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Outbreak Investigation & Management
Outbreak investigation & management for public health
48
Health Care
Professional
09/14/2012

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Term
Epidemic
Definition
The occurrence, in a community or region, of cases of an illness, specific health-related behaviour, or other health-related events clearly in excess of normal expectancy
Term
Outbreak
Definition
An epidemic that is limited to a localized increase in incidence of a disease (e.g., in a village, town or closed institution); upsurge is sometimes used as a euphemism for outbreak
Term
Endemic
Definition
When there is constant presence of [the disease] within a given geographic area or population group; the usual prevalence of a given disease within an area or group
Term
Pandemic
Definition
An epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people
Term
Pandemic, influenza
Definition
The WHO declaration of ____ occurs when the novel ____ virus is causing unusually high rates of morbidity and/or mortality in multiple, widespread geographic areas
Term
Cluster
Definition
An aggregation of relatively uncommon events or diseases (e.g., leukemia, multiple sclerosis…) in space and/or time in amounts that are believed or perceived to be greater than could be expected by chance
Term
Epidemiological triangle or triad
Definition
Host, agent, environment
Term
Host
Definition
A living being, human or animal, that allows the entry and subsistence of an agent (infectious or other) under natural conditions; in an epidemiological context, may be the group or population
Term
Host factors
Definition
The biological, social and behavioural characteristics of the host group that are relevant to health
Term
Agent
Definition
A factor, such as a microorganism, chemical substance or form of radiation, whose mere presence, excessive presence, or (in deficiency diseases) relative absence is essential for the occurrence of a disease
Term
Reservoir, transmission, susceptible
Definition
Transmission occurs when the agent leaves its ____ or host through a portal of exit, and is conveyed by some mode of ____, and enters through an appropriate portal of entry to infect a ____ host
Term
Etiology
Definition
The agent (pathogen [i.e., which can cause an illness]) that causes the disease or the outbreak
Term
Reservoir
Definition
The natural habitat of an infectious agent. Any person, animal, arthropod, plant, soil or substance, or combination of these in which an infectious agent normally lives and multiplies, on which it depends primarily for survival, and where it reproduces itself in such a manner that it can be transmitted to a susceptible host
Term
Mode of Transmission
Definition
Mechanism by which an infectious agent is spread from source or reservoir to a susceptible host
Term
Direct, indirect
Definition
Transmission can be classified as ____ or ____
Term
Direct Transmission
Definition
When an agent is transferred from a reservoir to a susceptible host by direct contact or droplet spread
Term
Indirect Transmission
Definition
When an agent from a reservoir to a host by suspended air particles, inanimate objects (vehicles), or animate intermediaries (vectors)
Term
Name at least 3 situations which may result in an outbreak
Definition
  • an increase in amount of the agent in a susceptible population
  • an increase in the virulence of the agent
  • the introduction of the agent into a setting where it has not been before
  • an enhanced mode of transmission so that more susceptibles are exposed
  • some change in the susceptibility of the host to the agent
  • factors that increase host exposure or involve introduction through new portals of entry
Term
Control & prevention, research, program review, and public, political, or legal concerns
Definition
Name at least 3 reasons to investigate an outbreak
Term
Etiological agent; source; tranmission
Definition
The balance between the investigation of an outbreak and the application of control measures depends on what is known on the ____ ____, its ____ and its method of ____.
Term
To control and prevent the occurrence of other cases
Definition
What is the primary goal of an outbreak investigation?
Term
1.Determine if an outbreak exists
2.Confirm the diagnosis
3.Assemble the team
4.Define cases and start case finding
5.Implement immediate control measures (if possible)
6.Orient the data in terms of time, person, and place
7.Determine who is at risk of becoming ill
8.Generate hypothesis explaining exposure that caused the disease
9.Test the hypothesis by appropriate statistical methods and compare the hypothesis with the established facts
10.Define objectives for further research (if applicable)
11.Write report with recommendations
12.Debrief the team
13.Develop long term control and prevention measures
Definition
Name at least the first five (of thirteen) steps of outbreak investigation
Term
"Outbreak" does not generate as much anxiety among the public
Definition
What is the primary distinction between the terms "outbreak" and "epidemic"?
Term
Surveillance
Definition
The systematic ongoing collection, collation, and analysis of data and the timely dissemination of information to those who need to know so that action can be taken
Term
Secular trend
Definition
Change in incidence of disease over a number of years
Term
Aberration
Definition
A significant deviation from usual frequency
Term
Diagnosis verification/confirmation of diagnosis
Definition
The object of this step is to eliminate an error in clinical diagnosis or in laboratory analysis, which could have been the cause for the increase in the reported cases
Term
Incubation period
Definition
The interval between exposure to an infectious organism and the first appearance of symptoms of infection
Term
Case definition
Definition
A set of uniform criteria (of inclusion and exclusion) used to decide whether an individual will be considered to have the disease of interest for the purpose of the investigation
Term
Clinical criteria, time, person, and place
Definition
Name the 4 elements of a case definition
Term
Clinical syndrome
Definition
Symptoms related to the clinical history and signs observed during the physical examination
Term
Primary case
Definition
A case whose symptoms appeared following exposure to the presumed source (within the minimum and maximum limits of the illness' known incubation period)
Term
Secondary case
Definition
A case whose symptoms appeared after contact with a primary case (within the minimum and maximum limits of incubation) but without exposure to the presumed source
Term
Alert
Definition
A succinct notification aimed at drawing attention to an event that could potentially threaten public health
Term
The Canadian Network for Public Health Intelligence (CNPHI)
Definition
Allows local health authorities to disseminate public health alerts on enteric and respiratory diseases of interest across Canada
Term
List at least 3 immediate outbreak control measures
Definition
  • Implement control measures specific for the disease.
  • Treat cases with recommended treatments.
  • Prevent exposure (e.g. isolation of cases in respiratory outbreaks)
  • Prevent infection (e.g. immunization in measles outbreaks)
  • Emphasize personal hygiene, particularly hand washing
Term
  • Pattern of spread
  • Magnitude
  • Outliers – unusual cases
  • Time Trend
  • Exposure and/or incubation period
Definition
Name at least 3 items to look for in an outbreak epidemic curve
Term
Point source outbreak
Definition
A common source outbreak in which the exposure period is relatively brief and all cases occur within one incubation period
Term
Propagated (person-to-person) source outbreak
Definition
Type of outbreak in which  cases usually occur over a longer period than in common source outbreaks of the same disease
Term
Outliers
Definition
Cases that do not appear to be related to the outbreak
Term
Attack rate
Definition
Expresses the occurrence of a disease in a specific population at risk for a limited period of time, often due to a very specific exposure
Term
Number of new cases of a specified disease reported during an outbreak period divided by the population at risk at the start of the period
Definition
How is attack rate calculated?
Term
Secondary attack rate
Definition
Expresses spread of disease within a group
Term
Number of new cases of a specified disease among contacts of known cases divided by the population of contacts at risk
Definition
How is secondary attack rate calculated?
Term
Source, mode, exposures
Definition
The hypothesis should address the ____ of the agent, the ____ (and vehicle or vector) of transmission, and the ____ that caused the disease.
Term
Generate, test
Definition
Descriptive studies ____ hypotheses, while analytic studies ____ them.
Term
To gather further information to support or reject the hypothesis
Definition
What is the purpose of the analytic study?
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