Outbreaks, Public Health Surveillance and Physician Reporting

Question 1

list steps 1-6 of outbreak investigation

Answer 1

1. confirm existence of an outbreak
2. verify the diagnosis
3. prepare for field work
4. construct a working case definition
5. find cases systematically and record information
6. perform descriptive epidemiology

Question 2

list steps 7-13 of outbreak investigation

Answer 2

7. develop hypotheses
8. evaluate hypotheses epidemiologically
9. refine hypotheses and execute additional studies as necessary
10. reconcile with lab/environ. studies
11. implement control/prevention measures
12. initate or maintain surveillance
13. communicate findings

Question 3

describe endemic vs epidemic

Answer 3

Question 4

describe step 2: verify the diagnosis

Answer 4

• ensure proper diagnosis
  
  • rule out laboratory error
• examine/see case-patients
• review medical records

Question 5

describe step 4: construct a working case definition

Answer 5

• simple, objective criteria
• develop a case definition using:
  
  • symptoms or laboratory resuls
  • affected population (person)
  • location (place)
  • time frame

Question 6

describe step 5: find cases systematically, develop line list

Answer 6

• conduct surveillance using case definition
  
  • active surveillance (e.g. review medical records)
  • try to identify all cases
• collect data on case-patients
• create line listing

Question 7

describe case finding

Answer 7

• active surveillance at all hospitals in area
• active surveillance for TFTs at alll area labs
• active surveillance among local endocrinologists

Question 8

describe step 6: perform descriptive epidemiology

Answer 8

• clinical features (table)
• time (epidemic curve)
  
  • ideally, when were they exposed or infected?
  • more practically, when did they become ill?
• place (spot map, shaded map)
  
  • ideally, where were they exposed?
  • more commonly, where do they live, work?
• person (tables)
  
  • who was exposed?
  • numerators and denominators
  • what do the cases have in common?

Question 9

describe step 7: develop hypotheses

Answer 9

• subject matter knowledge–known sources, vehicles, transmission modes
• review descriptive epidemiology–what would account for most?
• outliers (unique exposure opportunities)
• talk to case-patients–what do they think?
• what do local health officials think?

Question 10

describe step 8: evaluate hypotheses

Answer 10

• usually analytic epidemiology
  
  • cohort study & risk ratio
  • case-control study & odds ratio
• otherwise, compare facts with hypotheses

Question 11

describe step 11: implement control/prevention measures

Answer 11

• implement as early as possible
• usually targeted to one or more:
  
  • eliminate or treat the source
  • interrupt transmission
  • reduce susceptibility
• create mechanism to evaluate both short and long-term effectiveness of control/prevention measures

Question 12

describe step 12: initiate or maintain surveillance

Answer 12

• monitor for additional cases
• evaluate for effectiveness of control measures

Question 13

describe step 13: communicate findings

Answer 13

• reasons
  
  • documentation of findings, action
  • justification for recommendations
  • documentation for legal purposes
• methods
  
  • trip report
  • public health bulletin
  • peer-reviewed journal
  • oral presentation

Question 14

list the incidences that are physician-required reporting

Answer 14

• impaired driving
• abuse
  
  • child abuse
  • elder abuse
  • intimate partner violence
  • rape
• injuries
  
  • from weapons
  • from crimes
• burns over 5% of body

Question 15

name the diseases that are on the list of WHO’s International Health Regulations

Answer 15

• all cases of:
  
  • smallpox
  • poliomyelitis (wild-type)
  • human influenza caused by new subtype
  • severe acute respiratory syndrome (SARS)
• unexpected or “impactful” cases of:
  
  • cholera
  • pneumonic plague
  • yellow fever
  • viral hemorrhagic fevers
  • West Nile fever
  • diseases of regional concern