Running Head: IDENTIFYING THE UNKNOWN ILLNESS

Maryam Ebadi
Identifying The Unknown Illness On Flight 331
MPH 621 Keeler
University of San Francisco School of Nursing and Health Professions
04/29/13






























IDENTIFYING THE UNKNOWN ILLNESS 2
Identifying The Unknown Illness

The high risk magnitude and prevalent of an unknown illness has currently been
associated to foodborne illness in some cities of the United States such as Atlanta, Detroit, San
Antonio, and San Francisco. The etiology of the disease is unknown however it has been
hypothesized by Dr. Nick Riviera that the illness originated from a tainted cheese burger in a
can left on the tarmac for six hours on the flight 331.
Foodborne illness is a growing public health problem in developing and developed
countries. Foodborne illnesses comprise a broad spectrum of diseases and are responsible for
substantial morbidity and mortality worldwide. Foodborne illness result from consumption of
food containing pathogens such as bacteria, viruses, parasites or food contaminated by poisonous
chemicals. Although most of the foodborne illness cases are mild, severe cases can result in high
mortality and morbidity in the population. Foodborne illness such as this has an economic cost
and burden on the society in national, as well as regional level.
In order to investigate this unknown illness we first need to prevent transmission of the
unknown illness that can result in similar outbreaks in the future, we need to take following steps
such as recording clinical symptoms of the patients, laboratory investigation, systematic
surveillance and effective use of epidemiological measures.
Clinical information is very important source in this case study since it will help to identify
cases, verify that the case definition has been met. Clinical information allows to define clinical
manifestations and identify the following date and time of first signs and symptoms, nature of
initial signs and symptoms, severity and duration of symptoms, medical visits and hospital
admission, treatment and outcome of illness.
The number of cases with a particular symptom or sign should be recorded in a table.
Organizing the information in a table will help in determining the incubation period of the
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disease. The symptoms in this unknown illness includes initial stage high grade fever, muscle
aches, and unusual tiredness, second stage patients enter a comatose state and in the final stage
patients awaken, exhibiting highly aggravated and aggressive behavior, this can suggest that
onset of the illness is known and has long incubation period. To help us understand with the
time, course of this outbreak, and data best we need to draw an epidemic curve. The shape of an
epidemic curve is determined by the epidemic pattern (point source, common source or person to
person spread), the period of time over which persons are exposed and the incubation period for
the disease.

A measure of disease frequency is important in characterizing an outbreak such as this one,
and the commonest epidemiological measure is rate. Rate measures the differences in population
size and allow comparison of the occurrence of disease in various sub groups. Analytical
epidemiology will be used in the outbreak of this unknown illness to test Dr. Rivieras
hypothesize. The type of analytical study that would be used in this unknown illness will be
retrospective cohort study because the outbreak is small, well defined population. Cohort study
would compare the occurrence of the disease among those who were exposed to a suspected risk
factor with occurrence among those who are not. For our example, all persons on flight 331(the
cohort) may be interviewed to determine whether they became ill after the eating the tainted
IDENTIFYING THE UNKNOWN ILLNESS 4
cheeseburger in a can and to identify what other foods they had consumed. After collecting
information from each passenger, attack rates for the unknown illness would be calculated for
those who ate the tainted cheeseburger in a can and for those who did not eat that food.
Illness
No
Illness
Ate tainted cheese
burger
55 80
No tainted
cheeseburger
2 10
In this example, of a total of 135 passengers on flight 331 who ate the tainted cheeseburger in a
can 55 fell ill and the attack rate would be 55/135 is 40%. The attack rate for those who did not
eat the tainted cheeseburger in a can would be 2/12 would be 16%. These results suggest that
the tainted cheese burger in a can is likely risk factor for the unknown illness due to the attack
rate is higher among those exposed to the food and most cases were exposed to the tainted
cheeseburger in a can. We can also calculate the relative risk (RR) in this case as following
RR=Attack rate for those who ate tainted cheeseburger in a can/Attack rate for those who did
not eat tainted cheeseburger in a can= 40/16=2.5
The relative risk measures the strength of association between the exposure and the disease and
in the above case, the relative risk associated with eating the tainted cheeseburger in a can is
2.5 which means those who ate the tainted cheeseburger in a can are 2.5 times more likely to
develop the disease than those who did not.
Based on the results above we can say that there is a positive association between eating the
tainted cheeseburger in a can and the unknown illness but we have to also keep in
consideration the potential sources of bias such as dose response, checking the validity of the self
-reporting and ensuring the collection of appropriate clinical specimens. Preventive measures in
this case would be to keep the true positives isolated from rest of the population to avoid
spreading the illness since the mode of transmission is direct contact
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