Investigation of an outbreak

The ten steps

28.11.2012

*As on October 26, 2012

Objectives of the investigation

Define magnitude (time, place, person) Determine factors responsible Control the epidemic Prevent

1.Confirm the diagnosis

Syndromic Even with clinical examination alone Talk with the case, get details about possible exposures, their travels, meeting with similar cases etc Should not be delayed expecting laboratory investigation reports

2.Confirm that these is an outbreak

clearly in excess of expectations? Even a single case! Compare with previous years records, other areas

3.Define the population at risk

Rough line-listing People living in X slum, Inmates of a hostel... Detailed, current map Counting the population

4.Develop a valid case definition &

suspect Fever Joint pain probable Fever Joint pain Head ache Eye pain confirmed Fever Joint pain Head ache Eye pain Lab. Test positive

.&Quick-search for cases

Medical survey Epidemiological case sheet Search for more cases

Refined Line-listing
S.No. Name Age Sex Address-R Address-O Date of onset Main symptoms/ signs Doctor/ Hospital

5.Analyze the initial data

Time
Epidemic curve

Place
Spot map

Person
Age, Sex, Occupation, Exposed/non-exposed

Epidemic curve

6.Study the ecological factors

Sanitary status of eating /drinking water/milk supply Movements of human population Dynamics of insects/animals Atmosphere/Pollution

7.Formulate (tentative) hypothesis

Possible source(s) Causative agent Mode of transmission Environmental factors Control measures to be initiated

8.More detailed investigations

Among population at risk Examination of unaffected people, samples of food, blood, faeces Even clinically unapparent cases may be found Better understanding & Future prevention

9.Conclude final possible explanation

10.Report!

Background Historical data Methodology Analysis Control measures

The ten steps

Confirm the diagnosis Confirm that it is an outbreak Define the population at risk Search for cases & their characteristics Analysis of initial data Study of ecological factors Formation of hypothesis / control measures More detailed investigations Conclude final possible explanation Prepare the report

References
Epidemiology made easy, Tiwari Poornima, Tiwari Shashank, Jaypee publications Parks Textbook of Preventive & Social medicine, 19th edition Textbook of Public Health & Community Medicine, Edited by RajVir Bhalwar Notes of National Institute of Epidemiology for FETP

Thank you!