This case study is an example of a food-borne, infectious disease outbreak.

The measures and

calculations used here assess the source, nature, and spread of the outbreak.

After the holidays, a number of students who had been living in the new dorm returned the week
before school resumed. The new dorm’s cafeteria had been serving them 2 meals a day,
breakfast and dinner. On late Wednesday morning, students began to appear at the school
nurse’s office reporting symptoms of nausea, vomiting, dizziness, and fever. The Dean of Student
Affairs wants to know what is going on. She asks you to determine the source of this disease
outbreak.

Forty-five students were living in the new dorm on the day of the outbreak. You locate and
interview all 45 of them, thereby collecting the data presented in ANNEX B. To prepare a report
for the Dean of Student Affairs, you need to complete the following steps:

1. Describe the demographic makeup of the students who became ill and those who did not
(4 points).

In the students' demographic makeup, most of them became sick, especially the
students who ate muffins, eggs, and pancakes while students who ate oatmeal had the
least number of students who became ill. On the other hand, students who did not eat
oatmeal had the highest number of students who became ill, while students who did not
eat muffins had the least number of students who did not become ill. This indicates that
oatmeal is the least possible reason students became ill and that muffins are the highest
possible reason students became ill. Egg is a potential ingredient of both muffins and
pancakes, which may be why students who ate these foods also became sick.

2. Construct an epidemic curve, and determine the time of onset and incubation period for
this outbreak (5 points). (CLUE: The incubation period can be calculated for individuals
who reported sick to the school nurse by subtracting the time when they ate breakfast
from the time when they first reported to the nurse.)

Average incubation period: 3 hours 16 minutes

Minimum Incubation Period: 1 hour
Maximum Incubation Period: 6 hours
Earliest Case: 9:15 AM
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 Last Case: 2:45 PM

3. Calculate attack rates for each food item served by the cafeteria that morning, and identify
the probable source of the outbreak (10 points).

Food Ate Food Item Did Not Eat Food Item

Item

Sick Not Total Attack Sick Not Total Attack Risk

Sick Rate Sick Rate Ratio
(%) (%)

Ham 14 5 19 73.68% 21 5 26 80.77% 0.91

Sausage 19 5 24 79.17% 16 5 21 76.19% 1.04

Oatmeal 12 4 16 75% 23 6 29 79.31% 0.95

Eggs 23 2 25 92% 12 8 20 60% 1.53

French 16 4 20 80% 19 6 25 76% 1.05

Toast

Pancakes 17 5 22 77.27% 18 5 23 78.26% 0.99

Muffins 24 7 31 77.42% 11 3 14 78.57% 0.99

Based from the calculated risk ratio, the probable source of the outbreak is the eggs as
this has the highest risk ratio among the food items. This indicates that the students who ate
eggs are more likely to acquire the disease.

4. Determine the prevalence for this disease in the dorm student population by late afternoon
that day. What was the incidence rate for the 1-hour period, 11:45 a.m. to 12:45 p.m. (inclusive) (
2points)?

ALL NEW ∧PRE−EXISTING CASES

Prevalence rate = X 100
TOTAL POPULATION

35
=
45

= 77.78%

NEW CASES
Incidence rate = X 100
TOTAL POPULATION

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 12
=
45

= 26.67%

5. Comment on how the new cafeteria might prevent another such outbreak in the future (4
points).
To prevent another outbreak from occurring, the new cafeteria should be
responsible enough in protecting their customer’s health and safety. This includes checking
the expiration dates of products, storing food at safe temperatures, having proper sanitation
before and after handling the foods and avoiding cross-contaminations. In this way, safety of
the products and ingredients used to make the foods would be ensured and health problems
or complaints would not be encountered. This would also make people practice and promote
food safety which would be beneficial for both the cafeteria and customers.

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