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INF > OUTBREAK INVESTIGATION > Flashcards

OUTBREAK INVESTIGATION Flashcards

1
Q

STEPS OF AN OUTBREAK INVESTIGATION:

A
  • ESTABLISH THE EXISTENCE OF A REAL OUTBREAK
  • CONVENE AN OUTBREAK CONTROL TEAM
  • CONFIRM THE DIAGNOSIS
  • DEFINE A CASE
  • SEARCH FOR CASES (CASE FINDING)
  • GENERATE HYPOTHESES USING DESCRIPTIVE EPIDEMIOLOGY
  • ENVIRONMENT, LABORATORY AND OTHER INVESTIGATIONS
  • TEST HYPOTHESES USING ANALYTICAL EPIDEMIOLOGY
  • DRAW CONCLUSIONS
  • COMMUNICATE FINDINGS
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2
Q

WHAT TYPE OF EPIDEMIOLOGY IS USED FOR GENERATE HYPOTHESES AND WHAT TYPE FOR TESTING THE HYPOTHESES?

A

GENERATING: DESCRIPTIVE EPIDEMIOLOGY
TESTING: ANALYTICAL EPIDEMIOLOGY

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3
Q

WHAT CAN BE DEFINED AS AN OUTBREAK?

A
  • AN INCIDENT IN WHICH 2 OR MORE PEOPLE EXPERIENCING A SIMILAR ILLNESS ARE LINKED IN TIME AND PLACE
  • A GREATER THAN EXPECTED RATE OF INFECTION WITH THE USUAL BACKGROUND RATE FOR THE PLACE AND TIME WHERE THE OUTBREAK HAS OCCURRED
  • A SINGLE CASE FOR CERTAIN RARE DISEASE
  • A SUSPECTED, ANTICIPATED OR ACTUAL EVENT INVOLVING MICROBIAL OR CHEMICAL CONTAMINATION OF FOOD OR WATER
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4
Q

OUTBREAK CONTROL TEAM?

A

A FORMAL MEETING OF ALL STAKEHOLDERS IN AN OUTBREAK TO:

  • ASSESS THE RISK TO PUBLIC HEALTH
  • SEEK LEGAL ADVICE WHEN REQUIRED
  • ENSURE THE ASPECTS OF THE OUTBREAK ARE INVESTIGATED
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5
Q

USUAL AIMS OF OUTBREAK CONTROL TEAM INVESTIGATION?

A
  • TO DESCRIBE THE OUTBREAK IN TERMS OF TIME, PLACE AND PERSON
  • TO GENERATE (AND TEST) HYPOTHESES
  • TO IDENTIFY THE SOURCE
  • TO IMPLEMENT CONTROL MEASURES
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6
Q

STEPS IN CONFIRMING THE DIAGNOSIS DURING OUTBREAK INVESTIGATIONS?

A
  • GENERATE A SHORTLIST OF PLAUSIBLE DIAGNOSES BASED ON CLINICAL INFO (COMMUNICATE WITH CLINICIANS, MICROBIOLOGISTS ETC, EXAMINE HX..)
  • CONFIRM DIAGNOSIS WITH LABORATORY TESTS (BETTER PREDICTIVE VALUE IF TESTS GUIDED BY CLINICAL PICTURE I.E. THE PEOPLE TESTING KNOW WHAT TO LOOK FOR)
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7
Q

WHY IS IT IMPORTANT TO DEFINE A CASE IN OUTBREAK INVESTIGATION?

A
  • IT ENABLES ALL MEMBERS OF THE OCT TO AGREE ON BASIC TERMINOLOGY
  • IT ENABLES DESCRIPTIVE (AND LATER ANALYTICAL) EPIDEMIOLOGY
  • FACILITATES SEARCHING FOR CASES
  • AIDS DECISION ON WHO SHOULD HAVE A SAMPLE TAKEN
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8
Q

CASE DEFINITION IN OUTBREAK INVESTIGATION: HOW DOES IT CHANGE?

