak
2- confirm diagnosis
3- team, assemble this
4- define and find cases
5- do descriptive epidemiology
6- hypotheses, generate and test
7- prevention/control measures, implement
8- surveillance, initiate/maintain
9- communicate findings
10- end outbreak and debrief

Question 3

describe step 1 “Verify existence of OB” of the ten steps for OB mgmt (3)

Answer 3

1- is increased incidence an actual outbreak?
2- review surveillance data to see if # cases exceeds baseline (is observed > expected cases?)
3- r/o other reasons for increase: e.g. seasonal variation, change in reporting, new test for disease

Question 4

describe step 2 “confirm diagnosis” of the ten steps for OB mgmt (2)

Answer 4

1- detect/isolate causative agent
2- collect info about clinical symptoms

Question 5

describe step 3 “assemble a team” of the ten steps for OB mgmt (2)

Answer 5

1- internal members: A/MOH, epidemiologist, program manager, PHN, PHI, communications
2- external members: med micro/lab techs, other experts (e.g. vets), FPT partners (e.g. PHAC field epi)

Question 6

describe step 4 “define and find cases” of the ten steps for OB mgmt (1, 2abc, 3)

Answer 6

1- determine case definition (clinical signs/symptoms, lab dx, criteria for person/place/time, epi link) - apply to find other cases
2a- if case def is too broad: may include non-relevant individuals
2b- if case def is too narrow: may exclude cases and underestimate the OB
2c- need case def to be more SENSITIVE initially (i.e. more broad)
3- make line list with key info for each case

Question 7

describe step 5 “ do descriptive epidemiology” of the ten steps for OB mgmt (1)

Answer 7

1- identify the population at risk of acquiring the disease in terms of person/place/time

Question 8

describe step 6 “generate/test hypotheses” of the ten steps for OB mgmt (2)

Answer 8

1- make educated guesses about the potential source of the OB
2- draw epidemic curves, calculate attack rates, conduct case-control study

Question 9

describe step 7 “implement prevention/control measures” of the ten steps for OB mgmt (3)

Answer 9

1- identify/implement measures that target one or more elements of the chain of infection (agent-reservoir-exit portal-transmission-entry portal-sus host)
2- isolation: prevent movement of ill cases; driven by communicable period
3- quarantine: prevent movement of asymp contacts; driven by incubation period

Question 10

describe step 8 “initiate/maintain surveillance” of the ten steps for OB mgmt (2)

Answer 10

1- case finding
2- update case definition as needed

Question 11

describe step 9 “communicate findings” of the ten steps for OB mgmt (3)

Answer 11

1- send messaging to target groups, the public, and providers
2- generate Public Health alerts and OB summaries
3- document the OB, make recommendations for investigations of future OBs

Question 12

describe step 10 “end outbreak and debrief” of the ten steps for OB mgmt (2)

Answer 12

1- declare OB over (typically 2 incubation periods without any new cases)
2- review/debrief on how OB response went

Question 13

bringing the 10 steps into MICC, what are the steps of OB mgmt in the early phase under ‘manage’ (1)

Answer 13

1- assemble team - internal and external members

Question 14

bringing the 10 steps into MICC, what are the steps of OB mgmt in the early phase under ‘investigate’ (3)

Answer 14

1- verify existence of OB
2- confirm OB
3- establish case definitions

Question 15

bringing the 10 steps into MICC, what are the steps of OB mgmt in the early phase under ‘control’ (1)

Answer 15

1- implement immediate control measures (test, trace, isolate cases)

Question 16

bringing the 10 steps into MICC, what are the steps of OB mgmt in the early phase under ‘communicate’ (2)

Answer 16

1- notify key personnel
2- consider external notification/PSA as needed (e.g. measles exposure)

Question 17

bringing the 10 steps into MICC, what are the steps of OB mgmt in the middle phase under ‘manage’ (1)

Answer 17

1- meet with team regularly and expand as needed

Question 18

bringing the 10 steps into MICC, what are the steps of OB mgmt in the middle phase under ‘investigate’ (2)

Answer 18

1- find cases and contacts
2- organize in person/place/time (descriptive epi & line lists)

Question 19

bringing the 10 steps into MICC, what are the steps of OB mgmt in the middle phase under ‘control’ (1a, examples 1bc)

Answer 19

1a- expand control measures as needed
1b- e.g source control
1c- modify host response with chemo/immunoprophylaxis

Question 20

bringing the 10 steps into MICC, what are the steps of OB mgmt in the middle phase under ‘communicate’ (2)

Answer 20

1- update key personnel
2- consider public notification

Question 21

bringing the 10 steps into MICC, what are the steps of OB mgmt in the late phase under ‘manage’ (1)

Answer 21

1- as a team, decide when OB is over

Question 22

bringing the 10 steps into MICC, what are the steps of OB mgmt in the late phase under ‘investigate’ (1)

Answer 22

1- test hypotheses about potential source of OB

Question 23

bringing the 10 steps into MICC, what are the steps of OB mgmt in the late phase under ‘control’ (2)

Answer 23

1- monitor OB response thus far
2- do additional case finding (surveillance)

Question 24

bringing the 10 steps into MICC, what are the steps of OB mgmt in the late phase under ‘communicate’ (2)

Answer 24

1- generate OB summary report
2- notify public when OB is over