(F) Outbreak Investigation Flashcards by Geno Alinsub

Levels Of Disease

The amount of a disease that is usually present in a community; the observed but not necessarily the desired level; regarded as the expected level of disease

Baseline

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Levels Of Disease

→ First or initial Data
→ observe but not necessarily the desired level
→ Starting Point

Baseline

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Levels Of Disease - T or F

in baseline, it is the final data, and puts conclusion to the investigation

F (First or Initial Data)

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Levels Of Disease

A disease that occurs infrequently and irregularly

Sporadic

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Levels Of Disease

The constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area

Endemic

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Level of Disease - T or F

In endemic, it is the constant presence of specific disease to a specific place

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Levels Of Disease

The persistently high levels of disease occurrence

Hyperendemic

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Levels Of Disease

An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area

Epidemic

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Levels Of Disease

Similar to an epidemic but is often used for a more limited geographic area

Outbreak

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Levels Of Disease

An aggregation of cases grouped in place and time that are suspected to be greater than the number expected, even though the expected number maybe unknown

Cluster

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Levels Of Disease

An epidemic that has spread over several countries or continents, usually affecting a large number of people

Pandemic

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Level of Disease

what is the origin of a Pandemic??

it is an epidemic from one country that spread over several countries

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T or F

If there is an outbreak to a community, there is a need to conduct of outbreak investigation?

True

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Aims of Outbreak Investigation - T or F

Asses the situation

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Aims of Outbreak Investigation - T or F

identifying new syndrome and case

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Aims of Outbreak Investigation - T or F

For asset concers – need to inform the government official

F (Liability)

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Aims of Outbreak Investigation - T or F

Train drake, for experience

F (Epidemiologist)

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Aims of Outbreak Investigation - T or F

Asses the effectiveness of previous prevention strategies

F (current)

If the existing program is effective or not

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Aims of Outbreak Investigation - T or F

Find the loopholes this will help fixing the program

True

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Aims of Outbreak Investigation - T or F

To determine the cause of the outbreak (the disease detected)

True

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Aims of Outbreak Investigation - T or F

To continue further spread of the outbreak (the fire fighter)

F (prevent)

dumb ass or what????

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Aims of Outbreak Investigation - T or F

To educate responsible individuals in the prevention of similar outbreak in the future (the public health educator)

True

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Enumerate the Reasons for Investigating Outbreaks

lol make kabisado dont familliarize

Prevention and Control
Gain additional knowledge/ research
Training
Public, political, or legal concerns
Program considerations

bruh make kabisado of it okay? okay

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Principle under Prevention and Control

Primary ____________ Reason for investigation

Public Health

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# Principle under Prevention and Control Principal _____________

Considerations

# Principle under Prevention and Control How much is known about the ________, the ________, and the ________of the agent?

* Causitive Agent * Source * Mode of Transmission

# Principle under Prevention and Control The decisions regarding whether and how extensively to investigate an outbreak are influenced by the ____________ of the problem itself

characteristics

# Prevention and Control What is the main objective of Primary Public Health Reason for investigation

3P’s – Promote life, prolong heatlh, and prevent spread of disease

# Prevention and Control What are the questions asked in principal considerations?

* What is the stage of the epidemic? * Are cases occurring in increasing numbers? * Is the outbreak just about over?

# Prevention and Control - T or F cases are CONTINUING TO OCCUR: Goal is most probably to prevent occurrence of additional cases

True | So no more cases will be, and person to be infected

# Prevention and Control - T or F cases are CONTINUING TO OCCUR: The objective of the investigation would be to assess the extent of the outbreak, the size, and characteristics of the population that is not concerned

F (at risk)

# Prevention and Control - T or F outbreak appears to be ALMOST OVER: Goal may be to prevent similar outbreaks in the future

True

# Prevention and Control - T or F outbreak appears to be ALMOST OVER: The objective of the investigation is to identify factors which contributed to the dancebreak in order to design and implement measures that would prevent similar outbreaks in the future

F (Outbreak)

# Prevention and Control - T or F outbreak appears to be ALMOST OVER: This is to strengthen Program for different outbreaks

F (Similar)

# Control and Prevention Agent is Known and Mode of transmission and source is unknown , what is the priority?

CONTROL

# Control and Prevention Agent is known, and mode of transmission is unknown

Primary goal is **investigation**

# Control and Prevention Agent unknown

Investigation and control

# Gain additional knowledge/ research Each outbreak is an opportunity to study the ____________________ in question

natural history of the disease

# Gain additional knowledge/ research Each outbreak is an opportunity to study the natural history of the disease in question, Especially if this is a?

