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# X and Y Axes

An epidemic curve, or “epi curve,” is a visual display of the onset of illness among cases associated
with an outbreak. The epi curve is represented by a graph with two axes that intersect at right
angles.

The horizontal x-axis is the date or time of illness onset among cases.

## The vertical y-axis is the number of cases.

Each axis is divided into equally spaced intervals, although the intervals for the two axes may differ.

## What an Epi Curve Can Tell You

An epi curve is a visual display of the onset of illness among cases associated with an outbreak.

You can learn a lot about an outbreak from an epi curve, such as

 Time trend of the outbreak, that is, the distribution of cases over time
 “Outliers,” or cases that stand apart from the overall pattern
 General sense of the outbreak's magnitude
 Most likely time of exposure
 The magnitude of an outbreak can be assessed easily with a glance of the epi curve. Are
there many cases or just a few?
 The time trend, or the distribution of cases over time, will give an indication of where the
outbreak is in its course. Are cases still rising or has the outbreak already peaked? Does it
appear that the outbreak is over? How long has it been since the last case occurred?
 Outliers are cases that stand apart from the other cases. Outliers include the index case,
which might be the source of the outbreak, and cases that occur well after other cases,
which might indicate secondary spread of the illness.

## Magnitude, Time Trend, and Outliers

Below is the epi curve from an outbreak of hepatitis A. If today's date is August 17, what can you

## Note: The incubation period for hepatitis A is 25-30 days.

 Magnitude
 Time trend
 Outliers

Hepatitis A Cases by Date of Onset in Port Yourtown, Washington, June - August 2010

## Mode of Spread: Point Source

An epi curve can also be used to make inferences about inferences about an outbreak's most likely
mode of spread, suggesting how a disease is transmitted. Transmission occurs in the following
ways:

 Point source
 Continuous common source
In a point source outbreak, persons are exposed over a brief time to the same source, such as a
single meal or an event. The number of cases rises rapidly to a peak and falls gradually. The
majority of cases occur within one incubation period of the disease.

Cryptospordiosis Cases Associated with a Child Care Center by Date of Onset in Port
Yourtown, Washington, June 1998

## Mode of Spread: Continuous Common Source

In a continuous common source outbreak, persons are exposed to the same source but exposure
is prolonged over a period of days, weeks, or longer. The epi curve rises gradually and might
plateau.

## Salmonellosis Cases Exposed to Contaminated Salami by Date of Onset, United States,

December 2009 – January 2010

## Mode of Spread: Propagated Outbreak

In a propagated outbreak, there is no common source because the outbreak spreads from person-
to-person. The graph will assume the classic epi curve shape of progressively taller peaks, each
being one incubation period apart.

Measles Cases by Date of Onset in Aberdeen, South Dakota, October 15, 1970 – January 16,
1971

## Analyzing the Mode of Spread

Of course, the shape of an epi curve rarely fits any of these descriptions exactly. For propagated
outbreaks, the shape might show overlapping waves of cases that obscure subsequent peaks, and
peaks might diminish more slowly over time. You can, however, get a general sense about the mode
of spread of an outbreak from its epi curve.