Overview of Laboratory Diagnosis in Disease Outbreak

Dr.Kedar Karki Senior Veterinary Officer Central Vet. Laboratory Tripureshwor

Objectives
• Describe epidemiological approach to understanding disease etiology • Distinguish between the stages of the disease process

2

Biological and Chemical Epidemiology
The study of the distribution and determinants of diseases resulting from a biological or chemical attack

3

Sources of Epidemiologic Clues to a Disease Outbreak
• Clinician’s office or medical clinic • Emergency room • Laboratory • Veterinary Clinic • Pharmacy

4

Epidemiologic Approach to Understanding Disease Etiology
• Descriptive epidemiology identifying associations of disease in relation to
– Time – Place – Persons

5

Epidemiologic Approach to Understanding Disease Etiology
• Analytic epidemiology
– Identify associations of disease with possible etiologic factors (chemical release, biological agent) – Further refine and test hypotheses regarding etiology

6

Problems Investigating the Causes of Disease
• Specific agent might not be known • Location of agent release might not be known • Signs and symptoms might not differentiate disease • More than one agent might be used • Time of agent release might not be known • Latency period might not be known • Latency is not the same for all Animal

7

Epidemiologic Triad of Disease
Host

Agent

Environment
8

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

9

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

10

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

11

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

12

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

13

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

14

Modes of Transmission
• Direct
– Contact – Droplets Host

• Indirect
– Airborne – Vehicle-borne – Vector-borne Agent
• Mechanical • Biologic

Environment

15

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Temperature Humidity Altitude Wind Crowding

16

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Temperature Humidity Altitude Wind Crowding

17

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

18

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

19

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

20

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

21

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

22

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

23

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

24

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

25

Factors That May Be Associated With Disease
Host Characteristics Age Sex Race Religion Customs Occupation Genetic profile Marital status Immune status Vaccination status Types of Agents and Examples Biologic (bacteria, viruses, toxin) Chemical (nerve, blister) Nuclear Bombs and flammables Environmental Factors Location of release Temperature Humidity Altitude Wind Crowding

26

The Natural History of Disease

Healthy Disease Onset Symptoms Seek Care Diagnosis Treatment

Outcome Cure Control Disability Death

27

The Natural History of Disease

Healthy Disease Onset Symptoms Seek Care Diagnosis Treatment

Outcome Cure Control Disability Death

28

The Natural History of Disease

Healthy Disease Onset Symptoms Seek Care Diagnosis Treatment

Outcome Cure Control Disability Death

29

The Natural History of Disease

Healthy Disease Onset Symptoms Seek Care Diagnosis Treatment

Outcome Cure Control Disability Death

30

The Natural History of Disease

Healthy Disease Onset Symptoms Seek Care Diagnosis Treatment

Outcome Cure Control Disability Death

31

Conducting a Field Investigation

Conducting a Field Investigation
• When possible, collect information that describes:
– When people became ill – Where they acquired the disease – Characteristics of the people

33

Conducting a Field Investigation
• When descriptive information does not readily indicate risk factors, analytical methods will be required:
– Determining rates and comparing them
• Comparing ill and well or • Comparing exposed and unexposed

– Most analysis should be done in the field

34

Steps in Conducting a Field Investigation of a Bioterrorist Event
• Determine if there is an increase in the occurrence of disease • Confirm the diagnosis of disease • Determine definition of a case • Analyze the data in terms of time, place, and person • Determine who is at risk for becoming ill
35

Steps in Conducting a Field Investigation of a Bioterrorist Event
• Develop an hypothesis that explains the specific exposure that caused disease • Test hypothesis using statistics • Compare hypothesis with known facts • Execute control and prevention measures • Plan a more systematic study 36

Determine If There Is an Increase in the Occurrence of Disease
• Initial indication of an increase might be syndromic only • Might need to check hospital and clinic records for increase in symptoms • Might need to telephone a sample of physicians • Might require a rapid community survey • Might be difficult to distinguish between a disease outbreak related to bioterrorism and one from other causes
37

Confirm the Diagnosis of Disease
• Frequently requires laboratory techniques • Can not always wait for confirmation before starting treatment and prophylaxis • Might only require laboratory confirmation of first few cases before relying solely on signs and symptoms
38

Determine Definition of a Case
• Use signs and symptoms or simple, rapid laboratory techniques • At this point, more important to include all possible cases (high sensitivity) • Use simple case definition to initiate immediate treatment

39

Analyze the Data in Terms of Time, Place, and Person to Determine Who is at Risk
• When did patients first start becoming ill • Where were they when they became ill • What were their activities prior to becoming ill and where were they performing these activities

40

Explains the Specific Exposure That Caused Disease
• The origin of the specific exposure might not be obvious • Can be the most challenging aspect of the investigation

41

Test Hypothesis Using Statistics
• Statistics provide a set of tools that help an epidemiologist reduce the role of chance in hypothesis testing • Statistics can not substitute for an epidemiologists’ review of all the evidence before he decides on an intervention plan

42

Compare Hypothesis With Known Facts
• Is the hypothesis in agreement with laboratory, clinical, and other epidemiological evidence • Might need to consult other scientific disciplines (e.g. Medicine, Biology, Environmental Science, Laboratory Science)

43

Execute Control and Prevention Measures
• Important to get to this step as quickly as possible, particularly in a case of a highly lethal agent • Sometimes must make decisions that rely on incomplete information • These decisions must be continually reviewed as new information is obtained
44

Plan a More Systematic Study
• As control measures are initiated, additional questions will arise that will require additional studies • These studies should use the most applicable epidemiological study methods available

45

Prepare a Written Report
• A document for action • A record of performance • A document for potential medical/legal issues • A systematic review of the investigational methods that might suggest additional analysis • A document that will help others investigate and control future bioterrorist attacks
46

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