A
  • THE DEFINITION USUALLY CONSISTS OF THE PERSON, PLACE AND TIME
  • CAN CHANGE AS MORE INFO COMES IN
  • USUALLY DIFFERS DURING DESCRIPTIVE STAGE (CASE FINDING), WHEN IT IS KEPT SENSITIVE (E.G. DIARRHEAL SYMPTOMS) AND DURING THE ANALYTICAL STAGE (HYPOTHESIS TESTING), WHEN IT IS KEPT SPECIFIC (LABORATORY CONFIRMED CERTAIN BACTERIA TYPE)
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9
Q

HOW CAN CASE BE GRADED?

A

SUSPECTED, PROBABLE AND CONFIRMED

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10
Q

CASE DEFINTION:

A

A CASE IS THE OCCURRANCE OF (DISEASE/SYMPTOM) IN A RESIDENT OF (LOCATION) BETWEEN (BEGINNING DATE) AND (END DATE; IF THERE IS ONE)

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11
Q

TYPES OF CASE FINDING IN OUTBREAK INVESTIGATION?

A
  • STIMULATED, PASSIVE SURVEILLANCE (PHONE CALLS/VISITS TO FACILITIES TO TRIGGER REPORTING)
  • ACTIVE SURVEILLANCE (SEARCH FOR RECORDS IN HEALTH CARE FACILITIES, DOOR TO DOOR CASE SEARCH, ‘POTTING’ OF POSSIBLE CASES)
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12
Q

WHAT DOES ‘POTTING’ MEAN?

A

SENDING POTS TO COLLECT SAMPLES FROM POTENTIAL CASES OF AN OUTBREAK DURING CASE FINDING

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13
Q

WHAT DOES CASE FINDING IN OUTBREAK INVESTIGATION MAINLY RELY ON?

A

THE TIME, PLACE AND PERSON CRITERIA FROM THE CASE DEFINTION

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14
Q

TRAWLING QUESTIONNAIRES; WHAT ARE THEY USED FOR, WHAT IS THE OBJECTIVE, WHAT KIND OF QUESTIONS DO THEY HAVE?

A
  • USED IN HYPOTHESIS GENERATION
  • OPEN ENDED QUESTIONS FOR CASES
  • OBJECTIVE IS TO IDENTIFY WHAT IS COMMON TO ALL THE CASES
  • QUESTIONS: SYMPTOMS, TIME OF ONSET, TRAVEL, ACTIVITIES, BEHAVIOUR, OUTLIER?
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15
Q

WHAT IS THE OBJECTIVE OF TRAWLING QUESTIONNAIRES?

A

TO IDENTIFY WHAT IS COMMON TO ALL THE CASES

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16
Q

WHAT ARE OUTLIERS?

A

CASES IN AN OUTBREAK WHO COMPLETELY DO NOT FIT THE PATTERN/CASE DEFINITION BUT STILL HAVE THE CONDITION
- INDICATE THAT THE OCT MISSED SOMETHING?

17
Q

JON SNOW’S CHOLERA INVESTIGATIONS WERE ONE OF THE FIRST REAL EXAMPLES OF?

A

DESCRIPTIVE EPIDEMIOLOGY

18
Q

HOW ARE TIME, PLACE AND PERSON INFO EXPRESSED IN DESCRIPTIVE EPIDEMIOLOGY?

A

TIME: EPIDEMIC CURVE
PLACE: SPOT MAP + INCIDENCE BY AREA
PERSON: INCIDENCE BY AGE, SEX ETC. + TRAWLING QUESTIONNAIRE OF CASES + INTERVIEW OF OUTLIERS

19
Q

WHAT INFO CAN AN EPIDEMIC CURVE PROVIDE?

