Outbreak

By : Nigesh
 Contents
• Definition
• Outbreak history
• Steps of outbreak investigation
• Types of outbreak
 DEFINITION
• The occurrence in a community or region of
cases of an illness with a frequency clearly in
excess of normal expectancy.
• Outbreak: A higher-­than-expected number of
occurrences of disease in a specific location and time.
 Worst outbreaks - history

Ebola - 2014-2015
Plague - black death
in 400 BC
Small pox - 1492 to 1900
• Malaria
2800 children –dies per day
When was the first malaria outbreak?
It has probably afflicted humans throughout
our evolutionary history, although the first
historical reports of symptoms that match
those of malaria date back to the ancient
Egyptians (around 1550 B.C.) and the
ancient Greeks (around 413 B.C.).
COVID-19
2019-till now
In Nepal
Total cases-979,000(+9)
• Deaths
• 11,951
In world
Total cases
508M
Deaths
6.21M
 STEPS OF AN OUTBREAK INVESTIGATION

1. Verify the diagnosis and confirm the outbreak

The first step in an investigation is to determine whether the reported number of cases is unusual.
Baseline surveillance data is a useful resource for making this decision. Verifying the diagnosis
through laboratory testing is also important, especially for new or uncommon pathogens.
 
2. Define a case and conduct case finding
Investigators should establish a case definition by characterizing cases by clinical signs and
symptoms and epidemiologic information related to person, place, and time. Using the case
definition, investigators can search for additional cases.
 
3. Tabulate and orient data: time, place, person
Information about possible cases should be organized in a line listing and summarized according
to time, person, and place. 
4. Take immediate control measures
If the source of the outbreak is apparent and still a potential threat to public health, appropriate
control measures should be taken as quickly as possible. Examples of control measures are closing a
restaurant, prohibiting swimming in a certain area, and enacting isolation and quarantine. 
 Continue…
5. Formulate and test hypothesis
At this point, investigators develop a hypothesis about the cause of the outbreak. Understanding the
possible disease pathogen and mode of transmission is useful when creating hypotheses.
 
6. Plan and execute additional studies
Depending on available resources, investigators may test a hypothesis using an analytic study, such as
a case-control study or retrospective cohort study.
 
7. Implement and evaluate control measures
Once the cause of the outbreak has been identified investigators should work to implement longer-
term control measures to end the current outbreak and prevent future outbreaks. These control
measures are more extensive than earlier control measures and should be evaluated to determine if they
are effective. Examples of such measures are: recommending different food safety procedures in a
restaurant, implementing better disinfection protocols at a local swimming pool, and establishing
screening programs in local emergency rooms.
 
8. Communicate findings
Throughout the investigation, investigators should communicate findings within their agency, to other
organizations, and to the general public. Outbreaks provide a unique opportunity to educate the general
public about health promotion and disease prevention.
 Types of Outbreak
The place (or object) where people get infected by the micro organism is
called 'the source' of the outbreak.
Epidemics can be classified according to their manner of spread through a
population:
• Common-source
– Point (Common source outbreaks where the source has infected cases at one particular
geographical location, during a short period of time, are called 'point source outbreaks'. )
– Continuous (When all (or most) cases in an outbreak have been infected by the same
source, however over a prolonged period of time, then this type of outbreak is called
'continuing common source outbreak'. )
– Intermittent
• Propagated (When an infectious disease is communicable (i.e. can be transmitted from
person to person), then we can no longer consider that a single, common source is responsible
for the outbreak. The causative agent is propagated within the population through human
contact patterns. The shape of the epidemic curve in propagated outbreaks can vary and
depends on the contact pattern and the proportion of susceptible  individuals. )
 Reference

• North Carolina Center for Public Health Preparedness. Overview

of outbreak investigations. Focus on Field Epidemiology 1(1):1-6.
http://nccphp.sph.unc.edu/focus/vol1/issue1/index.htm.
Accessed March 27, 2008.(STEPS OF AN OUTBREAK
INVESTIGATION)
• Betty A.Forbes,Daniel F.Sahm and Alice S.Wessfeld:Bailey and
Scott’S Diagnostic Microbiology (11th Ed.) Mosby,St.Louis 2002
Thank you