EXERCISE TOPIC 8

MEASURES OF ASSOCIATION IN EPIDEMIOLOGY

Scenario A
You are selected as a member of a team of animal health professionals who are
investigating the health status of backyard flocks in your area as part of an outbreak
investigation. Your team evaluates 82 backyard flocks within the province. You and
other team members examine birds within each flock and note if any birds are exhibiting
clinical signs of respiratory disease (lethargic, coughing, open-mouth breathing, nasal
discharge). Furthermore, samples (tracheal swabs) from birds in each flock are collected
to determine the infection status of the flock. If one or more samples collected from one
flock test positive by virus isolation, then the entire flock is considered to be positive for
avian influenza virus and is classified as “ill”. If birds within the flock do not exhibit
clinical signs of respiratory disease and all of the samples collected test negative by virus
isolation, then the entire flock is considered negative for avian influenza virus.
As part of the investigation, you and your team members determine if birds within a flock
have contact with wild birds. Second, you determine if biosecurity measures are in place.
Last, you determine if the birds have been vaccinated using an approved or non-approved
vaccine.
Of the 82 flocks you evaluate, 45 of them are identified as positive for avian influenza
virus and classified as “ill”. A total of 45 flocks have contact with wild birds; 30 of
which are classified as “ill”. A total of 40 flocks appear to have good biosecurity and
only 5 of these are classified as “ill”. Last, you determine that 2 flocks out of a total of
22 who were vaccinated using a non-approved vaccine were classified as “ill”.
Questions

1. Create a factor-specific attack rate table using the supplied information.

2. Calculate the Relative Risk, Attributable Risk, Attributable Proportion, Population
Attributable Risk, and Population Attributable Risk Percent associated with contact
with wild birds, lack of biosecurity, and non-approved vaccine use.
3. Give the interpretation of your results.

Scenario B
Live bird markets have been documented to be in an important factor in the spread and
propagation of avian influenza viruses in both Southeast Asia and North America.
Currently, you are investigating outbreaks of highly pathogenic avian influenza virus in
backyard poultry flocks in your area. You want to evaluate whether or not flock owner
visits to live bird markets are a risk factor for introduction of highly pathogenic avian
influenza virus into a backyard flock.
You evaluate 73 backyard flocks. Samples (tracheal swabs) were collected from birds in
each flock and infection status of the flock was determined. If one or more samples
collected from one flock tested positive by virus isolation, then the entire flock was

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considered to be positive for avian influenza virus. If all of the samples collected from
one flock tested negative by virus isolation, then the entire flock was considered to be
negative for avian influenza virus.
Of the 73 flocks you evaluate, 17 of the flocks are identified as positive for avian influenza
virus. As you evaluate each flock, you interview the flock owner to determine whether
or not the flock owner has visited a live bird market within the last 30 days. Of the flock
owners with an avian influenza negative flock, 8 of them visited a live bird market in the
past 30 days. Of the flock owners with an avian influenza positive flock, 13 of them
visited a live bird market in the past 30 days.
Questions
1. Construct the appropriate 2 x 2 table to organize the data to investigate the risk
associated with owner visits to a live bird market.
2. Calculate the  2 test to test the association.
3. Calculate the relative risk associated with owner visits to a live bird market and
interpret your answer.
4. Calculate the attributable risk and interpret the meaning of your answer.
5. Calculate the odds ratio and interpret the meaning of your answer.

Scenario C

You are asked to investigate a possible outbreak of highly pathogenic avian influenza
virus in a backyard flock. The owner raises approximately 62 chickens at her premises.
When you arrive, you examine the flock and note that approximately 48 of the chickens
are exhibiting clinical signs of respiratory disease (coughing, lethargic, open-mouth
breathing and nasal discharge).
By your count, the flock is composed of 35 adult (one year of age or older) hens, 4 adult
roosters and 23 juvenile chickens (less than one year of age) of which 6 are roosters. Of
the 48 chickens that are exhibiting clinical signs of respiratory illness, 27 are adult hens,
3 adult roosters and 18 are juvenile chickens (4 juvenile roosters and 14 juvenile hens).
Suppose the adult hens are housed in a building that is fenced so the remainder of the
flock and wild fowl do not have access to it.
Questions
1. Using “no housing” as a risk factor and the presence of clinical signs during your visit
to indicate disease status, create a 2 x 2 table to organize the data for comparison.
2. Calculate the relative risk of respiratory disease associated with no housing. What
does this measure mean?
3. Calculate Attributable Risk, Attributable Proportion, Population Attributable Risk,
and Population Attributable Risk Percent and interpret its meaning.
4. Calculate the odds ratio and interpret its meaning.

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Application of Software Tools – Risk Measurements
This exercise will make use of the Winepiscope or Epitools Software

Questions
In a prospective cohort study of AI, 100 vaccinated and 100 non-vaccinated flocks were
followed for 12 months for outbreaks (based on a standard case definition). Five
vaccinated flocks had outbreaks compared with 25 non-vaccinated flocks. Answer the
following questions.

1. Calculate the relative risk of AI outbreaks for vaccinated flocks compared with non-
vaccinated flocks and a 95% confidence interval

2. Calculate the odds ratio of AI outbreaks for vaccinated flocks compared with non-
vaccinated flocks and a 95% confidence interval

3. Use a chi-square test to evaluate whether the association between vaccination and AI
is significant at the 5% level (P=0.05)