Investigation of

Epidemics
Understanding, Analysis, and Prevention

NAGENDRAPPA MALIPATIL
Moderator - DR.GURURAJ N A
Table of Contents :

Introduction
Objectives of Epidemic Investigations
Steps in Epidemic Investigation
References
Introduction :

Epidemic: An unusual occurrence in a community or region of a disease,

specific health- related behaviour, or other health-related events clearly in
excess of the expected occurrence.

Outbreak: A small, usually localised epidemic.

Endemic: The constant presence of a disease or infectious agent within a given

geographical area or population group, without importation from outside.
Introduction :

Sporadic: Irregular, haphazard, and infrequent cases.

Pandemic: An epidemic affecting a large proportion of the population over a

wide geographic area.
Objectives of Epidemic Investigations :

Magnitude Assessment: Define the extent of the epidemic in terms of time, place,
and affected population.

Causative Factors Determination: Identify specific conditions and factors

responsible for the epidemic’s occurrence.

Source Identification: Pinpoint the source of infection and modes of transmission.

Objectives of Epidemic
Investigations :
Control Measures Implementation: Implement immediate control measures to
prevent further spread.

Recommendations for Prevention: Make evidence-based recommendations to

prevent recurrence
Steps in Epidemic Investigation :

1. Verification of diagnosis

2. Confirmation of the existence of an epidemic

3. Defining the population at-risk

4. Rapid search for all cases and their characteristics

5. Data analysis

6. Formulation of hypotheses
Steps in Epidemic Investigation :

1. Testing of hypotheses

2. Evaluation of ecological factors

3. Further investigation of population at risk

4. Writing the report

Verification of Diagnosis :

First step in investigation of an epidemic

Confirm that the observed cases indeed constitute an epidemic.

Rule out other potential causes.

Not necessary to examine all cases, take sample

Lab investigations to confirm the diagnosis

Confirmation of the existence of an epidemic :

Done by comparing the disease frequencies during the same period of previous
years

An epidemic is said to exist when the number of cases (observed frequency) is in

excess of the expected frequency for that population, based on past experience.

Epidemic threshold- an arbitrary limit of 2 standard errors from the endemic

occurrence
Defining the population at-risk

i. Obtaining the map of the area

Should contain information concerning natural landmarks, roads & location of all dwellings

Area may be divided into segments, using landmarks & may again be divided into smaller
sections.

Within each sections dwelling units (houses) may be designated by numbers

Defining the population at-risk :

ii. Counting the population :

Carried out by house to house visits

Without an appropriate denominator of "population at risk" attack rates

cannot be calculated.

Go on a house-to-house survey and try ot find the entire

population at risk.
Rapid search for all cases and their
characteristics
ii. Counting the population :
Rapid search for all cases and their characteristics

Carried out by house to house visits

Without an appropriate denominator of "population at risk" attack rates

cannot be calculated.

Medical
Go onsurvey
a house-to-house survey and try ot find the entire Epidemiological case
sheet
population at risk.
Rapid search for all cases and their
characteristics
1. Medical survey :

a medical survey should be carried out in the defined area to identify all
cases including those who have not sought medical care, and those
possibly exposed to risk.

2. Epidemiological case sheet :

Searching for more cases at home, family or neighbourhood

The information collected should be relevant to the disease under Study

Rapid search for all cases and their
characteristics
1. Searching for more cases :

The search for new cases (secondary cases) should be carried out
everyday, till the area is declared free of epidemic.

The patient may be asked if he knew of other cases in the home, family,
neighbourhood, school, work place having an onset within the
incubation of the index case.

It is important to consider cases admitted to local hospitals.

Data analysis :

Analysed on the basis of classical epidemiological parameters

i. Time- construct an epidemic curve

ii. Place - prepare a spot map

iii. Person - analyse data by age, sex, occupation & other risk factors

The purpose of data analysis is to identity common event or experience,

and to delineate the group involved in the common experience.
Data analysis :

1.

