____________ Total Score ____________ Rank School Name: _________________________________ Team Number: ________________________________ Student Name(s) (1): ______________________________

(2): ______________________________

ANSWER KEY
DIVISION C DISEASE DETECTIVES
National Science Olympiad University of Wisconsin Madison, Wisconsin May 21, 2011
Developed by the Career Paths to Public Health Program Centers for Disease Control and Prevention (CDC)

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Part A: Food Illness/Safety

1. (2 pts.) (The ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.) 2. (2 pts.) (Persons with a severe illness are more likely to be tested than those with a milder one.). 3. (2 pts.) (Norovirus = 14663/5461731 = 0.002685; Salmonella = 19336/1027561 = 0.01882; Campylobacter = 8463/845024 = 0.010015.) 4. (1 pt.) (Toxoplasma gondii.) 5. (1 pt.) (Norovirus.) 6. (1 pt.) (STEC O157.)

7. (1 pt.) (Neither.) 8. (2 pts.) (E. coli enterotoxigenic. 142/2 = 71) 9. (3 pts.) (Elderly, young children, pregnant women, immunocompromised.) 10. (2 pts.) (Need a control or comparison group.) 11. (1 pt.) b. 20 seconds 12. (1 pt.) (Chilling slows growth.) 13. (1 pt.) (Cooking kills bacteria.) 14. (1 pt.) (Freezing slows growth and can kill bacteria. Give half credit for each answer.) 15. (1 pt.) b. 40-140 degrees F 16. (1 pt.) 2 (Half credit for any answer of less than or equal to 4 hours that is not 2.) 17. (1 pt.) a. USDA (U.S. Department of Agriculture) 18. (1 pt.) (Farm__ _processing__ _transportation__ __retail__ _home table) (Students should have farm and home table. 1 point for 3 middle steps as 1/3 credit) 19. (1 pt.) binary fission 20. (2 pts.) (4 hours.)

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Part B: Botulism1
21. (1 pt.) (A bacterium or bacteria.) 22. (1 pt.) (Indirect vehicle borne; half credit is allowed for only one of the two answers) 23. (2 pts.) (The father and son could have shared other meals or other exposures that could have resulted in these symptoms. The additional 4 cases strengthened the association between the symptoms and the restaurant. Outbreak is defined as common source with more than 2 unrelated people.) (1 pt. for each bolded pt.) 24. (2 pts.) (Age or mental status of respondents, interval between eating and interview, severity of illness, alcohol consumption.) 25. (3 pts.) (A person who ate at the Greek restaurant on April 8 or April 9 and who had C. botulinum detected in their stool.) 26. (2 pts.) (18/30 = 60%) (2 pts. for showing work and having the correct answer; 1 pt. if failed to show the work, but has correct answer; no points if % is not shown.) 27. (2 pts.) (Double vision is more severe than blurred vision or more severe cases were more likely to be diagnosed. The suspect cases may not have had botulism.) 28. (1 pt.) (Epi curve or histogram.) 29. (1 pt.) (The time between when someone is exposed to a pathogen and onset of symptoms.) 30. (1 pt.) (April 9-13.) 31. (1 pt.) (Median: 2 days.) 32. (1 pt.) (A point source.) 33. (2 pts.) (An outbreak is point source if it has a common source [e.g. contaminated food or water] and the exposure occurs over a finite period of time. 2 pts. 1 for common source and 1 for finite period.) 34. (1 pt.) (Dinner on 04/09.) Table 5. Ate the Food Ill Total 19 93 94 12 12 90 5 27 Did not Eat the Food Ill Total 11 105 18 104 108 18 25 171

