Case Study and Resources

Imagine that you work for the department of public health. You receive a report that there may be an outbreak of
antibiotic resistant tuberculosis at a local prison. Tuberculosis is a bacterial infection that targets the lungs. It is
estimated that a quarter of the world population has tuberculosis; however, in the United States, there are under
10,000 cases per year due to rigorous tracing efforts. In addition, in many individuals, tuberculosis can remain
latent and produce no symptoms. In others, however, tuberculosis can destroy lung tissue, leading to respiratory
failure. Consequently, you immediately initiate epidemic management procedures, which includes lockdown of
the prison and contact tracing efforts.

Upon contacting the prison, you learn that the prison has a population of roughly 1,000 individuals, in which 50
are positive for tuberculosis. None of the patients are responding to antibiotics. You also learn that five of the
prisoners who tested positive have had contact with visitors recently. Three weeks after that, one of the visitors
attended a sold-out sports event in an adjacent county where 60,000 fans were in attendance.

Given these circumstances, you pull together an epidemic response team consisting of medical personnel and
local leaders. You quickly learn that there are several differing views. One team member suggests “minimal
intervention,” in which individuals who are sick receive treatment as they normally would, and the prison is
locked down. This team member believes that the likelihood of an outbreak is low based on the limited
exposure. He doesn’t want to create a panic, and is also concerned about worsening antibiotic resistance if
people seek unnecessary treatment. Another team member suggests a “maximal intervention” approach.
Specifically, she believes that this strain of tuberculosis may be able to spread quickly, potentially posing a
significant threat to the prison population, healthcare personnel, and the surrounding community. Consequently,
this team member suggests that the public be notified, and that strict quarantine measures be put in place for any
individual who has been exposed.

Based on what you understand from Modules 6-9, create a proposal outlining how the team should proceed
keeping in mind the collective welfare and safety of the prisoners, healthcare workers, and community.
Specifically, based on your knowledge of population dynamics, what is the likelihood of a massive outbreak in
the prison and the community? Based on your knowledge of genetics, how should treatment be modified based
on the antibiotic resistance conferred by this bacterial strain? Finally, based on your knowledge of natural
selection, is worsening antibiotic resistance a concern?

In order to generate your report, consult the following resources:

 Tuberculosis (TB)
 Preventing TB Transmission | Infectious Diseases
 Antibiotic Resistance

Probable Solutions for the Case Study

Using the information in the case study above, the additional resources, and what you have learned from
Modules 6-9, which option would you choose from the choices below?

Option A: Minimal Intervention

The minimal intervention approach involves very little strategy in terms of containment. Specifically, given that
the most susceptible population will be under lockdown, it’s likely that the initial outbreak can be contained
within the prison and ancillary hospital settings. However, this approach carries risk, and assumes that the public
will not be put at risk. This is not a sure thing, however, given that there is a potential exposure at a major event.
While it’s unlikely that 60,000 people were infected, several individuals may have been. Therefore, notifying
the public will not immediately create a panic. However, if the bacteria begins to spread throughout the
community with a high frequency, an epidemic is likely. In such a case, public health would be put at great risk.

Option B: Maximal Intervention

The maximal intervention approach involves quarantining all individuals who may have been exposed to
tuberculosis. Given that this is a high number of individuals (60,000), this would be quite an undertaking, and
would likely be met with significant pushback. That being said, there is the possibility of a small fraction of the
60,000 being infected, who could then pass the disease on to others, eventually leading to an epidemic. If
implemented properly and adhered to, quarantine measures are nearly 100% effective in reducing disease
transmission, making this a viable option. However, given that this will require significant community
involvement, this may create a panic. This may increase doctor’s visits and, if not properly monitored, the
overprescription of antibiotics. While this may not directly impact this specific tuberculosis outbreak, this could
negatively impact the health of the community in the future.

Option C: Moderate Intervention

A moderate intervention approach could be devised in which aspects of the minimal and maximal interventions
are both utilized. Specifically, the prison should be placed on lockdown given its outbreak status. However,
instead of quarantining all possible exposures, it may be desirable to alert only confirmed contacts. In addition,
all local medical facilities should be alerted so that they can preemptively take any necessary measures. This
includes preparing for a large number of patients, having appropriate personal protective equipment, and having
alternative treatments other than antibiotics. While this approach is more tempered, there is the possibility for
significant disease spread, and guidelines should be put in place to ensure significant risk to the community.

Biology Lab: Discussion 2 V5

What you need to do:

1. Read through the case study and the accompanying resources.

2. Reflect on what you’ve learned in the course and how the information applies to the scenario.
3. Select which solution you think is best for the given scenario.
4. Compose a discussion post by clicking on the “Comment” button. Your first post should
include the following information:

a. Which option you selected (You can say A, B, C, or D.)

b. A brief statement as to why you selected that option

c. An outside source that supports your conclusion; this can be a reference to a book,
website, journal article, etc.

5. Your post can be no more than 800 characters and no fewer than 600 characters. Your post
should be in your original words, not in quotes or citations. In-person discussions are short, so your
challenge is to be concise and articulate to demonstrate your understanding of the course. You can
use additional discussion posts to further support your position if needed. If you go below or over the
character limit, you will not be able to post your reply. If you prefer to write your post first in a word
processor, check your character counts first.

6. Once you have submitted your initial post, read through what others have posted. Find
someone who has selected a different solution than you and has really made you think about your
choice. Reply to their post with a thoughtful question. These should not be “who, what, when, or
where” types of questions. They should be substantive “how and why” types of questions that seek to
understand why someone chose the solution they did.