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    Case study pada materi perkuliahan investigasi wabah fkm

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    Case study pada materi perkuliahan investigasi wabah fkm

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    8 views13 pages

    Case Study

    Uploaded by

    Tri Wahyuni
    Case study pada materi perkuliahan investigasi wabah fkm

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    © All Rights Reserved
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    CHAPTER ADDENDUM 2 (CASE STUDY): FOODBORNE DISEASE OUTBREAK Source: Adapted from DHEW/CDC training materials as presented in the University of California, Berkeley Infectious Disease Epidemiology course, Spring 1984. Comment Foodborne disease outbreak investigations generally involve both a laboratory and an epi- demiologic component. The epidemiologic investigation determines the number of cases, types und frequency of symptoms, location, date, and time of the suspect meal, on- (CHAPTER ADDENDUM 2 (CASE STUDY}: FOODBORNE DISEASE OUTBREAK 261 set time of symptoms in cases, history of food preparation and handling (including stor. ‘age conditions), food and biologic samples (wien possible), 24-hour Tood histories For all persons attending the suspect meal, and attack rates by fo0d items eaten and not eaten. By piccing together these bits of information, the epidemiologists can usually determine the agent in question an its ultimate source, The laboratory investigation is necessary to detect the presence ofthe agent in eases and the environmient, The laboratory investigation is also useful in identifying other or- ganisms in the environment that might be present in large enough riumbers to Suggest in- adequacy of general stnitary conditions of food preparation. Laboratory procedures should include aerobic and anaerobic plate counts of samples collected during the epi ‘demiologic investigation, with samples (eg, stool, saliva, vomit) coming from both cases and foods, as appropriate, depending on the suspected etiologic agent. Culture and other dlagnostic procedures aimed atthe suspected agent should be pursued. Background “The local medical center in a rural California county notiies the county health depast- rent of a hospitalized ease of gastioenteriis. From interviewing this patient, you dis- cover that the case had attended a church supper in Rhynedale, California, seven days cares. You find out that approximately 50 other individuals had attended this Church sup- per and that several participants had become ill with symptoms similar to those seen in te sentinel case. Your assignment is to investigate this case and determine whether it was the resutt of Food poisoning. The Locale Rhynedale is a small, unincorporated town of 581 residents in northern California, nox far from Sacramento, Question 1 Discuss how you might prepare forthe field work ‘The Church Supper Between the hours of 6:00 p.m, and 9:30 p.m. on Saturday, July 23, a Rhynedale commu- nity church held a pot luck supper in a wooded area near their church. The attending fam- ilies each brought food from home, which was laid out on tables for all to share. Though ‘many brought similar foods, none of these foods were mixed, and all food remained in US original container, No caterers or other persons were involved in handling the food. The bulk of the food was eaten between 6:30 and 7:30 p.m. All cases that were contacted de- nied having a diateheal illness before or during the supper and denied knowledge of the same for others attending the supper. ‘The involved Group. Fifty-one people from 16 family groups attended this affair, Thirteen of the families were from the Rhynedale area. One family was from a nearby town. Two families were from outof-state, 262 cUTBREAK INVESTIGATION Materials and Methods You place phone calls to all families who had attended the supper, Family rosters are recorded and, for anyone reporting symptoms, the course and duration of thei illness are described by onset, duration, symptoms, and the need for physician care or hosptaliza~ tion. Food histories are obtained on all supper attendees—whether ill or not—for each item served at the supper. Inquiries are made of pet and other animal contacts, and of prior contacts with persons known to have had diartheal illnesses, ‘You request each family to furnish a fist of foods they brought to the supper. You also in- quire where they purchased these foods, how they were prepared, what foods they took hhome from the supper, and whether food items were still available for laboratory testing. Visits are made t0 two families who did not have telephones. (This is fairly old case study.) Outof-state parties are not reached, although multiple velephbone calls are atempred Data Each study subject is uniquely identified with a record (REC) number. Information