Disease Detectives 102: How to Investigate an Outbreak

Science Olympiad Eleventh Annual Coaches Clinic October 3-4, 2003

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Investigating an Outbreak---a Challenge for the Disease Detective

What Is an Outbreak? Uncovering Outbreaks Why Investigate an Outbreak? Interactive exercise at:
www.cdc.gov/excite/classroom/outbreak.htm

What Is an Outbreak?

An outbreak, or an epidemic, exists when there are more cases of a particular disease:
in an area,

among a specific group of people, or

over a particular period of time

Uncovering Outbreaks

Health departments learn about most outbreaks in one of two ways:

Calls from a physician or other healthcare

provider.
Public heath surveillance

Why Initiate an Investigation?

Describe the problem
Control and prevention based on scientific evidence

Political and public concerns

Training of epidemiologists Research--answer scientific questions

Guidelines for Epidemiologic Field Investigations

Prepare for field work

Verify diagnosis Confirm epidemic

Identify and count cases

create case definition develop line listing

Guidelines for Epidemiologic Field Investigations

Tabulate and orient data: time, place, and person Take immediate control measures Formulate and test hypothesis Plan additional studies Implement and evaluate control measures Initiate surveillance Communicate findings

Field Investigation: Time

Epidemic curve: # of cases by time of onset

Shape of the curve gives you clues:
agent known: use incubation period to look back

at exposure agent unknown, but common event likely: postulate agent by determining the incubation period

Number of bioterrorism-related anthrax cases, by date of onset and work location District of Columbia (DC), Florida (FL), New Jersey (NJ), and New York City (NYC) September 16-October 25, 2001

MMWR, November 2, 200l/Vol. 50/No. 43

Salmonellosis in passengers on a flight from London to the United States, by time of onset, March 13--14, 1984

Legionnaires' Disease By date of onset, Philadelphia, July 1-August 18, 1976

Field Investigation: Place

Orient to:
place of residence place of work

activity sites (church, reunions, weddings, etc.)

Spot map: specific residence and/or exposure

within buildings

city blocks or neighborhoods

county or state level

Distribution of cholera cases and implicated water well - Golden Square area of London, AugustSeptember, 1848

Culture-positive cases of shigellosis, by sites along the Mississippi River where each case swam within three days of onset of illness - Dubuque, Iowa, September 1974

Field Investigation: Person

Thoroughly describe the case group (things such as age, sex, race)
Identify things shared in common (events, behaviors, etc.) Get information on people who are NOT cases as well - the population!

Compare groups

Deaths associated with tractor injuries, by age group, Georgia 1971-1981

Student resources for outbreak investigation

Introduction to epidemiology
www.cdc.gov/excite/classroom/intro_epi.htm

How to investigate an outbreak

www.cdc.gov/excite/classroom/outbreak.htm

Disease Detectives
www.cdc.gov/excite/disease_detectives/index.htm

Questions?
Paul Garbe Pgarbe@cdc.gov 404-498-1305