6

After studying this lesson and answering the questions in the exercises, you will be able to:
List the reasons that health agencies investigate reported outbreaks
List the steps in the investigation of an outbreak
Define cluster, outbreak, and epidemic
Given the initial information of a possible disease outbreak, describe how to determine
whether an epidemic exists
State the purpose of a line listing
Given information about a community outbreak of disease, list the initial steps of an
investigation
Given the appropriate information from the initial steps of an outbreak investigation,
develop biologically plausible hypotheses
Draw and interpret an epidemic curve
Given data in a two-by-two table, calculate the appropriate measure of association
E. coli
Control and prevention
Opportunity to learn (research opportunity)
Public, political, or legal concerns

Program considerations

Training
Scientific and investigative issues
Management and operational issues
outbreak epidemic

cluster
they
 °
°
false-positive
passive surveillance

active surveillance
Identifying information

Demographic information
person

Clinical information

Risk factor information

Reporter information
 descriptive epidemiology

Time

epidemic curve
epi curve

Salmonella enterica
Drawing an epidemic curve.
x
Interpreting an epidemic curve.

log-normal
point-source epidemic

continuous common-source epidemic

propagated epidemic
 Control of
29
Communicable Diseases Manual.

x
—
Place
B. anthracis
Person

Summarizing by time, place, and person

 Salmonella

Yes
Not really
Visit my father and buy the locally produced ground beef
that he sells in his store
observed
expected
Retrospective cohort studies

Relative and attributable risk.

risk
ratio relative risk

Salmonella
 Ate beef

Ate be

Ate be
Statistical significance testing.

null hypothesis
alternative hypothesis
is

p-value
H1 x H0 x V1 x V2
Confidence intervals.

Case-control studies

odds ratio

Choosing controls.
bias
Odds ratios.

odds ratio
Salmonella

S.
 Clostridium
botulinum
 E. coli

E. coli
cohorted
An oral briefing for local authorities.
A written report.
Initial Case Definition Revised Case Definition
E. coli

E. coli

E. coli
—

Escherichia coli

—
Campylobacter jejuni

—
Escherichia coli Campylobacter jejuni