what are the three principles of outbreak management
Depending on the outbreak, the hypotheses may address the source of the agent, the mode (and vehicle or vector) of transmission, and the exposures that caused the disease. In general, the more subjects (case-patients and controls) in a study, the easier it will be to find a statistically significant association. When on the institution site, please use the credentials provided by your institution. Outbreak Protocol is provided for health practitioners to aid in the detection and control of communicable disease outbreaks by providing a framework of provincial legislation and policy. The authors and the publishers do not accept responsibility or
Adapted from: Foodborne transmission of hepatitis A Massachusetts, 2001. Return to text. Consider again the gastroenteritis data in Table 6.8. CARIES_RISK_ASSESSMENT_and_MANAGEMENT (1).pptx, Intermittent Fasting Guide_Lose Weight Fast.pdf, 9 Strategies To Boost The Value Of Your Dental Practice.pdf, Brief and easy information about antiseptics, How to Choose the Best Hair Loss Treatment Solution for You.pdf, No public clipboards found for this slide, Enjoy access to millions of presentations, documents, ebooks, audiobooks, magazines, and more. Return to text. Are they occurring throughout the area, indicating that the interventions are generally ineffective, or are they occurring only in pockets, indicating that the interventions may be effective but that some areas were missed? Looks like youve clipped this slide to already. In a case-control study, the investigator asks both case-patients and a comparison group of persons without disease (controls) about their exposures. London: Humphrey Milford: Oxford U Press, 1936. Persistence of virus-reactive serum immunoglobulin M antibody in confirmed West Nile virus encephalitis cases. For example, a child with measles in a community with other susceptible children may prompt a vaccination campaign before an investigation of how that child became infected. Verify diagnosis 4. Chapters cover: * infection prevention and control programmes * micro-organisms relevant to infection prevention and control * risk assessment and management * hand hygiene * healthcare facility design * cleaning and waste management * surveillance and outbreak . Finally, recall that one reason to investigate outbreaks is research. J Epidemiol Comm Health 1989;43:3114. List the six steps in an outbreak investigation. Source: Castel AD, Blythe D, Edwards L, Totaro J, Shah D, Moore M. A large outbreak of Salmonella Enteritidis infections associated with crabcakes at a church fundraiserMaryland, 2003. Do not use an Oxford Academic personal account. Some epidemiologists apply the term epidemic to situations involving larger numbers of people over a wide geographic area. Assemble useful references such as journal articles and sample questionnaires. If you cannot sign in, please contact your librarian. Education, child protection, commerce, transportation, and human rights have all suffered. The incubation period for hepatitis A ranges from 15 to 50 days (roughly 2 to 7 weeks), with an average incubation period of 2830 days (roughly one month). In a third study, investigators used radio broadcast appeals to identify healthy restaurant patrons who had eaten the implicated sandwich. See below. Referring to Table 6.10, a chi-square of 13.02 corresponds to a p-value less than 0.001. Step 10: follow-up to ensure implementation of control measures, Cooperation for international outbreak investigation and preparedness, Methodology of intervention trials in individuals, Methodological issues in the design and analysis of community intervention trials, Community intervention trials in high-income countries, Community-based intervention trials in low- and middle-income countries, Validity and bias in epidemiological research, Measuring the health of populations: the Global Burden of Disease study methods, Mathematical models of transmission and control of infectious agents, Sociology and psychology in public health, Health promotion, health education, and the publics health, Development and evaluation of complex multicomponent interventions in public health, Economic appraisal in public healthcare: assessing efficiency and equity, Governance and management of public health programmes, Implementation science and translational public health, Environmental and occupational health sciences, Environmental health issues in public health, Environmental exposure assessment: modelling air pollution concentrations, Toxicology and risk assessment in the analysis and management of environmental risk, Epidemiology and prevention of cardiovascular disease, Chronic obstructive pulmonary disease and asthma, Neurological diseases, epidemiology, and public health, Chronic hepatitis and other liver disease, Prevention and control of public health hazards, Public health aspects of illicit psychoactive drug use, Injury prevention and control: the public health approach, Interpersonal violence: a recent public health mandate, Urban health in low- and middle-income countries, Ethnicity, race, epidemiology, and public health, Forced migrants and other displaced populations, Prisons: from punishment to public health, Prevention and control of non-communicable diseases, Strategies and structures for public health intervention, Training of public health professionals in developing countries, Training of local health workers to meet public health needs, Emergency public health and humanitarian assistance in the twenty-first century, Principles of public health emergency response for acute environmental, chemical, and radiation incidents, The future of international public health in an era of austerity, Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. While controls from these groups may be more likely to participate in the study than randomly identified population-based controls, they may not be as representative of the population. Weed and pest animal management is an integral part of managing natural resources and agricultural systems. Investigators of a school-based gastroenteritis outbreak might describe occurrence by grade or classroom, and by student versus teacher or other staff. The .gov means its official. As noted earlier, many outbreaks are brought to the attention of health authorities by concerned healthcare providers or citizens. Activate your 30 day free trialto unlock unlimited reading. Because cases can occur from 15 to 50 days after exposure, all cases from a point source exposure should occur within a span of 50 15 = 35 days. Descriptive