Black olives Greek salad Gyros Spaghetti

While the outbreak presented here occurred many years ago (1994), these are examples of classic investigations used for this competition.
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35. (2 pts.) Fill in the gaps in the above table. (2 pts., pt for each correct answer.) 36. (1 pt.) (The number of individuals who ate spaghetti.) 37. (2 pts.) Relative risk compares exposed and diseased among 2 groups; have an exposed (sick) group and an unexposed (not sick) group; compare risk (attack rates) among exposed and unexposed (1 pt for relative risk; 1 point for reason) 38. (6 pts.) (Eggplant dip or potato dip. 1 each for eggplant and potato dip, 2 points for each set of calculations, only 1 point each if used odds ratio.) EGGPLANT: 6/9 = 0.6667 24/189 = .126984 RR = 5.25 19/22 = .8636364 11/176 = .0625 RR = 13.818181

POTATO DIP :

39. (2 pts.) (The potato dip; it has the highest relative risk or RR.) (2 pts. 1 for each answer.) 40. (2 pts.) (The risk of becoming ill was 13.8 times higher for restaurant patrons who are potato dip compared to patrons who did not eat potato dip.) (2 pts. 1 for correct interpretation of RR and one for specifying potato dip in the answer.) 41. (2 pts.) (Next to one another in the fridge; sharing serving utensils; put in the same dish to serve; both foods taken from serving dish and put on personal plate; contaminated ingredient used in both foods; both were contaminated, confounding [always eaten together]; next to each other on same plate or eaten together simultaneously; accept all reasonable answers.) 42. (1 pt.) (The CI provides information on the precision, reliability (significance) of the estimate of the relative risk.) 43. (2 pts.) (Not significant, because the CI crosses 1.0.) (2 pts. 1 for no and 1 for CI crossing 1). 44. (1 pt.) (I would expect electromyography to have a lower PPV than a stool test.) 45. (2 pts.) (PPV is the proportion of positive test results that accurately help diagnose a case. The outbreak investigators felt confident enough to define a confirmed case according to a positive stool test, but only used a positive electromyography test to indicate that a case was probable. Therefore, we can assume that a positive stool test more reliably predicts a case of botulism and therefore has a higher PPV than electromyography.) (ACCEPT ANY REASONABLE ANSWER.)

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46. (2 pts.) Fill in the 2 x 2 table below. (2 pts. for each correctly-filled box.)

Test (+) Botulism (+) Botulism (-) 20 10

Test (-) 5 5

47. (4 pts.) (Sensitivity = 20 / (20 + 5) = 20/25 = 80%; Specificity = 5 / (5 + 10) = 5/15 = 33% (4 pts. 1 each for calculations; 1 each for correct answers.) 48. (4 pts.) (Yes. The high sensitivity of the test (80%) indicates that persons with botulism will likely be detected by the test. However, the low specificity (33%) suggests that persons who do not have botulism are also likely to have a positive electromyography test. Therefore, because a positive test is inclusive of cases but not exclusive of non-cases investigators were wise to not consider all positive electromyography tests as confirmed cases; but rather to use it as an indication of a probable case.) (ACCEPT ANY ANSWER THAT CORRECTLY INTERPRETS SENSITIVITY, SPECIFICITY, AND LINKS IT BACK TO CASE DEFINITIONS.) (4 pts. 1 for yes, 1 for relating high sensitivity to the answer; 1 for relating low specificity to the answer; and 1 for the link between sensitivity and specificity.)

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Part C: Lassa Fever2

49. (1 pt.) Figure 3b. (correct answer)

50. (1 pt.) (10/26 = 38.5%.) 51. (1 pt.) (7/26 = 26.9%.) 52. (3 pts.) Airborne transmission, Direct contact, Vehicle borne transmission 53. (1 pt.) zoonosis. 54. (1 pt.) (Reservoir if they only have host; minus 0.5 point for Div. C, 1 pt. for Div. B.) 55. (1 pt.) fomites 56. (6 pts.)
Case 2 3 6 8 9 10 Classification (Not a case) (Suspect) Confirmed (Probable) (Probable) (Suspect)

57. (1 pt.) (3/12 = 25% (or 250 per 1000, other units are acceptable.)