* Rare * New * Emerging disease

# Gain additional knowledge/ research what should be the channel for outbreak investigation?

Proper scientific method | take not thet Epidemiologic study uses different design

# Gain additional knowledge/ research For a newly recognized disease, field investigation provides an opportunity to define the natural history, enumerate what could possibly defined.

* agent * mode of transmission * incubation period * clinical spectrum of the disease

# Gain additional knowledge/ research - T or F Are able to characterize the populations at lesser risk

F (its always the poopulation at GREATER RISK) | identify specific risk factors!!!

# Identify whose population are at risk Leptospirosis Season A. People at lowlying area B. those who are suspended in air C. birds that doesnt stop flying D. Rich kid in katips

A | is it questionable ??? hell nah

# Gain additional knowledge/ research Can we asses the impact of control measures??

Yes we can it is theoretically always available but it cannot be always feasible in practice (Resources wise)

# Training - T or F Investigating an outbreak requires a combination of diplomacy, logical thinking, problem-solving ability, quantitative skills, epidemiologic know-how and judgment.

True | diplomacy?? (high pitched voice)

# Training what are the skills improved in investigatin an outbreak?

* Diplomacy * Logical Thinking * Problem-Solving Ability * Quantitative Skills * Epidemiologic know-how * Judgement

# Training Skills are improve with?

Practice and Experience

# Training - T or F Exposure of the epidemiologist and public workers, they will be more compenetnt and ready for more outbreak

True

# Training The investigating team can be composed of?

a seasoned epidemiologist with trainee/s

# Public, political, or legal concerns - T or F The existing knowledge for program we have are jeopardized by political reasons

True -- Nag ma-magaling pa mga politiko kesa sa mga specialist or trained individual ex. epidemiologist./.

# Public, political, or legal concerns Increasingly, the public has taken an interest in ________________ and potential environmental exposures, and has called upon the health department to investigate

Disease Clusters

# Public, political, or legal concerns involves community in every process so they can be more empowered, and they can solve problems on their own within their community)

Active community participation

# TOF in Program considerations you can change or modify the existinge program/s?

True - Cause it may be ineffective and change it to be better Esp to the overlook populations

# Program considerations An outbreak of a disease (which is targeted by a public health program) may reveal a ________ in that program and provide an opportunity to modify/strengthen the program’s efforts.

Weakness

# Program considerations Investigating the causes of an outbreak may identify populations which may have been ____________, failures in the ________________, changes in the ________, or events beyond the scope of the program.

* Overlooked * Investigation strategy * Agent

SO WHAT IS THE BOTTOM LINE OF Reasons for Investigating Outbreaks

Prevent the spread of disease

Steps in and Outbreak Investigation, enumerate : P | familliarize if u want

1. Verify the diagnosis and confirm the outbreak 2. Define a case and conduct case finding 3. Tabulate and orient data: time, place, person 4. Do immediate control measures 5. Formulate and test hypothesis 6. Plan and execute additional studies 7. Implement and evaluate control measures 8. Communicate findings

# Steps in and Outbreak Investigation ________ the diagnosis and confirm the outbreak

Verify

# Steps in and Outbreak Investigation ________ a case and conduct case finding

Define

# Steps in and Outbreak Investigation _____________ and _________ data: time, place, person

Tabulate and Orient

# Steps in and Outbreak Investigation Do ________ control measures

Immediate

# Steps in and Outbreak Investigation Formulate and test ________________

Hypothesis

# Steps in and Outbreak Investigation Plan and execute additional _____

Studies

# Steps in and Outbreak Investigation Implement and evaluate ______________

Control Measures

# Steps in and Outbreak Investigation Communicate _________

Findings

# Steps in and Outbreak Investigation - T or F The steps can occur simultaneously or repeated

True

# What are What are the preparation for field work?

* Investigation * Administration * Consultation

# Preparation for Field Work Appropriate scientific knowledge, Supplies, and equipment Consult regarding epidemic Laboratory specimen collection Storage Transport

INVESTIGATION

# Preparation for Field Work Travel arrangements and travel orders Logistics, administration and contracts

ADMINISTRATION

# Preparation for Field Work Specific roles and responsibilities Understand your own role so that you can contribute more dearly.