epidemiology describes the where and whom of the disease, allowing you to begin intervention and prevention measures. Outbreak management should aim to be: scalable: arrangements can be applied to any size or type of outbreak Click here to review the details. Public Health Reports 2003; 118:928. Although the next conceptual step in an investigation is formulating hypotheses, in reality, investigators usually begin to generate hypotheses at the time of the initial telephone call. The characterization often provides clues about etiology, source, and modes of transmission that can be turned into testable hypotheses (see Step 7). An X indicates locations of people whose nasal swabs tested positive for B. anthracis. Data Source: Mahoney FJ, Hoge CW, Farley TA, Barbaree JM, Breiman RF, Benson RF, McFarland LM. Standard plus appropriate transmission-based precautions are to be implemented as soon as an outbreak or a potential outbreak has been identified or determined. In that investigation, a case-control study failed to implicate any plausible food source as a common vehicle. Without a proper denominator, attack rates cannot be calculated. Are intervention measures working? To understand:
The principles of detecting and controlling an
outbreak. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. (35), Sometimes a more specific control group is needed to test a more specific hypothesis. (31) For example, clustering of cases in a wing of a nursing home is consistent with either a focal source or person-to-person spread, whereas scattering of cases throughout the facility is more consistent with a widely disseminated vehicle or a source common to the residents that is not associated with room assignment, such as a common dining hall or water supply. Examples of case report forms are shown in Figure 6.1 (in Exercise 6.5). An intermittent common-source epidemic (in which exposure to the causative agent is sporadic over time) usually produces an irregularly jagged epidemic curve reflecting the intermittence and duration of exposure and the number of persons exposed. Only occasionally do public health officials decide to conduct a field investigation before confirming an increase in cases and verifying the diagnosis. Bethesda, MD 20894, Web Policies The first step in interpreting an epidemic curve is to consider its overall shape. Drawing an epidemic curve. legal liability for any errors in the text or for the misuse or misapplication of material in this work. For questions about this textbook please contact textbookuse@umn.edu. Readers must therefore always . Many health departments strive to communicate directly with the public, usually through the media, both during an investigation and when the investigation is concluded. The reader can assume oneself as investigator who has to organize the team, review previous knowledge, prepare the technical and management aspects, before starting the investigation. The severity of epidemic depends on - 1. What additional information might be helpful in making this determination? The investigators asked case-patients and controls how much time they spent in the store and where they went in the store. Finally, laboratorians were able to culture E. coli from the well, the supply line, and the tap at zone 6. If so, where are the new cases? Return to text. The document includes a detailed overview of the principles of outbreak management; additionally, the Reclassify each patient using the revised case definition. Is the attack rate low among persons not exposed to that item? Sodium hypochlorite may also need to be used, but must be used according to guidelines. Epub 2009 Aug 21. Identify investigation team and resources 2. Source: Jani AA, Barrett E, Murphy J, Norton D, Novak C, Painter J, Toney D. A steamship full of trouble: an outbreak of Salmonella Typhimurium DT 104 gastroenteritis at a holiday banquet Virginia, 2003. They also enrolled two controls per case, a total of 54 controls. Only kitchen/catering staff can enter the kitchen area and these staff members should not be accessing outbreak rooms/areas. Outbreak Management Definition An outbreak of infection is defined as: An incident in which two / more people experiencing a similar illness are linked in time or place A greater than expected incidence of infection compared to the usual background rate for the particular location A single case for certain rare diseases These cookies may also be used for advertising purposes by these third parties. MMWR 1989;38:7657. response to an enhanced normal disease management process while being prepared for a significant outbreak. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. If you are a member of an institution with an active account, you may be able to access content in one of the following ways: Typically, access is provided across an institutional network to a range of IP addresses. Case definitions: meningococcal disease and viral meningitis. A square indicates the location where the envelope was opened. Users can also be actively notified of breaking health events as they occur. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Ungchusak, Kumnuan, and Sopon Iamsirithaworn. Once control and prevention measures have been implemented, they must continue to be monitored. How would you interpret your results? These incubation periods can be compared with a list of incubation periods of known diseases to narrow the possibilities. Outbreak management control measures are to be implemented in consultation with the outbreak coordinator/management team, infection prevention personnel and notification advice from local public health authorities. Epidemic curves are a basic investigative tool because they are so informative (see Lesson 6). Establish existence of outbreak 3. Table 6.3 Line Listing of 7 Persons with Suspected Eosinophilia-myalgia, * Severe enough to affect the patients ability to pursue usual daily activities, Eventually, public health officials agreed on the following revised case definition:(26). The earliest case occurred during the week of October 28. quadrant, offices of Senators A & B and the hallway outside. Community-based testing, testing through the private sector, and disease outbreak management will be essential to reopening the Nevada economy. What do they think caused their illness? Finally, a survey of the community may be conducted to establish the background or historical level of disease. Eosinophilia-myalgia syndrome and L-tryptophan-containing products New Mexico, Minnesota, Oregon, and New York, 1989. Potentially correlated events can be noted on the graph. Develop case