Some of the studies and data presented in this event have been fabricated or pooled in an effort to develop a cohesive event. However, we believe the underlying concepts and descriptions of the epidemiology of Lassa fever to be scientifically sound.
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58. (2 pts.) Possible answers include: Ensure every case is diagnosed consistently Using objective criteria Sensitive and specific case definition captures only true cases of the disease in question So that we can compare cases across time and place with some certainty that theyre really the same condition To detect differences in disease occurrence Accept all reasonable answers

59. (2 pts.) (Because of its non-specific symptoms, Lassa fever can easily be confused with other illnesses common in the tropics, like malaria, typhoid, and other viral hemorrhagic fevers. In low-income countries, laboratory facilities may not be available to perform diagnostic tests.)

60. (2 pts.) (You would want to use a loose case definition because it is important to identify every single case so that you can begin planning what action to take. It would be better to include some patients who do not in fact have Lassa to make sure that you dont miss any true [and potentially infectious] cases. 1 point for broad/narrow; 1 point for explanation) 61. (4 pts.) (1 pt for proper labels, 1 point for correct numbers, 2 points for calculations; minus 2 points if not odds ratio)

Storing open food Not storing open food

Households with Lassa Fever 29 55

Households without Lassa Fever 5 117

(12.34 or = 29*117/55*5 = 3393/275 = 12.34) 62. (2 pts.) (Households that store open food have 12.34 times the odds (more likely) to have Lassa fever than people who live in households that do not store open food.)

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63. (4 pts.) (1 pt for proper labels, 1 point for correct numbers, 2 points for calculations; minus 2 points if not odds ratio)

Good Housing Quality Poor Housing Quality

Households with Lassa Fever 34 50

Households without Lassa Fever 73 49

(0.456 OR = 34*49/50*73 = 1666/3650 = 0.456) 64. (2 pts.) (Households that have good housing quality have 0.456 times the odds (54.4% less likely) to have Lassa fever than people who live in households that have poor housing quality. Also can be 1/0.456 or 2.193 times the odds (119.3 % more likely).) 65. (1 pt.) protective 66. (1 pt.) (Case control.) 67. (2 pts.) X= hospitalized patients Y= total cases X/Y = proportion of total cases that are hospitalized .01Y=.15X .01 = .15X/Y .01/.15 = X/Y (About 6.7% of cases are hospitalized, because of the 1520% range.) (Accept any answer from 56.7%.) 68. (1 pt.) .01Y.15X .01 .15X/Y .01/.15 X/Y (Underestimate.) 69. (1 pt.) (Nosocomial, healthcare-associated infections, or HAIs)

70. (1 pt.) (19) 71. (3 pts.) (Wear gloves, masks, protective clothing, patient isolation, and dont reuse syringes.)

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72. (2 pts.) (Hospitals have more severe cases and have later stages of the disease.) 73. (4 pts.) A: Possible advantages include: Serious illness, so many cases go to the hospital Because medical professionals can provide a correct diagnosis Because medical records are available from hospitals Hospitalized patients are a captive audience and will answer questions about risk factors Poor community-based surveillance Easier to collect data B: Possible disadvantages include: No information on less severe cases that dont go to the hospital or more severe cases that die before they get to the hospital Selection bias for people who can get to the hospital Might miss very rural or very poor people who cant get to the hospital Eighty percent of patient-cases are asymptomatic 74. (5 pts.) (Use rodent-proof containers, dispose of garbage away from the home, keep a clean house, have cats, keep food off the ground, use mouse traps, health education, and do not eat rats.) 75. (3 pts.) (Stay away from infected people, bandage sores and cuts, do not exchange bodily fluids.) Table 8.
Antibody Test Viral Isolation Positive Negative

Positive Negative
Total

22 3
25

7 68
75

76. (2 pts.) a = 22, c = 3 0.88*25 = 22; 25 22 = 3 77. (1 pt.) (7/75 = 9.33333% = 9.33%.) 78. (1 pt.) (4/25 = 16%.) 79. (1 pt.) (51/55 = 92.7272% = 92.7%) 80. (1 pt.) (92.7% of samples that test negative on the DNA Amplification [PCR] test are not actually infected with Lassa fever virus. Use the number calculated in the previous question.) 81. Page 9 of 9

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