Sei sulla pagina 1di 5

Mondays exercise Outbreak investigation

Pivi Rajala-Schultz, DVM, PhD Veterinary Preventive Medicine Scenario: You are called up to a facility that is experiencing a disease outbreak. Your task is to identify the source/the cause of the outbreak and to control it.

Mondays exercise
During the class period, you will be able to ask questions about the case in order to solve the problem There will be 8 persons giving out the information you request, i.e., one person will work with 4 groups

Mondays exercise
After getting the description of the problem, reach a consensus in your group about which piece of information you want to request first Raise up your hand to get the attention of the facilitator when you are ready to request some info You can only request one piece of information at a time You will be able to solve the problem within the class period by requesting relevant pieces of information

Mondays exercise
You might want to take a calculator along You are more than welcome to take e.g., Mercks manual

Definition of an outbreak
Outbreak is an epidemic a cluster of disease in which the number of cases clearly exceeds the number expected

Types of outbreaks
A point/common source epidemic:
A sharp increase in disease occurrence No host-to-host spread

Goals of outbreak investigation


To identify key determinants of disease, i.e. risk factors Recognize the cause, source and mode of transmission

A propagating epidemic
A gradually-building increase Host-to-host spread

Goals of outbreak investigation


The ultimate goal is to stop the outbreak and to prevent it from recurring

Outbreak investigation
In principal, very similar to clinical examination of a patient in a clinic: History, clinical and laboratory examinations are often used to try to identify the cause(s) of disease

Outbreak investigation
Descriptive phase: Determine if an outbreak exists Define the case Describe occurrence of disease in time and in place Describe the demographic patterns

Outbreak investigation
Analytical phase: Descriptive data is compared and analyzed What associations exist, e.g., what risk factors appear to be associated with the disease ? Calculate attack rates, risk or odds ratios What is the probable source of the etiologic agent? H i it b i d?

Outbreak investigation
Intervention phase: What are you going to do? How do you control the outbreak? What preventive options are available?

How/why do epidemics arise?


Introduction of a pathogenic agent or toxic material Adequate number of exposed and susceptible individuals An effective means of transmission

How do epidemics arise?


Very virulent agent very contagious Novel in the area, i.e., a new agent No immunity in hosts (lack of herd immunity) High population density => lot of contacts between individuals, increased transmission

Where do you look for the source of the outbreak?


Method of difference
Two situation appear to be generally similar, except for the disease rate Anything else you can find thats markedly different might be the cause

Method of agreement
Two situations appear to be generally different, except for the rate of disease Look for something similar

Looking for the source of the outbreak


Seek the exposure associated with the highest incidence rates for the epidemic disease

Tools for outbreak investigation


Attack rate =
Number of cases Number at risk

Risk ratio / odds ratio


Risk or odds of disease in exposed group Risk or odds of disease in unexposed group

Finding the cause


Definite diagnosis is not always necessary for solving the problem However, often different samples are collected to confirm the suspected cause Diagnostic tests

Summary: steps in an outbreak investigation


Establish criteria for defining a case Verify that there really is an epidemic Describe the epidemic regarding
Time, place and subjects

Formulate and test your hypotheses ACT!! (establishing a diagnosis without any action is not enough!)

Monkeypox
A rare viral disease, mainly found in the rainforest countries in Africa Caused by Monkeypox virus (orthopox) First discovered in laboratory monkeys in 1958 Also in various rodent species

Monkeypox in the US
An emerging infectious disease in North America In early June 2003, monkeypox reported in several residents in the US who became ill after having contact with sick pet prairie dogs

Monkeypox in the US
Prairie dogs became infected from a shipment of animals from Africa to Texas on April 9, 2003 Imported animals included Gambian giant pouched rats, rope squirrels, dormice

Monkeypox in the US
A total of 81cases of human monkeypox reported to CDC from WI (39), IN (22), IL (16), MS (2), KS (1), OH (1)

Monkeypox in the US
Spread to humans: Through a bite or direct contact with the infected animals blood, body fluids or lesions Majority of the cases in the US were exposed to prairie dogs

Monkeypox
Case definition Clinical criteria:
Rash (vesicular, macular, pustular) Fever Chills/sweats, headache, backache etc

Epidemiologic criteria
Exposure to an exotic/wild mammalian pet obtained after April 15, with clinical signs

Monkeypox
Case definition Epidemiologic criteria
Exposure to an exotic/wild mammalian pet w/o clinical signs that had been in contact with animal with monkeypox Exposure to suspect, probable ro confirmed human case

Monkeypox epidemic curve

Laboratory criteria
Isolation of virus Demonstration of virus with PCR, EM, IHC

Potrebbero piacerti anche