CONSULTATION

# Knowledge Necessary to Prepare for Outbreak Investigation Various types of ________ agents and the ___________

* Etiologic * Resultant Disease

# Knowledge Necessary to Prepare for Outbreak Investigation Epidemiologic characteristics of outbreaks associated with ________ etiologic agents or resultant diseases;

Different

# Knowledge Necessary to Prepare for Outbreak Investigation ____________________ of resultant diseases;

Clinical Symptoms

# Knowledge Necessary to Prepare for Outbreak Investigation ________ and ________ sanitation practices

* Environmental * Food Sanitation

# Knowledge Necessary to Prepare for Outbreak Investigation Sources of exposure which are vulnerable to ________ with an infectious or chemical agent

Contamination

# Knowledge Necessary to Prepare for Outbreak Investigation ________________ available to determine causative agents

Laboratory Tests

# Knowledge Necessary to Prepare for Outbreak Investigation - T or F a joint effort of different faculty, it is a pool of knowledge

F (Different Professional)

# Verify the diagnosis and confirm the outbreak What is needed to ensure the existent and properly identification of disease? | clue LAB

* Confirm laboratory testing * Rule out misdiagnoses or laboratory error * Review clinical findings, check lab results and medical findings

# 1. Verify the diagnosis and confirm the outbreak T or F Knowledge/Awareness of the existence of an epidemic through: Regular analysis of surveillance data- detect unusual patterns of disease occurrence

True

# 1. Verify the diagnosis and confirm the outbreak Knowledge/Awareness of the existence of an epidemic through: why theres a need to call the citizen who knows a several cases?

To gather information then confirm the cases when notified

# 1. Verify the diagnosis and confirm the outbreak Initial investigation may turn out to be? ____ outbreak with a common cause; OR ________ outbreak

* True * False

# 1. Verify the diagnosis and confirm the outbreak Initial investigation may turn out to be? ________and unrelated cases of the same disease OR Unrelated cases of similar but ____ disease

* Sporiadic * Unrelated

# 1. Verify the diagnosis and confirm the outbreak Comparison of the number of the observed number of cases with the expected number which can be?

The number of cases: * Previous few weeks or months * Comparable period during the previous few years

# 1. Verify the diagnosis and confirm the outbreak Source of data to establish ‘expected number cases’: ____ ________ surveillance data if disease is a notifiable disease

Health Department

# 1. Verify the diagnosis and confirm the outbreak Source of data to establish ‘expected number cases’: T or F Hospitals discharge records, mortality statistics, cancer or registries if disease is non-notifiable

True

# 1. Verify the diagnosis and confirm the outbreak Source of data to establish ‘expected number cases’: Apply rates from ____________ or conduct an informal survey among local physicians

neighboring areas

# 1. Verify the diagnosis and confirm the outbreak Source of data to establish ‘expected number cases’: ________ ____________ of the community to establish background level of the disease

Conduct Survey

# 1. Verify the diagnosis and confirm the outbreak Factors which could explain excess cases: existence of ___ outbreak

True

Factors which could explain excess cases: Changes in ________ reporting procedures

Local

Factors which could explain excess cases: Changes in ________ definition

Case

Factors which could explain excess cases: ________ ________ because of local or national awareness

Increased interest

Factors which could explain excess cases: Improvements in ________ procedures

Diagnostic

Factors which could explain excess cases: ________ ________ in size of population in particular areas

Sudden Increases

# 1. Verify the diagnosis and confirm the outbreak Factors influencing decision regarding investigation of the outbreak

- Severity of the illness - The potential for spread - Political consideration - Public relations - Availability of resources, etc.

# Define a case and conduct case-finding T or F - who are the individuals to be included in case

True

# Define a case and conduct case-finding This is to discern the proper cases, and if the individuals should be really in the case

Standard set of Criteria

# Define a case and conduct case-finding Develop a specific case definition using ________

Criteria

# Define a case and conduct case-finding Conduct surveillance using _____ _______

Case Definition | existing surveillance active surveillance

# Define a case and conduct case-finding TOF - Interview non-case-patients

False

# Define a case and conduct case-finding - Allows a simple, uniform way to identify cases - “standardizes” the investigation - Is unique to the outbreak but is based on objective criteria

Case Definition

# Define a case and conduct case-finding what is always included in defining case?

Person, place, and Time

# Define a case and conduct case-finding Relevant information about personal characteristics

Person

# Define a case and conduct case-finding Information about where the exposure is thought to have occurred

Place

# Define a case and conduct case-finding Dates during which exposure was thought to have occurred

Time

if u see this

study the example of Case definition

→ Categories of Cases - Symptoms characteristic of the agent - Lab test (+ result) - Epidemiologic link

