MD3150E Epidemiology,

Biostatistics and Public Health

Week 5

Ekaterine Cherkezishvili, MD, MPH

November 2, 2020
University of Georgia
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Review of weekly grading policies

• For those who miss grades for weeks 2,3,4 submit (improve) week 4 assignment: make
sure you follow instructions for weeks 2 & 4 both. I will use grading rubric for these weeks.
For week 3 I will give you 1 point for writing if you demonstrate you can find good
academic sources and cite them properly

• If you wish to get the only additional bonus point for week 3, complete
https://new-learning.bmj.com/course/10062927 upload the certificate in week 4 in
addition to the draft of final paper. (If you have already uploaded certificate in week 3 no
need to do it again). In my feedback for week 4 there will be my records of your activity and
earned points for week 2 and 3. If you don’t agree, let me know and we can compare out
notes.

• I am uploading your performance in the quizzes + bonus points earned during the oral
discussion on the day of the quiz. Please remember, you can retake the quiz in the same
week during my office hours. These grades become final at the start of the next weeks
seminar.
• I am awarding 1 bonus point for participation in the lecture. No rules, this is at my
discretion only! Bonus points earned during the lecture can be used in this and any
previous week.
• Cheating is punished by assigning 0 points for everybody who submitted the mistakes that
most likely could not occur by chance. Don't risk your grade and don't share the answers. 
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Cargo Cult science

• It seems a weird hypothesis is going around: That you need to contact me and claim you deserve
a grade for missing week, without even understanding the assignment and grading policy for
that week. I encourage students speaking up but only after you know what you earned and
claiming that. Wasting my time and yours should does not give you any credit in my class. 

• Approaching with questions that show that you have been engaged and paid
attention are encouraged, welcomed and even receive a bonus if needed!

https://en.wikipedia.org/wiki/Cargo_cult_science
 Epidemiologic approach

Reading Materials: 
Required: 
CDC, An Introduction to Applied Epidemiology and Biostatistics, third edition,  
lesson 1 section 5-11  
https://www.cdc.gov/training/QuickLearns   
 
Recommended: 
Katz, David et al., (2014). Jekel`s epidemiology, biostatistics, preventive medicine, and public
health-4th ed. chapter3 
Greenberg, Raymond (2015).Medical Epidemiology: Population Health and Effective Health
Care, 5th ed.  Chapters: 3  
Epidemiologic Approach

• Count
• Divide
• Compare
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Case definitions
• Standard criteria for determining whether an
individual should be categorized as having a particular
disease or health-related condition.
▫ Standard definitions

• For an outbreak,
▫ clinical criteria + specification of time, place, and
person.

▫ degrees of certainty: suspected, possible confirmed cases

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Descriptive Epidemiology
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The Epidemiologic Approach

• How do the epidemiologists proceed to identify

the cause of a disease?

• Common sequence is as follows:

Epidemiological
Recognizing a new or increased
Observation
disease pattern

Descriptive Describe distribution, identify clues for

Studies further study –generate a hypothesis
that exposure E causes disease D

Analytic Studies Testing hypothesis that exposure E

causes disease D
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Exposures Disease

• What (case definition)

• Descriptive
Who (person)
Epidemiology
• When (time)
• Where (place)

• Why (cause and effect) –analytical epidemiology

• How (mechanism) –biological models

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Descriptive Epidemiology

Includes descriptive I keep six honest serving

statistics that provide men
They taught me all I
information on disease know;
or health-related event Their names are what
and why and when
patterns by various And how and where
characteristics of and who.
(Kipling)
person, place and
time.
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Descriptive Epidemiology:Time
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Descriptive Epidemiology:Time
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Descriptive Epidemiology:Place
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Descriptive Epidemiology:Place
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Descriptive Epidemiology:Person
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Descriptive Epidemiology:Person
Chain of Infection
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Disease characterstics
• Spectrum of disease: healthy carrier, subclinical, mild,
moderate, severe, fatal
• Infectivity: proportion of exposed persons who become infected
• Patogenicity: proportion of infected individuals who develop
clinically apparent disease.
• Virulence: proportion of clinically apparent cases that are severe or
fatal
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Chain of Infection

the agent leaves its reservoir or host through a portal of exit, is conveyed by

some mode of transmission, and enters through an appropriate portal of
entry to infect a susceptible host. 
Epidemic disease Occurence
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Levels of Disease
• Sporadic: disease occuring infrequently and irregularly.
• Endemic: the constant presence of a disease or infectious
agent in a population within a geographic area.
▫ Hyperendemic -- persistent, high levels of disease occurrence.
• Epidemic: the occurrence of more cases of disease than
expected in a given area or among a specific group of
people over a particular period of time.
• Pandemic refers to an epidemic that has spread over
several countries or continents, usually affecting a large
number of people.
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More definitions

• Outbreak: epidemic limited to localized

increase in the incidence of disease
• Cluster: aggregation of cases in a given area
over a particular period without regard to
whether the number of cases is more than
expected
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Exercise
• For the month of August, 12 new cases of
tuberculosis and 12 new cases of West Nile virus
infection were reported to a county health
department. You are not sure if either group of
cases is a cluster or an outbreak. What additional
information might be helpful in making this
determination?
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Describe the phenomena

• Traditionally, a special type of histogram is used
to depict the time course of an epidemic. This
graph, called an epidemic curve, provides a
simple visual display of the outbreak's
magnitude and time trend.
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https://www.cdc.gov/training/QuickLearns
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Determining Most Likely period of exposure

Average incubation
period 4 days
Minimum incubation
period 2 days
Maximum incubation December 6th (3-7), 2011
period 10 days
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Different types of epicurves

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Different types of epicurves

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Different types of epicurves

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Different types of epicurves

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 Attack Rate

Number of people @risk who

develops a certain disease
= ––––––––––––––––––––––
Total number of people @risk
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Cross-Tabulation
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Thank You

Questions?