Advanced epidemiology

Garba Bashiru
Outline
Sampling methods

Field investigations
 Population

• For researchers, the population is

the universe of cases to which the
research applies.

• Once you know your research

project, you have to determine the
set of cases that meet your criteria.

• This might be people, animals,

organizations, governments— it
depends on your discipline and
your project.
 Sample

• A sample is any subset of a population.

• It is a slice of the population, and there

are usually rules about how that slice is
chosen.

• Researchers often work with samples

rather than populations.

• Any time you are limiting your actual

data collection to a subset of cases
within a population, you are using a
sample.
Why study a sample rather than the population

• Research is time consuming, expensive and occasionally

impractical.
• Limited skill set (e.g studying global social media habits).
• Research is cumulative.
• Sometimes population may be too large to study.
• It may also not be possible to study the population (absence of
data) due to other extraneous factors like accessibility etc.
 SAMPLING PROBLEMS

Data collection is fraught with challenges that often affect the results
of studies.

Generalizability
Refers to the extent to which the results from analyzing a sample can be said to apply to the
entire population.

Sampling error
Is the difference between a sample statistics (such as a mean) and a true value of the
population. It’s actually highly connected to the issue of representativeness.
 Sampling methods

Sampling: This refers to the procedure you follow to determine the exact cases that make it into your
sample from the population

Probability sampling

• A probability sample is one where each unit in the population has an equal chance of being included in
the sample.

• Increases sample's representativeness of the population.

• Decreases sampling error and sampling bias.
• Simple random sampling- assign each sample a number.
• Stratified random sampling- Divided into subgroups, called strata (age, gender, ethnicity etc).
• Cluster sampling-The population is first listed by clusters or categories (externally
homogeneous vs internally heterogeneous).
• Systematic sampling- Every nth (e.g. every 5th element) or member of the population is
selected for the sample after a random start is determined .
 Sampling methods

Non-probability sampling

• In this case, the chance of anyone unit being included is not only not equal to
that of other units, but isn’t known at all.
• Not every unit of the population has equal chance of being selected.
• More likely to produce bias.
• Convenience sampling-Selection of the most readily available sample/unit
for a study.
• Purposive sampling-Researcher uses judgement to select subjects.
• Quota sampling: Similar to stratified but does not involve random selection
(select 50 male and 50 female).
• Snowball sampling-Subjects refer the researcher to others who might be
recruited as subjects.
Field investigations

• Outbreak: A disease outbreak is the occurrence of cases of disease

in excess of what would normally be expected in a defined
community, geographical area or season.
The importance of outbreak investigation

• The primary reason for conducting a field/outbreak investigation is to

identify the source of a disease.

• Information gathered may also be used to evaluate existing prevention

strategies and identify ways to prevent future outbreaks.

• Outbreak investigations provide an opportunity to;

• Determine how quickly the disease is spreading within a population of
interest.
• The spatial distribution and pattern of disease.
• Characteristics features, risks and routes of introduction.
The role of a disease investigator

-unfold the factors and circumstances

leading to an outbreak.
- determine the animals/humans
involved in an outbreak (visitors, animal
health workers and veterinary
practitioners).
 Pattern of disease occurrence

Endemic disease Epidemic disease Pandemic disease Sporadic disease

• A disease that is • In broader terms, • A pandemic is • A sporadic disease refers
consistently present epidemics can refer declared when a to a disease that occurs
but limited to a to a disease or other disease’s growth is infrequently and
particular region. specific health- exponential. irregularly.
• This makes the related behavior • This means growth • Diseases that are seen
only occasionally, and
disease spread and (e.g., smoking) with rate skyrockets, and usually without
rates predictable. rates that are clearly each day cases grow geographic
• Malaria, for example, above the expected more than the day concentration, are called
is considered an occurrence in a prior. sporadic diseases.
community or region. • Examples of sporadic
endemic in certain • Swine flu, Influenza,
diseases include tetanus,
countries and • Examples are Lassa SARS-CoV-2. rabies.
regions. fever, Ebola.
A step-by-step approach to outbreak investigation
Preparing for field investigation

• Before starting the field component of the outbreak investigation, you should
ensure that you are well prepared for field activities.

