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a
M
vs
Re S4 Lec 20: Outbreak Investigation (not lectured)
ai
Draby Dra. Moderes ---  ---
M
n Example.
Re Patient older than 5 years with severe
Definition of Outbreak dehydration or dying of acute watery diarrhea in
co  Occurrence of more cases of disease than town “X” between 1 June and 20 July 2006
Ri expected in a given area among a specific
ul group of people over a particular period of Examples of Case Definition:
Pa time • Possible
vs or – Patient with severe diarrhea
Vi  Two or more linked cases of the same • Probable
ne illness – Patient older than 5 years with
le severe dehydration or dying of
Ar Objectives of Outbreak Investigations acute watery diarrhea in town “x”
 To determine the cause of the between 1 June and 20 July 2006
• Confirmed
a
outbreak
– Isolation of Vibrio cholerae from
ň
Ni  To control ongoing outbreaks
g  To prevent future outbreaks stool of patient
an  To provide statutorily mandated
ad services
 To strengthen surveillance at local
Control the Source of Pathogen
D
level
 Remove source of contamination
er
 To advance knowledge about a disease
 Remove persons from exposure
h
ac  To provide training opportunities
e
 Inactivate / neutralize the pathogen
T Specific Demands when Investigating  Isolate and/or treat infected persons
ar Outbreaks
be  Unexpected event Interrupt Transmission
co  Need to act quickly  Interrupt environmental sources
Ri  Need for rapid control  Control vector transmission
ie  Work carried out in the field  Improve personal hygiene
ck
Ni Steps of an Outbreak Investigation Modify Host Response
ad  Confirm outbreak and diagnosis  Immunize susceptible
Gl  Case definition and identification  Use prophylactic chemotherapy
Je  Descriptive data collection and
nz analysis At the End
Ay  Develop hypothesis  Prepare written report
h  Analytical studies to test  Communicate public health messages
at hypotheses  Influence public health policy
K  Special studies  Evaluate performance
o  Implementation of control measures
Cessation of an outbreak occurs when there
Jh  Communication, including outbreak
is:
h report
a - elimination of source of contamination
n - interruption of transmission
- reduction/exhaustion of susceptible
e Case Definition
- modification of the effect of primary
Gi  Standard set of criteria for deciding if a
pathogen
o person should be classified as suffering
from the disease under investigation.
An investigator should have knowledge on
Ed
e  Clinical criteria, restrictions of time, place, the following:
ll person
 various types of etiologic agents and the
ce  Simple, practical, objective resultant disease
Jo  Sensitivity versus specificity
be
Jo

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z
Iv
k
ar
h
ac
R
G  epidemiological characteristics of
n outbreaks associated with different
h etiologic agents of resultant diseases
Jo  clinical symptoms of resultant diseases
n  environmental and food sanitation
Ia practices
a  sources of exposure which are vulnerable
n to contamination with an infectious or
Ni chemical agent
g  laboratory test available to determine
A causative agents
n  read/search for additional data on studies,
e prevention and control
Bi

Coverage of Exam:

 Poster making and


guidelines (5pts)
 Outbreak (20 pts)
 NCD (25pts)
 CD (25pts)
 Screening Test (25pts)

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