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2024 SEM 2 COMMUNITY AND PUBLIC HEALTH (LEC) > outbreak investigation > Flashcards

outbreak investigation Flashcards

1
Q

what is the difference and similarities between outbreak and epidemic

A

similarities:
more cases of disease than expected

differences:
outbreak is a localized increase in disease cases (an outbreak of Legionnaires’ disease in a hotel with contaminated water system)

epidemic is a widespread and rapidly spreading, affecting a much larger population across multiple areas (covid, ebola)

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2
Q

define disaster cluster

A

unusual grouping of disease cases in one place and time w/o implying the no. of cases is higher than expected
(hurricane cluster - multiple hurricanes or wildfire cluster - multiple wildfires)

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3
Q

it can be the first indication of a larger outbreak or epidemic but they can also occur by chance or due to other factors that may not be immediately apparent.

A

disease clusters

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4
Q

briefly explain on how does outbreak gain attention of the public health agencies

A

epidemiologic surveillance systems:
continuous monitoring and analysis of data related to the occurrence and spread of disease = public health officials investigate further

direct notification:
from healthcare providers, laboratories or school (school reporting high absenteeism due to illness or laboratories reporting +ve results for a notifiable disease)

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5
Q

factors affecting the decision to mount an outbreak investigation

A

[PPAASI]
Ability to confirm that the observed cases is significantly greater than expected

Scale and severity of the outbreak (how widespread the cases r)

If the outbreak disproportionately affects an identifiable sub-group (ex: elderly, children)

Potential for spread

Political and public relations considerations (attract media attention)

Availability of resources (have sufficient staff, fund and lab capacity to conduct)

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6
Q

main objective of outbreak investigation

A

help guide disease prevention and control strategies

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7
Q

briefly explain the relative priority of investigative and control effects during an outbreak, based on knowledge of the source, mode of transmission and causative agent

known source/ MOT + known causative agent =
known source/ MOT + unknown causative agent =
unknown source/ MOT + known causative agent =
unknown source/ MOT + unknown causative agent =

A

known source/ MOT + known causative agent =
highest priority: control
lowest priority: investigation

known source/ MOT + unknown causative agent =
highest priority: investigation & control

unknown source/ MOT + known causative agent =
highest priority: investigation
lowest priority: control

unknown source/ MOT + unknown causative agent =
highest priority: investigation
lowest priority: control

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8
Q

what are the objectives of outbreak investigation

A

[PAARII]
Asses range and extent of the outbreak

Reduce the no. of cases associated w the outbreak

Identify new disease syndromes

Identify new causes of known disease symptoms

Assess the effectiveness of currently employed prevention strategies

Provide for good public relations and educate the public

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9
Q

briefly explain the agencies responsible for outbreak investigation

A

local health departments
CESU: City Epidemiology and Surveillance Unit
MESU: Municipal Epidemiology and Surveillance Unit

higher level health agencies
RESU: Regional Epidemiology and Surveillance Unit
DOH-EB: Department of Health - Epidemiology Bureau

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10
Q

what are the 10 steps in outbreak investigation

A
  1. prepare for fieldwork
  2. establish the existence of an outbreak
  3. verify the diagnosis of cases
  4. construct a working case definition and search for additional cases
  5. conduct a descriptive epidemiological study
  6. develop hypotheses in
  7. evaluate hypotheses
  8. reconsider hypotheses, conduct additional studies if necessary
  9. implement control and prevention measures
  10. communicate findings
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11
Q

step 1 in outbreak investigation: prepare for fieldwork

A

scientific aspect
working knowledge/ backgrnd on public health concern

administrative aspect
- travel arrangements
- supplies and equipment
-administrative and scientific contacts

personal aspect
- clear understanding of the role in the field
- familiarity of the chain of authority involved in the process

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12
Q

step 2 in outbreak investigation: establish the existence of an outbreak

A

to confirm that there is actually an outbreak, certain criteria need to be met.