Confirmed

→ Categories of Cases - Symptoms confirmed - No lab test (+ result) or epidemiologic link

Probable

→ Categories of Cases - Symptoms are reported but not Confirmed - No lab or epidemiologic link

Suspected

Create a line listing of identified cases

3.Tabulate and Orient data

# 3.Tabulate and Orient data Who was infected? - What do the cases have in common?

Person (Anon only initials)

# 3.Tabulate and Orient data Where were they infected? - May be useful to draw a map

Place

# 3.Tabulate and Orient data When were they infected? - Create an epidemic curve

Time

if u see this card

shake yo ass, jk study examples under tabulate and orient data

# 3.Tabulate and Orient data Is a graphical depiction of the number of cases of illness by the date of illness onset

EPIDEMIC CURVE

what can be provided by and Epidemic Curve?

* Pattern of spread * magnitude * outliers * time trend * exposure and/or disease incubation period

# 3.Tabulate and Orient data - T or F The overall shape of the epidemic curve can reveal the type of outbreak

True

what are the types of epidemic curve??

* common source (point, continuous, intermittent) * Propagated * Mixed

# 3.Tabulate and Orient data People are exposed continuously or intermittently to a harmful source

COMMON SOURCE

# 3.Tabulate and Orient data Has KNOWN common source

COMMON SOURCE

# 3.Tabulate and Orient data under common source, how long the period of exposure for?

BRIEF (underwear??) or Long periods

# 3.Tabulate and Orient data Intermittent exposure often results in an epi curve with irregular peaks that reflect the timing and the extent of exposure

Intermittent – sporadic

# 3.Tabulate and Orient data Cases were all exposed to the same source during a brief period of calendar time;

COMMON SOURCE – Common Point Source

ONE SHARP PEAK in the curve

Common Point Source

# Common source Typically shows a sharp upward slope and a gradual downward slope

Common Point Source

# Common source Is a common source outbreak in which the period of exposure is brief, and all cases occur within one incubation period

Common point source

# COMMON SOURCE Continuous exposure will often cause cases to rise gradually (and possibly to plateau, rather than to peak)

Continuous Exposure

# 3.Tabulate and Orient data Spread from person-to-person → lasts longer and control is challenging

PROPAGATED EPIDEMIC

# PROPAGATED EPIDEMIC what is the common outbreak under propagated epidemic?

Outbreak of respiratory cases

# PROPAGATED EPIDEMIC Disease agent may replicate in a susceptible host as part of?

Transmission cycle

# PROPAGATED EPIDEMIC how many waves are there?

Multpile | can be also called as "SURGES"

The classic epi curve for a propagated outbreak

- Progressively taller peaks - One incubation Period apart

if u see this card

review the Examples of Epidemic According To The Incubation Period

# 3.Tabulate and Orient data Involve both a single, common exposure to an infectious agent and secondary propagative spread to other individuals (e.g., person to person transmission)

MIXED EPIDEMIC

# 3.Tabulate and Orient data Examples are: Many food borne pathogens (Salmonella, typhoid, Hepatitis A) and airborne organism (M. tuberculosis)

MIXED EPIDEMIC

# → Factors Affecting Duration of an Epidemic The number of _________ _________ who are exposed to a source of infectious and become infected;

susceptible persons

# → Factors Affecting Duration of an Epidemic The period of time over which susceptible persons are ________ to the source

Exposed

# → Factors Affecting Duration of an Epidemic The minimum and maximum ____ ________ for the disease.

Incubation Periods

# → Factors Affecting Duration of an Epidemic - T or F are attack rate and secondary attack rate belongs to this principle?

Truw

A special cumulative incidence ( or incidence proportion) that measures the proportion of persons in a population who experience an acute health event during a limited time (e.g., outbreak)

ATTACK RATE

Number of new cases of a health problem during an outbreak divided by the size of a population at the beginning of the period who are at risk of the event

ATTACK RATE

The frequency of new cases of a disease among the contacts of known patients;

SECONDARY ATTACK RATE

The ratio of the number cases among contacts occurring within the acceptable incubation period following exposure to a Primary Case to the total number of exposed contacts.