A
  • INFO ABOUT THE CAUSATIVE ORGANISM
  • INCUBATION PERIOD
  • TIME OF EXPOSURE
  • MAGNITUDE OF AN OUTBREAK
  • SOME INDICATIONS OF THE PATTERN OF SPREAD DEPENDING ON THE TYPE OF THE OUTBREAK
20
Q

EPIDEMIC CURVE IS DRAWN AS A:

A

HISTOGRAM

21
Q

TYPES OF OUTBREAK SOURCES AND EXAMPLES:

A
  • COMMON SOURCE, CAN BE INTERMITTENT (E.G. DELIVERIES OF INFECTED VEGETABLES EVERY FEW WEEKS) OR CONTINUOUS (SOURCE STILL PRESENT, E.G. A WATER FOUNTAIN)
  • POINT SOURCE (TYPE OF COMMON SOURCE OUTBREAK, E.G. PEOPLE WHO ATTENDED THE SAME EVENT)
  • PROPAGATED SOURCE (PERSON TO PERSON TRANSMISSION, NUMBER OF CASES PROGRESSIVELY INCREASING)
22
Q

WHAT TYPE OF INVESTIGATIONS/STUDIES CAN BE DONE WHEN INVESTIGATING AN OUTBREAK?

A
  • LABORATORY STUDIES (E.G. MICROBIOLOGICAL TYPING)
  • ENVIRONMENTAL STUDIES (E.G. TEST WATER, VECTOR STUDIES, SITE VISITS..)
  • ANTROPHOLOGICAL STUDIES (UNDERSTAND RISKY PRACTICES AND BEHAVIOUR)
23
Q

ROLE OF RATIONALE IN HYPOTHESES TESTING?

A
  • ALLOWS RIGOUROUS TESTING OF HYPOTHESES AND PROVIDES STATISTICAL MEASURE OF CONFIDENCE IN RESULTS
  • AIMS TO REDUCE BIAS
24
Q

WHICH STUDY DESIGN ALLOWS ATTACK RATE AND RELATIVE RISK (RR) TO BE CALCULATED?

A

COHORT STUDIES

25
Q

WHICH STUDY DESIGN ALLOWS CALCULATION OF THE ODDS RATION (OR)?

A

CASE CONTROL

26
Q

WHEN DRAWING CONCLUSIONS OF AN OUTBREAK INVESTIGATION, WHICH QUESTIONS SHOULD BE CONSIDERED?

A
  • IS SUSPECTED EXPOSURE ASSOCIATED WITH ILLNESS?
  • IS THERE A DOSE RESPONSE RELATIONSHIP?
  • DOES THE SOURCE EXPLAIN MOST CASES?
  • DOES HYPOTHESIS FIT WITH ALL AVAILABLE EVIDENCE
27
Q

WHAT SHOULD BE IMPLEMENTED ALONG ALL 10 STEPS OF OUTBREAK INVESTIGATION?

A

CONTROL MEASURES

—– MOST IMPORTANT!

28
Q

GENERAL PRINCIPLES OF OUTBREAK CONTROL MEASURES:

A

1) REMOVE THE SOURCE (ISOLATE AND TREAT CASES, REMOVE/DESTROY IMPLICATED FOODSTUFFS)
2) PROTECT PERSONS AT RISK (INFECTION CONTROL MEASURES, PROPHYLAXIS)
3) PREVENT RECURRENCE (LOCAL: RECOMMENDATIONS, NATIONAL: GUIDELINES)

29
Q

DESCRIBE THE STEC OUTBREAK IN THE UK IN 2020?

A
  • STEC O157:H7 OUTBREAK
  • AUGUST, 2020
  • LINKED WITH CONSUMPTION OF A FAST-FOOD PRODUCT CONTAINING IMPORTED CUCUMBERS
  • WHOLE GENOME SEQUENCING REVEALED THAT 36 CASES FORMED A GENETICALLY DISTINCT CLUSTER
  • CASE CONTROL STUDY CONDUCTED (25 OUT OF 36 CASES INCLUDED + 85 CONTROLS)

INF (40 decks)

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