on cease status and demographic factors appear in Table 14.5. Information on signs, symp- TABLE 14.5. Case Status and Demographic Data: Foodborne Disease Outbreak Case Study Variable Names and Descriptions REC ‘Record (identification) number CASE ——_ Case of gastroontrits (¥/N) SEX Gender (MF) AGE ge (years) Date REC CASE SEX AGE AEC CASE SEX AGE. 1 Y w 7 a N F 2 2 y F 8 2a N F 5 3 Y M 37 2 N M a 4 Y F 7 30 N F 42 5 y F 8 31 N a a 6 y ” 26 32 N F 19 ? ¥ a 2 33 N M 16 8 ¥ F 5 34 N M 3 a ¥ Mw 14 35 N F 66 10 ¥ uw 8 36 N F 18 1" y F 2 a N M 33 e y M 10 38 ¥ F 7 13 ¥ Mw 14 9 N F 4 14 ¥ ™ 13 40 N M 46 8 y uw 28 4a N F 6 6 Y F 3 a N F 16 7 y M 6 6 N F " 18 Y F 5 44 N Mw 26 19 ¥ F 33 45 N F 7 20 y M 10 48 N Mw 0 at y M " a7 N F 24 22 y M 7 48 N a 16 2 Y M 33 49 N M 18 2 y F 4“ 50 N i 4 25 ¥ M 13 5 N M cy 26 N FE 32 (CHAPTER ADDENDUM 2 (CASE STUDY): FOODBORNE DISEASE OUTBREAK — 269, TABLE 14.6. Signs, Symptoms, Duration of lliness, and Incubstion Periods: Foodborne Disease Outbreak Case Study Variable Names and Deserptions RMP Campa (YN ~ mecing} DAR ——_Diathea (iN = missing) BOAR ——_Blocdydarnea {YIN = missing) AUS Nausea (YiNY-= missing) VOMIT Vomiting (¥AV-= missing) Fey Fever (YIN = missing) CHL Onl (YIN. = essing} HEAD Headache (YIN!-~ missing) aya Myalgla (YIN = missing) DUR ‘Duron of syepome Sys) NC Incubation (hous Cetwean the begining of supper ar fitst symptoms} ata REC CRAMPS DIAR BDA NAUS VOMIT FEV GHIL HEAD MYAL OUR ING + YY oN YY YN Y Yo 9 cv 0 a Yee ve Vera me 3 ¥ oy oN N WN YY ¥ ¥ N 38 9 ao oyY oY YoY oR vv 7 19 5 oY ¥ oN ON N ¥Y N ¥ ¥ 5 2 eet a VV gees 7 ¥ Yo oN ¥ N NON ¥ a8 eo oY oy YoY yo yoy 78 8 oY Yo oN ¥ Yo ¥ YY ¥ 8 be woo oY vy oN oN N ¥Y ¥ YY ¥ 2 48 me Ye oe Ye eo ea eo ale evga You voy oY oy a @ mY ¥ N WN N YN Y v6 32 wy Yo N YY Yo ¥ ¥ oY oy 7 3% % YY Y¥ oN N ON ¥ ¥ ¥Y ¥ 3 4 ® YY oY N Y N ¥ ¥ Y ¥ 6 «7 we ey hee en oe ee wo oY ¥ ¥ ¥ oN YY ¥ NON 8 7 mY YY oN oN N YN YY 4 7 a YY yo oN YY oY N ON ¥ 7 89 oe ey NoN YN Y 7 97 BY oY oN ¥ ¥ oY N ¥ ¥ 4 98 m2 YY ¥ N ON ON ¥Y ¥ ¥ ¥ 7 100 ey oy oN Y¥ ON YY ¥ YY ¥ 6m toms, duration of illness, and time of onset relative (0 the beginning of the church supper appears in Table 14.6. Note that a dot indicates missing data. Information about food items consumed by people attending the church supper appears in Table 147. Question 2 Draw an cpidemie curve. Determine the minimum, maximum, and median incubation times “The median isthe data point that is greater than or equal to half the values i the sample. Before calculating the median, data are sorted in ascending order and ranked from 1 107, ‘where represents the number of eases. The median vale isthe value half down the eank= ordered list. If 1 is odd, this comesponds to the value of the observation with rank (m+ 1)/2. If nis even, this corresponds to the average of values associated with ranks /2 and (n/2) + 1. 264 ‘OUTEREAK INVESTIGALION TABLE 14,7. Food Histories: Foodborne Disease Outbreak Case Study REC CASE SHRIMP OLIVE FROHICK BBOCHICK BEANS POTSAL GJEL RJEL SHRIMP ‘OuvE FRCHICK BBOCHICK BEANS POTSAL GEL Ruel ac. BEER ROLL BUTTER DEVEGS POTCHIE Pick scP. Nop. CAKE Tom Variable Narnes andl Descriptions Ship salad (YIN: ~ missing) (ives (iNV- = missing) Fe chicken (Y/N! = missing) Barbecued chicken (YIN: = missin] Beans (VIN: = missing) Polat Salad (VIN = missing) (Gre07 Jel-O(¥iNv- = missing) Fed Jel-O (N= missing) Macaroni salad (¥IN/- = missing) Foot beer (YIN: = missing) Ral (YIN- = missing) Bute (VIN ~ missing) Deviled eggs (VIN = missing) Potato Chips (WN! = missing} Pek (VIN. ~ missing) Stravnerry cream pie (¥INI-~ missing) Neagoltan eream pio (YIN: = missing) ako (¥IN/-~ missing} “Tomato (VIN = missing) Data, Part! (Shrimp Salad, Ota, Friad Chicken, Barbaque Chickon, Beans, Poito Salad, Groen JellO, Red Jel-O, Macaroni Salad) zeeee<<ZZzr>rnZrZrem oz zezezezzzzz2 2222222- DOR EER R DDD DDD Green Jel-0, Red Jel-©, Macaroni Salad) Z>Zz2z>E222z>>>>Z0>>>> N ¥ N zezzzzzzzzzz2>Z2> zzezzzezzzezzezzzzez2722 Data, Part | (Shrimp Salad, Ofves, ied Chicken, Barbeque Chicken, Haans, Potato Salad, TABLE 147. (Continued) st 2 33 34 35 6 7 28 39 40 4a 42 “a “a 45 46 7 48 ey ey 5 ata, Part li (Root Beer, Rolls, Butter, Deviled Eogs, Potato Chips, lees, Strawberry Cream Pie, [Neapolitan Cream Pie Cake, Tomato) zezzzez-2zz22>z22> (Continued) gezzzzzz 22-2 zezzzezezzzzezz222 Zez>zez>>>>zzr>rze ZErzr errr rr zerorzz oe oe eS Bron ero oe ezogzrz>zzr2z zezezezzz-zzz2zz>>Zz22-2>>2 FF ezzzzzz2-2z2z22Z>>z222-z2>>z Dep ED ED D> PDD RD DDD REC _CASE PREER ROLL AUTTER DEVEGG POTCHIP PIGK SCP _NOP CAKE TOM 266 oUTBREAK INVESTIGATION TABLE 147. (Continued) Data, Part (Foot Boor, Rolls, But, Deviled Eggs, Potato Chips, Pickles, Strawberry Cream Pi, "Neapolitan Cream Pie Cake, Tomato) AEC CASE RBEER ROLL BUTTER DEVEGG POTCHIP PICK SCP NCP CAKE TOM 28 N N or zz ze<

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