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This document outlines the steps for investigating an outbreak:
1) Define the outbreak and validate its existence by determining the cases, population at risk, and whether observed cases exceed expected numbers.
2) Examine the distribution of cases by person, place, and time to identify common exposures and generate hypotheses.
3) Look for interactions between relevant variables and develop hypotheses based on literature, existing knowledge, and interviews.
4) Test hypotheses through analytic studies and refine hypotheses as new data is collected.
5) Recommend control measures to stop ongoing and prevent future outbreaks, then implement and evaluate the effectiveness of these measures.
This document outlines the steps for investigating an outbreak:
1) Define the outbreak and validate its existence by determining the cases, population at risk, and whether observed cases exceed expected numbers.
2) Examine the distribution of cases by person, place, and time to identify common exposures and generate hypotheses.
3) Look for interactions between relevant variables and develop hypotheses based on literature, existing knowledge, and interviews.
4) Test hypotheses through analytic studies and refine hypotheses as new data is collected.
5) Recommend control measures to stop ongoing and prevent future outbreaks, then implement and evaluate the effectiveness of these measures.
This document outlines the steps for investigating an outbreak:
1) Define the outbreak and validate its existence by determining the cases, population at risk, and whether observed cases exceed expected numbers.
2) Examine the distribution of cases by person, place, and time to identify common exposures and generate hypotheses.
3) Look for interactions between relevant variables and develop hypotheses based on literature, existing knowledge, and interviews.
4) Test hypotheses through analytic studies and refine hypotheses as new data is collected.
5) Recommend control measures to stop ongoing and prevent future outbreaks, then implement and evaluate the effectiveness of these measures.
Why to investigate an outbreak Define the outbreak and validate
Stop the epidemic the existence of an outbreak
Characterize a public health problem Identify preventable risk factors Define the numerator (cases) Prevent new episodes (1) Clinical features: is the disease Provide new research insights into known? disease (2) What are its serologic or cultural Train health department staff in aspects? methods of public health Appropriate test, time , method and investigations and emergency handling response (3) Are the causes partially Evaluate the system understood? b. Define the denominator: What is the population at risk of developing Steps in Outbreak Investigation disease? Define the outbreak and validate the c. Determine whether the observed existence of an outbreak number of cases clearly exceeds the Define Case and Examine the expected number distribution of cases d. Calculate the attack rates Look for combinations (interactions) of Verifying the existence of a true relevant variables (descriptive outbreak is critical to proceeding with epidemiology) an investigation. Confirmation of the Develop hypotheses diagnosis with a laboratory is Test hypotheses important, especially if the pathogen is Recommend control and preventive new or unusual. measures An attack rate is defined as: Prepare a written report No of people at risk in whom certain Communicate findings illness develops These steps may occur simultaneously Total No of people at risk or be repeated as new information is received. Who must report In epidemiology, an attack rate is Confidentiality of report the cumulative incidence of infection in a group of people observed over a period of time during an epidemic It is measured from the beginning of an outbreak to the end of the outbreak. The attack rate (or the incidence rate) is useful for comparing the risk of disease in groups with different exposures
2. Examine the distribution of
cases Examine the distribution of cases by the following: person time Place} Look for timeplace 4. stool culture yielding E. coli O157:H7 interactions with the outbreak strain PFGE pattern. Frequency tables, mapping, What could account for the epidemiological curve Create line listing increase in cases? Person Who was infected? Real increase What do the cases have in Increase in population size common? Place Changes in population Where were they infected? characteristics May be useful to draw a map Random variation Time Outbreak When were they infected? Create an epidemic curve Artificial increase New testing protocol Contamination of samples Changes in reporting procedures 3. Look for combinations (interactions) of relevant variables Look for combinations (interactions) of relevant variables 4. Develop hypotheses Develop hypotheses based on the Develop a Case definition following Incubation period for E. coli O157:H7 ranges from 3-8 days with a median of 3-4 days. literature reviews of previous The infection often causes severe outbreaks bloody diarrhea and abdominal cramps, Existing knowledge (if any) of but can also cause a non-bloody the disease diarrhea or result in no symptoms. In some persons, particularly children interviews of several under 5 years of age and the elderly, case-patients infection can be complicated by correlation to diseases of hemolytic uremic syndrome (occurs in about 2-7% of infections) known etiology Case Definition Findings from investigation of Outbreak investigation definition: the outbreak 1. diarrhea (>3 loose bowel 5. Test hypotheses movements a day) and/or abdominal cramps 2. resident of Michigan Conduct an analytic study to 3. onset of symptoms between June 15 and test hypotheses July 15 Retrospective cohort study Case-control study communicate progress and Refine hypotheses and collect findings additional data that may be needed Communicate findings to 6. Recommend control those involved in policy measures development and implementation and to the Control of current outbreak Prevention of future similar outbreaks Implement and evaluate control measures Prevent further exposure and future outbreaks by eliminating or treating the source Work with regulators, industry, and health educators to institute measures Create mechanism to evaluate public both short- and long-term success 7. Prepare a written report of the investigation and the findings Summarize investigation, You are called upon to carry out make recommendations, and an outbreak of vomiting and disseminate report to all stomach cramps following a participants reception held by the High Commission Organization. The following table derives from this investigation.
8. Communicate findings
Identify a single member of
the investigation team to interact with media and Conclusions The steps listed for an outbreak investigation comprise a brief introduction and rough guide. Only by conducting investigations repeatedly over an entire career will public health professionals truly learn the methods of outbreak investigations.
Particle emission concept and probabilistic consideration of the development of infections in systems: Dynamics from logarithm and exponent in the infection process, percolation effects