definition 5. The illness was given the name eosinophilia-myalgia syndrome. To compare incidence between different areas with different population densities, an area map showing area-specific rates is preferable. For other diseases and conditions, the expected number may be based on locally available data such as hospital discharge records, mortality statistics, or cancer or birth defect registries. Infection prevention and control is the application of microbiology in clinical practice. The 95% confidence interval for the risk ratio of 5.7 ranged from 2.2 to 14.6. The social, institutional, and political background associated with outbreaks usually makes their investigation complex and should be taken into account. Once a decision is made to investigate an outbreak, three types of activities are generally involvedthe epidemiologic investigation; the environmental investigation; and the interaction with the public, the press, and, in many instances, the legal system. Which study design would you choose to investigate a possible association between cell phone use and brain cancer? Adequate supplies of PPE will need to be available for initial set-up, as well as ongoing use during the outbreak. To test the statistical significance of this finding, a chi-square test can be computed using the formula shown earlier. Feed and water consumption and production should be carefully monitored at all times, as well as the typical sounds and behaviors of individual animals. B. Following successful sign in, you will be returned to Oxford Academic. Finally, particularly in areas with sudden changes in population size such as resort areas, college towns, and migrant farming areas, changes in the numerator (number of reported cases) may simply reflect changes in the denominator (size of the population). Early in an investigation, investigators may restrict the descriptive epidemiology to numbers of cases. In some challenging investigations that yielded few clues, investigators have convened a meeting of several case-patients to search for common exposures. Carbapenem-resisant Enterobacteriaceae (CRE), Steps of outbreak investigation and management, Principles of outbreak management control measures, Procedure following contaminated sharps injury or accidental splash to mouth or eyes, Staff vaccination, risk categorisation, screening and vaccination recommendations, Exclusion periods for workers with acute infections, Medical conditions that affect susceptibility to infection or colonisation, Issues for the healthcare worker with bloodborne viruses, Environmental cleaning and decontamination, D Appendix B: Recommended Cleaning Frequency Guide, Medical records, reception and business areas, Reprocessing of medical instruments and equipment, E Appendix A: Management of Catheter-Associated UTIs, CM Environmental cleaning and decontamination, Appendix C: Recommended cleaning frequency guide, Section B2: Transmission-Based Precautions, Section B1.3: Standard Precautions: Hand Hygiene and Hand Care, Section B1.5: Standard Precautions: Personal Protective Equipment. How is it usually transmitted? This communication usually takes two forms: Epi-X is the CDCs Web-based communications solution for public health professionals. Spot maps are useful for demonstrating cases within a geographic area, but they do not take the size of the underlying population into account. In an outbreak of pneumococcal pneumonia in a nursing home in New Jersey, cases were more common in the north wing than in the south wing (Figure 6.6). Here, as in other areas of epidemiology, the observed is compared with the expected. Reporting the methods used in public health research and practice. The opposite can also occur a p-value less than 0.05 can actually be a chance finding rather than the true explanation of the outbreak. Single case of disease caused by an uncommon agent (e.g., glanders, smallpox, viral hemorrhagic fever, inhalational or cutaneous anthrax) without adequate epidemiologic explanation, Unusual, atypical, genetically engineered, or antiquated strain of an agent (or antibiotic-resistance pattern), Higher morbidity and mortality in association with a common disease or syndrome or failure of such patients to respond to usual therapy, Unusual disease presentation (e.g., inhalational anthrax or pneumonic plague), Disease with an unusual geographic or seasonal distribution (e.g., tularemia in a non-endemic area, influenza in the summer), Stable endemic disease with an unexplained increase in incidence (e.g., tularemia, plague), Atypical disease transmission through aerosols, food, or water, in a mode suggesting deliberate sabotage (i.e., no other physical explanation), No illness in persons who are not exposed to common ventilation systems (have separate closed ventilation systems) when illness is seen in persons in close proximity who have a common ventilation system, Several unusual or unexplained diseases coexisting in the same patient without any other explanation, Unusual illness that affects a large, disparate population (e.g., respiratory disease in a large population may suggest exposure to an inhalational pathogen or chemical agent), Illness that is unusual (or atypical) for a given population or age group (e.g., outbreak of measles-like rash in adults), Unusual pattern of death or illness among animals (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in humans, Unusual pattern of death or illness among humans (which may be unexplained or attributed to an agent of bioterrorism) that precedes or accompanies illness or death in animals, Ill persons who seek treatment at about the same time (point source with compressed epidemic curve), Similar genetic type among agents isolated from temporally or spatially distinct sources, Simultaneous clusters of similar illness in noncontiguous areas, domestic or foreign, Large number of cases of unexplained diseases or deaths. 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Increase in cases and verifying the diagnosis be taken into account without a proper denominator, attack can... Are brought to the attention of health authorities by concerned healthcare providers or citizens useful references such as articles... Or a potential outbreak has been identified or determined any errors in the text or for the misuse or of... ( in Exercise 6.5 ) reason to investigate outbreaks is research the methods in! Or citizens between cell phone use and brain cancer as they occur or Adapted from: transmission... Investigations that yielded few clues, investigators may restrict the descriptive epidemiology describes the where whom...