Evalua&on

 of  Secular  (Long-­‐Term)  Trends

Sample  Line  Graph:  Decline  in  reported  incidence/mortality  from  
diphtheria  in  the  US
Decline in reported incidence/mortality from diphteria in the US.
•  Semilogarithmic graph
(log scale on y-axis;
arithmetic
scale on x-axis)
•  Incidence/mortality lines
are
parallel (on a log scale, this
indicates
that they changed
proportionally.)
•  Observed secular trend
may be explained
by changes in disease
detection, disease
reporting, or both.
Epidemiologic Surveillance and Epidemic Outbreak Investigation
Katz, David L., MD, MPH, FACPM, FACP, Jekel's Epidemiology, Biostatistics, Preventive Medicine, a
Public Health, 3, 32-49

Copyright © 2014 Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc
• Periods  of  highest  incidence  depend  on  route  of  spread  
• Epidemiologic  year:  defined  as  4me  from  month  of  lowest  incidence  of  
disease  in  one  year  to  same  month  the  next  year
• Devia4ons  in  usual  pa<erns  of  disease  or  health  
 
• May  be  infec4ous  (e.g.,  cholera)  or  non-­‐infec4ous  (e.g.,  
cancer,  childhood  obesity)  
 
• May  be  poten4ally  serious  to  all  (e.g,.  ebola)  or  only  to  
some  (e.g.,  common  colds  for  people  with  AIDS)  
 
• Even  a  single  case  can  represent  an  outbreak  (e.g.,  
smallpox)  
 
• When  a  condi4on  is  established  at  a  high  level  in  a  
popula4on,  it  is  called  endemic  
 
• Epizoo4c  and  enzoo*c  are  analogous  terms  for  
condi4ons  in  animal  popula4ons
Epidemiologic Surveillance and Epidemic Outbreak Investigation
Katz, David L., MD, MPH, FACPM, FACP, Jekel's Epidemiology, Biostatistics, Preventive Medicine, and Public Health, 3, 32-49
Copyright © 2014 Copyright © 2014, 2007, 2001, 1996 by Saunders, an imprint of Elsevier Inc
 • AEack  rate  =  propor4on  of  people  “exposed”  who  
become  “ill”  (exposure  and  illness  defined  case  by  
case)

• Case  defini&on  =  criteria  for  determining  what  

cons4tutes  “ill”  (case),  as  dis4nguished  from  “not  
ill”  (non-­‐case).  In  an  ideal  world,  would  have  perfect  
sensi4vity  and  specificity.
• Surveillance  is  the  founda&on  of  public  health  
control  of  disease.  It  may  be  ac&ve  or  passive.  
• Func4ons:  Determining  baseline  rates  of  
disease,  detec4ng  outbreaks,  and  evalua4ng  
control  measures  

• Applica4ons:  Data  used  for  sePng  disease  

control  policy
Inves&ga&on  of  Outbreaks
1. Make  diagnosis  
2. Establish  case  defini4on  
3. Determine  if  definite  outbreak  
4. Characterize  cases  by  4me,  person,  place  
5. Develop  hypotheses  regarding  infec4on  
source,  pa<ern  of  spread,  and  mode  of  
transmission  
6. Test  hypotheses  
7. Set  up  control  measures  
8. Follow-­‐up  surveillance
  
•  David  L.  Katz,  Joann  G.  Elmore,  Dorothea  MG  
Wild,  Sean  C  Lucan.  Jekel’s  epidemiology,  
biosta*s*cs,  preven*ve  medicine,  and  public  
health.  4TH.  Edi4on,  Elsevier,  2  014.