Outbreak is a special form of epidemics i.e.

when an epidemic occurs suddenly in a relatively There A pathogen in sufficient

limited geographical area. should quantities to affect multiple
be: persons
In an outbreak or epidemic, the cases are usually
For an
Investigation related to one another or that they have a Outbreak to An appropriate mode of
transmitting the pathogen to
of an common cause.
develop and susceptible persons
Outbreak persist:
Cluster (unlike outbreak) is just an aggregation
An adequate pool of
of cases in a given area over a particular period, susceptible persons who are
regardless of whether the number of cases is exposed to the pathogen
more than expected or related to each other.

To control ongoing
Person to person outbreak: occurs when
the causal agent is transmitted from one outbreaks
person to another e.g. Typhoid fever.
Types of Objectives of
transmission To prevent future
outbreak
during investigations
outbreaks
Common source exposure outbreak:
outbreak occurs when the causal agent is
To advance our knowledge
transmitted to the affected individuals by
some shared features in the about a disease
environment. e.g. consumption of
contaminated water or milk
Steps of an Outbreak Investigation (10 steps)
• Prepare for field work
• Verify the diagnosis
• Establish the existence of an
outbreak
• Define and identify cases
• Describe and orient the data
in terms of time, place, and
person
• In practice, several steps may be done
• Develop hypotheses
• Evaluate hypotheses
• Refine hypotheses and carry
out additional studies
• Implement control and
prevention measures
• Communicate findings
at the same time, or they may be done
in a different order. For example,
control measures should be
implemented as soon as the source
and mode of transmission are known,
which may be early or late in any
particular outbreak investigation.
In practice ….

Review literature (specially for uncommon diseases in

Review
the community) The Goal: is to rule out misdiagnosis and laboratory error.

Prepare Prepare the supplies and equipment

Examine case-patient(s)

Visit and interview for similar other cases

Consult Consult laboratory staff
Review medical records
Arrange Arrange for portable computer, camera
Review clinical findings and laboratory results

Consult Consult local staff Confirm laboratory findings

Step 1: Prepare for Field Work Step 2: Verify the Diagnosis

 1. Establish a case definition: A case
definition usually includes 4 components:
If current number of reported cases
exceeds expected number • Clinical information about the disease, Characteristics
Step 3: about the people who are affected, Information about
Step 4: Define the location or where, and Specification of time
Establish the (when) during which the outbreak occurred
and Identify
Existence of Done by comparing the current
2. Identify and count cases: to determine
Cases the size and geographic extent of the
an Outbreak number of cases with the expected problem:
number from the previous few weeks
or months, or from a comparable Following information should be taken for
period during the previous few years every person: Identifying information,
Demographic, Clinical, and Risk factors

After summarizing and correlating the time,

Time: epidemic curve place, and person characteristics, hypotheses
will be generated.
Step 5:
Describe the
Place: spot map Step 6: Consultation with health officials in
Data in community can help in developing the
Develop hypothesis
Terms of
Hypotheses
Time, Place,
The hypotheses should address the source of
and Person Person: Personal the agent, the mode (vehicle or vector) of
transmission, and the exposures that caused
characteristics the disease.
 Test the hypotheses using a
comparison group to quantify
relationships between exposures and
the disease (analytic epidemiology). • When analytic epidemiological
studies do not confirm the
There are two types of analytic studies: hypotheses, laboratory and
cohort studies and case-control environmental studies are needed
Step 7: studies.
to test the hypotheses
Evaluate
Hypotheses NB:

Step 8: Refine Hypotheses and

You should be able to calculate the
attack rate Carry out Additional Studies

• Control measures, which can Prevention of exposure

be implemented early, should
be aimed to interrupt the
chain of transmission targeting Prevention of infection
Control
the agent, the source, or the
strategies
reservoir of infection Prevention of disease

Step 9: Implementing Control Prevention of death

and Prevention Measures
 Finally communicate the findings to others
through:

Oral briefings, Meetings, E-mail, Written

Step 10: reports

Communicate
Findings The report should include:

Background of disease, Historical data,

Methodology of investigation, analysis of
data, and control measures.