SECONDARY ATTACK RATE

From those who contracted the disease from the + individual

SECONDARY ATTACK RATE

# → EPIDEMIC CURVE Can provide a sense of the magnitude of an outbreak Additional information can be obtained by stratifying the epidemic curve

Outbreak Magnitude

# → EPIDEMIC CURVE Provides information on the time trend of the outbreak based on the following: a. date of illness onset for the first case b. date when the outbreak peaked c. date of illness onset for the last case

Outbreak Time Trend

# → EPIDEMIC CURVE Outliers are cases at the very beginning and end that may not appear to be related to the rest of the cases Unexpected cases – similar symptoms but may or may not be the same disease

Outbreak Outliers

# → EPIDEMIC CURVE What are the outbreak outliers

* baseline level illness * outbreak source * a case exposed earlier than the others * an unrelated case * a case exposed later than the others * a case with a long incubation period

# → PERIOD OF EXPOSURE/INCUBATION PERIOD FOR THE OUTBREAK If the timing of the exposure is known, epi curves can be used to estimate the ?

incubation period of the disease

# → PERIOD OF EXPOSURE/INCUBATION PERIOD FOR THE OUTBREAK In common source outbreaks with known incubation periods, epic curves can help determine the?

AVERAGE PERIOD OF EXPOSURE

# → PERIOD OF EXPOSURE/INCUBATION PERIOD FOR THE OUTBREAK TOF Average and minimum incubation periods should be far and should represent the probable period of exposure

F (CLOSE)

# → PERIOD OF EXPOSURE/INCUBATION PERIOD FOR THE OUTBREAK Widen the estimated exposure period by 10-20%

10 - 20%

If an obvious source of the contamination is identified? what should u do A. shake yo ass B. Institute contol measure C. KEEP ON INVESTIGATING D. YOLO

B. nstitute control measure IMMEDIATELY!

what are the statistical part in Steps in and Outbreak Investigation

- Formulate and test hypothesis - Plan and execute additional studies - Implement and evaluate control measures - Communicate findings

reducing the risk in the individual level

Prevention

what is the goal of PREVENTION?

- To Hinder - To make impossible by advance - Individual and community (More on individual)

disease is present; ongoing operation aim to reduce the cases and burden of the disease

Control

what is the goal of CONTROL

- To hold in check - To restrain - Community and Population

refers to aggregation of two or more diseases in a population in which there is some level of positive biological interaction that exacerbates the negative health effects of any or all of the diseases

Syndemic

what is the level that excarbates negative health effets in the principle of syndemic?

some level of ** positive biological interaction**

# Prevention or Control With disease and exposed

Control

# Prevention or Control Unexposed, and w/o disease

Prevention

# → Levels of Prevention * Before risk factors * Preventing the community/individual to be at risk

Primodial

# → Levels of Prevention * Pre-pathogenesis * Manage the risk factor, prevent the onset of disease

Primary

# → Levels of Prevention * Subclinical or very early clinical * Early diagnosis and prompt treatment

Secondary

# → Levels of Prevention * Middle to late clinical * Reduce complication and disability

Tertiary

Prevent development of risk factors – wala pang risk factor

Primordial Prevention

what are the target and programs under primodial?

Target: General Population Programs: - National Policies and Programs - Mass Education - Individual Education

Primodial disease is ideal for?

Ideal for chronic disease and non-communicable disease

# what prevention - Reduction of risk factors – it is already present - Immunization - Removal of harmful agents - Aim – Reduce the incidence

Primary

what are the target of Primary Prevention

Susceptible Groups – at risk

# what prevention * Early detection → Earlier recovery Prompt treatment * Cure disease at the earliest stage * Reduce the prevalence of the disease – make sure that they recover

Secondary Prevention

target population of secondary prevention?

Target: Asymptomatic

# What Prevention * Complete treatment * Limit disability * Rehabilitation * Reduce the number and impact of complication

Tertiary

target of tertiary prevention

Positive with the disease and know with the disease

if u see this card

study the example under tertiary prevention

# Scope of Control Measures the objective of the applied measure is limited to the protection of health or the presence of the disease in a person

Individual

# Scope of Control Measures use of measure directed towards the community with the objective of reducing the morbidity and mortality caused by the disease in the community

Disease Control

# Scope of Control Measures situation in which cases of the disease no longer exist but one or more factors potentially important in the occurrence still persist Re-emission

Elimination of disease

# Scope of Control Measures * Total wipe out of disease and agent of disease → remove the root * Still existent and pwedeng bumalik

Eradication

# Scope of Control Measures Agent no longer exist

Extinction

# Basic Principles of Prevention and Control Recognize focus of ?

infection or agent

# Basic Principles of Prevention and Control Determine the ________ in the chain of causation

Weakest Link