Disease Detectives Quiz One Study

Guide
Ten Steps of an Outbreak Investigation:
1) Prepare for Field Work
2) Establish the Existence of an Outbreak
3) Verify the Diagnosis
4) Define and Identify Cases
5) Describe and Orient the Data in Terms of Time, Place and
Person
6) Develop Hypotheses
7) Evaluate Hypotheses
8) Refine Hypotheses and Carry Out Additional Studies
9) Implement Control and Prevention Measures
10) Communicate Findings
Case Definitions:
For a good review of case definitions, follow the link
www.cdc.gov/urdo/downloads/casedefinitions.pdf
Confirmed cases have been verified by laboratory results, while
probable cases have the correct symptoms but have not been
verified by the lab. Possible cases are a step down from
probable, so they may have fewer symptoms but it is still
possible that they have the disease.
Definitions:
Expected # of Cases for an Area: The number of cases that
would normally occur in an area (example: By looking at doctors
files, we can approximate that the city of Hudson usually has
about thirty people with a cold, etc.). If you have better
reporting, it means that the number of cases in an area may
appear to increase, but what is really happening is that the
percentage of sick people who go to the doctor and report their
sickness is increasing. The actual number of sick people is not

necessarily increasing just the number of people who tell the

doctors that they are sick.
Line Listing:

Epi Curves:
If you look at the epi curve below, you will notice that all of the
cases fall before the maximum incubation period the
greatest amount of time it would take a person to get sick once
they have been exposed. Everyone is exposed at the same time,
and then people get sick at different times between the minimum
and maximum incubation times. Since nobody gets sick after the
maximum incubation period, you can tell that the disease is not
being spread from person to person.

In the next example, the disease is spread from person to person

(known as propagation). You can see that above the index
case arrow is the first person to get sick. After this person walks
around and exposes other people, they enter the incubation
period and get sick a few days later. The process repeats and
builds on itself, creating multiple peaks that eventually lead to the
largest peak between days twenty three and twenty eight.

The final example has a continuous source such as polluted

water. The disease may last beyond its maximum incubation time,
but this is not because it spreads from person to person. Instead,
the exposure is from something like polluted water that people
are continuously using and therefore continuously getting sick
from.

Starting on day zero, the water becomes polluted. A few people

drink the water that day and get sick four to five days later.
Meanwhile, other people have been drinking the water, and now
these people will get sick a few days later. Until the source is
found and people stop drinking the water, this process will
continue.
Spot Map:

Cohort Study: (attack rate and relative risk)

A retrospective cohort study looks past exposures, while a
prospective cohort study looks at a current exposure and
looks to people who get sick in the future.
2x2 Table:

An example scenario for this table could be that 108 people

were at a party
where ham was the main dish. Some of these
people dont like ham, so they only ate the side dishes. After
that night, almost half of the people at the party got sick. You
are suspicious that it might have been caused by the ham, so
you are doing a cohort study to test your hypothesis.

You want to calculate the attack rate/cumulative incidence and

the relative risk, so you should start with the attack rates for
the exposed (ate ham) and unexposed (did not eat ham)
groups, respectively. For the exposed group, divide the number
ill by the total exposed to get .5 or 50%. For the unexposed
group, divide the number ill by the total unexposed to get .4 or
40%.
You then calculate the relative risk by dividing the attack rate
of the exposed by the attack rate for the unexposed. .5/.4 is
equal to 1.25, so there is some evidence that the ham played a
role in people getting sick. If this number was even higher, we
would be more certain.
Case-Control: Similar to a cohort, a case-control study takes a
group of people who are sick and a control group of people who
are not sick, then tests them for different exposures.
The chart and illustration below show the differences:

Odds ratio:
(Sick exposed x Control unexposed) (Control exposed x Sick
unexposed)
The odds ratio represents the number of times more likely the
exposed people are to get sick than the unexposed people.

For this chart, we took a group of people with some health

problem lung cancer, lets say and a group of people who did
not have lung cancer. We then asked them if they were ever
smokers. Out of 100 people with lung cancer, 60 had smoked and
40 had not. Out of 400 people without lung cancer, 100 smoked
and 300 did not. To calculate the odds ratio, plug in the numbers:
(60 x 300) (100 x 40) = 4.5

So according to this chart, people who smoke are 4.5 times more
likely to develop lung cancer.
Remember the groups of three that we have gone over so far:
Time/Place/Person
Agent(what causes the disease)/Host/Environment

Remember to have one 8.5x11 sheet of paper with

information that you will need for the test on
Saturday! If you have any questions, feel free to
send them to me. You guys will do just fine