• This involves making sure you have all the equipment (disinfectants, recording
gears, restraints etc) and information (species involved, time of outbreak,
location) you require to conduct the initial outbreak investigation

• In addition, roles and responsibilities of those involved in the investigation must

be delineated. For instance, laboratory scientists to note types of testing and
specimens needed for the field investigation.

• Concerns related to the safety of the field team (e.g., whether personal
protective equipment will be needed) also should be considered during this first
step.
 Confirm the diagnosis

• Confirming or verifying the diagnosis ensures that you are addressing the problem that was
reported initially and rules out misdiagnosis.

• Diagnoses can be confirmed by; interviewing the affected farmers; clinical examination
of the affected animals by veterinarian; reviewing clinical history; confirming the
results of laboratory testing.

• If the epidemiologist does not have the expertise to assess the adequacy, accuracy, or
meaning of the laboratory findings, laboratory scientists and other personnel should be
consulted.

• Although laboratory data might be the best and only link between a putative cause and case,
not every case requires laboratory confirmation before further action can be taken.
 Determine the existence of an outbreak

• Determining the existence of an outbreak is a sometimes difficult step that should be

completed before committing program resources to a full-scale investigation.

• This step also is necessary to rule out spurious problems (e.g., pseudoepidemics or
reporting increases caused by surveillance artifacts).

• To confirm the existence of an outbreak, the field investigation team must first
compare the number of cases during the suspected outbreak period with the number
of cases that would be expected during a non-outbreak timeframe by;

• Establishing the seasonality of the disease.

• For certain problems, an outbreak can be rapidly confirmed through use of existing
surveillance data.
 Identify and count cases

• The aim of this step is to identify, or ascertain, as many cases as

possible without including non-cases.

• This entails casting a broad net through use of a classification scheme-

the case definition that maximizes sensitivity (i.e., correctly identifies
animals who have cases of the condition [true-positives]) and optimizes
specificity (i.e., does not include animals who do not have cases of the
condition [false-positives]).

• Depending on the nature, scope, and extent of the outbreak,

consideration should be given to the need for additional active case
finding and surveillance once sufficient information has been collected to
support prevention and control efforts.
Record data in terms of time, place, and animal

• This step involves translating and transforming data from the line
listing into a basic epidemiologic description of the outbreak.

• This description characterizes the outbreak in terms of time, place,

and animal (referred to as descriptive epidemiology).

• Through systematic review of data, key actions typically involve;

drawing epidemic curves, constructing spot maps or other special
spatial projections, and comparing groups of animals.
 Consider whether control measures can be
implemented now
• Control measures include two categories of interventions:
• Those that can be directed at the source(s) of most infectious and other disease-causing agents
(e.g., treating infected persons and animals or isolation).
• Those that can be directed at animals who are susceptible to such agents (administering post-
exposure prophylaxis, vaccinating in advance, or employing barrier techniques).

• In practice, however, decisions about control measures might be necessary at any step in the
sequence, and preliminary control measures can be instituted on the basis of limited initial
information and then modified as needed as the investigation proceeds.

• Control measures should be considered again after more systematic studies are complete.
 Develop and test hypotheses

• Hypotheses about the disease-causing agent, source or reservoir of the agent, transmission
mode, and risk factors for disease can be developed based on information from multiple sources
including:
• Expert subject-matter knowledge by field epidemiologists, laboratory colleagues, and others;
• Descriptive epidemiologic findings resulting from analysis of the line listing of identified affected
animals;
• Information obtained from interviews of animal owners by using structured questionnaires or
open-ended questioning;
• Consideration of outlier cases (i.e., cases with onset occurring at the beginning or end of the
outbreak period).

• In certain instances, descriptive epidemiologic findings alone, or results of cross-sectional survey

data or other studies will be sufficient for developing hypotheses.
Implement & evaluate control & prevention measures

• The ultimate purpose of an epidemiologic field investigation is to

implement scientifically rational and advisable control measures for
preventing additional outbreak-associated morbidity or mortality.

• Control measures implemented in outbreaks will vary based on the

causative agent; modes of spread; size and characteristics of the
population at risk; setting; and other considerations, such as
available resources, politics, and community concerns.
Communicate Findings

• Field epidemiologists must be diligent and effective communicators

throughout and after outbreak investigations.

• The information they provide helps keep the public and

stakeholders accurately apprised during an outbreak, informs
decisions about actions to halt the outbreak, and documents the
investigation.