1. Time :

Prepare a chronological distribution of dates of onset of cases and construct an "epidemic

curve".

An epidemic curve suggests :

Pattern of spread

Magnitude

Outliers
Formulation of hypotheses :

To explain possible source, causative agent, modes of spread & environmental factors

The hypothesis should explain the epidemic in

terms of:

1. Causative agent

2. The possible source

3. Possible modes of spread

Testing of hypotheses :

Conduct analytical studies (e.g., case-control, cohort) to test hypotheses.

When evaluating hypotheses, epidemiologists compare attack rates between

exposed and unexposed groups for each suspected factor. This helps determine
which hypothesis aligns with all known facts.

When faced with divergent theories, distinguishing sound ones from merely
plausible ones isn’t straightforward.

Thus, revisiting arguments tested by subsequent events provides valuable

insights.
Evaluation of ecological factors :

To prevent further disease transmission during an outbreak, epidemiologists conduct

a thorough investigation. They focus on ecological factors that contribute to the
epidemic, including:

Sanitary conditions in eating establishments.

Water and milk supply status.

Human population movements.

Atmospheric changes (such as temperature, humidity, and air pollution).

Population dynamics of insects and animal reservoirs.

Evaluation of ecological factors :

By studying the outbreak in a case-control fashion,

epidemiologists aim to understand the disease’s

1. source of infection

2. identify reservoirs

3. determine modes of transmission

These insights guide effective preventive measures

Further investigation of population at risk :

1. Population Study:

Investigate the population at risk or a representative sample.

Methods include medical examinations, screening tests, and analysing samples

(suspected food, faeces, blood).

Assess immunity status and perform biochemical studies.

The approach can be retrospective (looking back) or prospective (looking

forward).
Further investigation of population at risk :

1. Serological Study:

Serological analysis can reveal clinically silent cases (asymptomatic individuals).

Provides insights into the pathogenesis of the condition.

2. Case-Control Study:

Study healthy individuals (not ill) from the same population.

Classify members based on:

Exposure to specific potential vehicles.

Whether they are ill or not.

Writing the report :

The report should be complete and convincing.

Information to be included in the final report on an epidemic is :

1. Background

2. Historical data

3. Methodology of investigations

4. Analysis of data

5. Control measures
1.Background :

Geographical location

Climatic conditions

Demographic status (population pyramid)

Socio-economic situation

Organisation of health services

Surveillance and early warning systems

Normal disease prevalence.

2.Historical data :

Previous occurrence of epidemics

of the same disease,

locally or elsewhere

Occurrence of related diseases, if any

in the same area

in other areas

Discovery of the first cases of the present outbreak.

 3.Methodology of investigations :
Case definition

Questionnaire used in epidemiological investigation

Survey teams :

Household survey

Retrospective survey

Prospective surveillance

Collection of laboratory specimens

Laboratory techniques.
 4.Analysis of data

Clinical data

Epidemiological data

Modes of transmission

Laboratory data

Interpretation of data
5.Control measures

Definition of strategies and methodology of implementation :

constraints

results

Evaluation :

significance of results

cost/effectiveness

Preventive measures.
It may be necessary to implement temporary control measures at the
commencement of an epidemic on the basis of known facts of the disease.

These measures may be modified or replaced in the light of new knowledge

acquired by the epidemic investigation.

As Frost (154) observed, an epidemiological investigation is more than the

collection of established facts.

It includes their orderly arrangement into chains of inference, which extend more
or less beyond the bounds of direct observation.
It may be necessary to implement temporary control measures at the
commencement of an epidemic on the basis of known facts of the disease.

These measures may be modified or replaced in the light of new knowledge

acquired by the epidemic investigation.

As Frost (154) observed, an epidemiological investigation is more than the

collection of established facts.

It includes their orderly arrangement into chains of inference, which extend more
or less beyond the bounds of direct observation.
THANK YOU