EPIDEMIC INVESTIGATION

Lecturer: Dr. Collao

Date of lecture: January 25, 2011
Transcriptionist: TransMistress Razeille IV-2

Definition of Outbreak • Probable

• Occurrence of more cases of disease than expected in – Patient older than 5 years with severe
a given area among a specific group of people over a dehydration or dying of acute watery
particular period of time diarrhea in town “x” between 1 June and
• Two or more linked cases of the same illness 20 July 2006
• Confirmed
Objectives of Outbreak Investigations – Isolation of Vibrio cholerae from stool of
• To determine the cause of the outbreak patient
• To control ongoing outbreaks
• To prevent future outbreaks Control the Source of Pathogen
• To provide statutorily mandated services • Remove source of contamination
• To strengthen surveillance at local level • Remove persons from exposure
• To advance knowledge about a disease • Inactivate / neutralize the pathogen
• To provide training opportunities • Isolate and/or treat infected persons

Specific Demands when Investigating Outbreaks Interrupt Transmission

• Unexpected event • Interrupt environmental sources
• Need to act quickly • Control vector transmission
• Need for rapid control • Improve personal hygiene
• Work carried out in the field
Modify Host Response
Steps of an Outbreak Investigation • Immunize susceptibles
• Confirm outbreak and diagnosis • Use prophylactic chemotherapy
 Case definition and identification
 Descriptive data collection and analysis At the End
 Develop hypothesis • Prepare written report
 Analytical studies to test hypotheses • Communicate public health messages
• Special studies • Influence public health policy
• Implementation of control measures • Evaluate performance
 Communication, including outbreak report
Cessation of an outbreak occurs when there is:
Case Definition
• Standard set of criteria for deciding if a person should - elimination of source of contamination
be classified as suffering from the disease under - interruption of transmission
investigation. - reduction/exhaustion of susceptibles
• Clinical criteria, restrictions of time, place, person - modification of the effect of primary pathogen
• Simple, practical, objective
• Sensitivity versus specificity An investigator should have knowledge on the
following:
Ex. • various types of etiologic agents and the resultant
Patient older than 5 years with severe dehydration or dying of disease
acute watery diarrhea in town “X” between 1 June and 20 July • epidemiological characteristics of outbreaks
2006 associated with different etiologic agents of resultant
diseases
Examples of Case Definition: • clinical symptoms of resultant diseases
• Possible • environmental and food sanitation practices
– Patient with severe diarrhea • sources of exposure which are vulnerable to
contamination with an infectious or chemical agent
• laboratory test available to determine causative agents
• read/search for additional data on studies, prevention
and control

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