Professional Documents
Culture Documents
SESSION 1
Objectives of training
1.
2.
3.
4.
To understand clinical description and epidemiology To understand the disease case definition, lab specimens needed, labs role, and lab tests needed for confirmation To understand prevention and control procedures including available treatment and post-exposure prophylaxis, isolation and infection control procedures. To understand contact tracing and surveillance procedures
2.
3.
Face-to-face interviewers
Telephone interviewers Data base support
4.
5.
Employee Health
1.
Education of risks of disease from exposure to BT agents or infectious patients Vaccination Personal protective equipment (PPE)
2.
3.
BT AGENTS
Prioritization Categories
Category A
High public health impact and public perception Variable dissemination potential Comprehensive PH preparedness
Less public health impact Variable dissemination potential Less comprehensive PH preparedness Addressed with current preparedness efforts (BT/EID)
Category B
Category C
Category A Agents
Variola virus - smallpox
via aerosol Organisms fairly stable in aerosol Susceptible civilian populations High morbidity and mortality Person-to-person transmission Difficult to diagnose and/or treat Previous development for BW
* Priority agents may exhibit all or some of the above characteristics
Category C Agents
Emerging infectious disease agents (Hantavirus, Nipah virus, etc.) Salmonella
E-coli O157:H7
Vibrio cholerae cholera
OUTBREAK INVESTIGATION
Definition
Occurrence of more cases of disease than expected Nosocomial outbreak-any group of illnesses of common etiology occurring in patients of a medical care facility acquired by exposure of those patients to the disease agent while confined in such a facility.
Reasons to investigate
Control/prevention Research opportunities Training Public, political, or legal concerns Program considerations
Control / Prevention
Where are we in the outbreak? Goals will be different depending on answer(s) Cases continuing to occur Goal: prevent further cases Assess population at risk, implement control measures Outbreak appears to be coming to an end Goal: prevent future outbreaks Identify factors contributing to outbreak, implement measures to prevent similar events in the future
1. Preparation
Investigation
Scientific knowledge
Review literature Consult experts Sample questionnaires
Supplies
Equipment
Preparation, cont.
Lead investigator or just lending a hand? Know who to contact when you arrive
True outbreak Sporadic and unrelated cases of same disease Unrelated cases of similar unrelated disease
Determine the expected number of cases before deciding whether the observed number exceeds the expected number
through surveillance records for notifiable diseases hospital discharge data, registries, mortality statistics data from other facilities, states, surveys of health care providers community survey
Ensure proper diagnosis and rule out lab error as the bias for increased diagnosis
Better understand clinical features Mental image of disease and the patients affected Gather critical information
Source of exposure What they think caused illness Knowledge of others with similar illness Common denominators Helpful in generating ideas for hypothesis about etiology and spread
Case definition Standard set of criteria for deciding whether an individual should be classified as having the health condition of interest Includes clinical criteria and restrictions by time, place and person Must be applied consistently and without bias to all persons under investigation Must not contain an exposure of risk factor you want to test
Classification
Definite (confirmed) Laboratory confirmed Probable Typical clinical features without lab confirmation Possible (suspected) Fewer of the typical clinical features
Better to collect more than necessary so you dont need to make repeat visits Identify extent of problem and population affected Generating hypotheses
Later when hypotheses are sharpened investigator may tighten case definition
Target health care facilities where diagnosis likely to be made Enhanced passive surveillance e.g. letter describing situation and asking for reports Active surveillance e.g. phone or visit facility to collect information Alerting the public Media alert to avoid contaminated food product and seek medical attention if symptoms arise
OB population restricted and large proportion of cases are unlikely to be diagnosed e.g. on a cruise ship
Always ask case-patients if they know of any others ill with the same symptoms
Demographics
Clinical findings
Verify case definition met Chart time course Supplemental date e.g. deaths
Reporter information
Time
Epidemic curve
Histogram of the number of cases by their date of onset Visual display of the outbreaks magnitude and time trend Where you are in the time course of the outbreak Future course? Probable time period of exposure Helps in development of questionnaire focusing on that time period Common source vs. Propagated
Place
Person
Usually define population by host characteristics or exposure Use rates to identify high-risk groups
Numerator = number of case Denominator = number of people at risk
Develop Hypotheses
Vector or vehicle
Develop Hypotheses
Generating the hypothesis What do you know about the disease? Reservoir, transmission, common vehicles and known risk factors Talk to several case-patients Use open ended questions Ask lots of questions Talk to local health department staff Use descriptive epidemiology e.g. epi curve
7. Test Hypotheses
Cohort Small, well defined population Contact each attendee and ask a series of questions Ill Vs not ill Look for source exposure
Attack rate is high among those exposed Attack rate is low among those not exposed Most of the cases were exposed, so that the exposure could explain most, if not all, of the cases Relative risk = measure of association between exposure and disease
Population not well defined Case patients and comparison group (controls) questioned about exposure(s) Compute measure of association = Odds Ratio
Epidemiologic
When analytical epi unrevealing need to reconsider your hypotheses Go back and gather more information Conduct different studies
Laboratory
Additional tests
Environmental studies
possible
May
Short
Local health authorities and persons responsible for implementation of control and prevention measures
Written reports (consider publication) for planning, record of performance, legal issues, reference, adding to knowledge base