  1. use standard diagnostic criteria
  2. compare observed rate to expected rate
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13
Q

step 3 in outbreak investigation: verify the diagnosis cases

A
  1. ensure disease in question have been correctly identified and diagnosed
  2. rule out lab error - check the increase in reported areas are not due to mistake or errors in lab testing
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14
Q

how to verify cases in an outbreak investigation

A

review clinical findings and lab results

check if said result r consistent with what is known clinically and epidemiologically of the disease

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15
Q

how to determine the expected baseline rate in the establishment of existence in an outbreak

A

to know the “normal”

  • national surveys
  • special registries
  • data from neighboring localities
  • publishing literature
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16
Q

how to make comparison in the establishment of existence in an outbreak

A

look at the no. of cases in
- previous week/ months
- same period from previous years

17
Q

step 4 in outbreak investigation:
construct a working case definition and search for additional cases

A

case definition
- a set of standardized criteria used to determine whether someone should be classified as having the disease of interest
- restricted by time, place and person

systematic case finding
- search for previously unidentified/ unreported cases that fit the criteria

in simple terms:
consistent identification of true cases. to capture all possible cases meeting that definition rather than relying on initially reported cases

18
Q

how do we stratify cases in construct a working case definition in an outbreak

A

confirmed cases (positive lab test)
probable cases (symptoms but no test done)
possible cases (some symptoms but doesn’t meet full criteria)

19
Q

step 5 in outbreak investigation: conduct a descriptive epidemiological study

A

determine the range and extent of the outbreak (determine hoe widespread is - the geographic area, no. of ppl time period)

assess possible source of exposure (ex: contaminated food/water), mode of transmission (airborne, contact), incubation period, environmental host or agent factor

generate hypotheses abt outbreak (abt what factors led to and drive this outbreak)

in simple terms:
aims to characterize and describe the key details of an outbreak

20
Q

step 6 in outbreak investigation: develop hypothesis

A

address:
- source of exposure to etiologic agent
- MOT
- next step in investigation
- future control measures

search for specific exposures that have the strongest association with the disease (to test the hypotheses). this is done by calculating measures
- relative risk RR (how much more likely exposed ppl r to get disease)
- odds ratio OR (odds of exposure in case vs. non cases)
- risk difference RD (diff in disease risk btwn exposed and unexposed)

investigate notable expectations (examine cases that dont fit the main hypotheses)

21
Q

step 7 & 8 in outbreak investigation:
7 - evaluate hypotheses
8 - reconsider hypotheses, conduct additional studies if necessary

A

hypotheses r re-examined, refined and tested throughout the investigation
tested using
- qualitative methods (gather descriptive info through interviews and observations)
- quantitative epidemiological (analyze data statistically to measure association btwn exposure and disease)
- investigation and laboratory/ environmental studies (test samples, food, water etc to identify contaminant)

22
Q

what are the specific analytical studies may be conducted in steps 7 and 8

A

retrospective cohort study
- small, well circumcised outbreak
- incidence is high

case-control study
- large, poorly-circumcised outbreaks
- incidence is low

23
Q

step 9 in outbreak investigation: implement control and prevention measures

A

levels of prevention
- primordial prevention
- pri prevention
- sec prevention
- tertiary prevention

natural history of disease
- stage of susceptibility
- stage of subclinical disease
- stage of clinical disease
- stage of recovery, disability or death

the epidemiological triad
- agent
- host
- environment

24
Q

step 10 in outbreak investigation: communicate findings

A

it is not complete until the results r disseminated to the public and the profession
- initial informants
- persons involved in the investigation
- public health agencies
- community

forms
- oral briefing
- written report

25
Q

it is the visual study of the magnitude and time trend of outbreak

A

the epidemic curve

26
Q

the epidemic curve
x-axis:
y-axis:

A

x-axis: no. of cases (%)
y-axis: timeline

27
Q

what information r obtained from the epidemic curve

A

Probable period of exposures
Nature of the epidemic
Future courses of the epidemic
Effectiveness and timeliness of prevention and control measures

28
Q

describe the outbreak in terms of place

A

dot maps:
Document geographic extent of probs and can provide evidence of clustering
maps of area-specific rates:
Compare areas w population of unequal sizes

29
Q

describe the outbreak in terms of person

A

Identify high risk grp
Frequency of disease shld be described by age and sex (at minimum)
Person factors relevant to outbreak investigation
- Demographic characteristics
- Personal activities and practices
- Genetic predisposition
- Physiological states
- Concurrent disease and immune status

30
Q

briefly explain the patterns of epidemic curve

A

point source epidemic:
curve has upslope but a more gradual downslope
Person exposed to the same source over a relative short period

continuous common source epidemic:
curve has plateau instead of a peak
Exposed duration is prolonged

intermittent common source epidemic:
curve is irregularly jagged
Exposure to the agent is sporadic over time

propagated epidemic:
curve has a series of progressively taller peaks one IP apart
Disease agents spread from one person to another w increasing. of cases in each generation

2024 SEM 2 COMMUNITY AND PUBLIC HEALTH (LEC) (10 decks)

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