Name: _____________________________________

Time started: __________________

Time finished: _________________
DISEASE DETECTIVES TRY-OUT TEST (2008-2009) ANSWER KEY

1. Define the following terms: [1-2 pts]

a. Public surveillance:
The systematic and ongoing collection, analysis, interpretation, and
dissemination of health data. The purpose of public health surveillance is to gain
knowledge of the patterns of disease, injury, and other health problems in a
community so that we can work towards their prevention and control

b. Epidemic curve (epicurve):

a histogram that displays the course of an outbreak or epidemic by plotting the
number of cases according to time of onset

c. Bias – (also, please name one possible type of bias):

a systematic deviation of results or inferences from the truth or processes
leading to such systematic deviation; any systematic tendency in the collection,
analysis, interpretation, publication, or review of data that can lead to
conclusions that are systematically different from the truth

2. Explain the difference between a cohort study and a case-control study (including advantages
and disadvantages). [5 pts]

In a cohort study, enrollment is based on the status of a person to a certain exposure or

membership in a certain group – These people are then followed, and their health-
related outcomes are recorded. In a case-control study, people are enrolled based on the
presence of a certain disease or health condition, as well as a control group, and then
each group’s exposures are compared.
3. a) Based on the following table (using the variables), show how you would calculate attack
rate for the exposed and unexposed groups, and then relative risk for the data. [10 pts]

Have Disease Do Not Have Disease

Exposed a b
Unexposed c d

Attack rate:

ARexposed = a/(a+b)
ARunexposed = c/(c+d)

Relative Risk:

RR = ARexposed/ARunexposed = [a/(a+b)]/[c/(c+d)]

b) What does an attack rate tell you as an epidemiologist? What does relative risk tell you (at a
value less than, equal to, and greater than 1.0)? [6 pts]

Attack rate is the rate that a group experienced an outcome or illness; it essentially tells
you the percent of a group affected by a condition. Relative risk estimates the extent of
association between an exposure and a disease. RR<1 means the exposed group had a
decreased risk of getting the disease (and possibly had a protective effect). RR=1 means
there is no evidence for an association. RR>1 means there is a positive association and
increased risk for the exposed group.

4. List and describe the steps of an outbreak investigation in a logical order. [10 pts]

See separate sheet

5. Explain and describe the chain of disease transmission. [3 pts]

The disease-causing agent leaves its reservoir through a portal of exit, and is conveyed
by some mode of transmission, and then enters an appropriate portal of entry to infect
a susceptible host
6. What information might you collect to create a line listing for an outbreak? [4 pts]

[1 pt for each criteria, max of 4]

-identifying information (ID or case #, person’s initials, etc.)
-clinical information (diagnosis, symptoms, etc.)
-time (date of onset, date of report)
-person (age, sex, occupation, etc.)
-place (street, city, county, etc.)
-risk factors and possible causes

7. You are called to help investigate a cluster of 17 men who developed leukemia in a
community. Some of them worked as electrical repair men, and others were ham radio
operators. Which study design would you choose to investigate a possible association
between exposure to electromagnetic fields and leukemia? [2 pts]

[explanation not necessary, 2 pts for “case-control study”]

Because the total population at risk is not well defined, you would use a case-control
study. You would begin by enrolling the 17 people already identified with leukemia as
the case group. You would also need to determine what group might serve as an
appropriate comparison, or control, group. Neighbors might be used for the control
group, for example. In your case-control study, you would determine whether each
case-patient and each control had been exposed to electromagnetic fields (however you
defined that exposure). Finally, you would compare the exposures of case-patients and
controls.