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INVESTIGATION OF EPIDEMIC
Dr Sara T

EPIDEMIC

The unusual occurrence in a community or region of disease , specific health related behaviour or other health related events clearly in excess of expected occurrence.

OBJECTIVES OF EPIDEMIC INVESTIGATION

Magnitude of epidemic outbreak Conditions and factors responsible Identify cause , source and modes of transmission Recommendations to prevent recurrence.

SIMPLE OUTLINE

EPIDEMIC INVESTIGATION- 10 STEPS

1.

2.
3. 4.

5. 6. 7.

8.
9. 10.

Verification of epidemic Confirmation of existance of epidemic Defining the population at risk Rapid search for all cases and their characteristics Data Analysis Formulation of Hypothesis Testing of Hypothesis Evaluation of ecological factors Further investigation of population at risk Writing the report

TEAM Epidemiologist Clinician Pathologist Entomologist Environmental Specialist Local authorities , people for digging etc.

EQUIPMENT Sample collection bottles/camera Personal protective measures LIASON WITH LOCAL AUTHORITIES

VERIFICATION OF DIAGNOSIS
Clinical examination of cases Laboratory Investigation

CONFIRMATION OF EXISTANCE OF EPIDEMIC

Comparing the disease frequencies during the same period of previous years.

DEFINING THE POPULATION AT RISK

Map of the area Counting the population at risk denominator for caculating rates.

RAPID SEARCH OF ALL CASES AND THEIR CHARACTERISTICS

Medical Surveys To identify all cases and those who have not sought medical care and those possibly exposed to risk. Searching for more cases - May reveal person to person spread

Epidemiological case sheet

DATA ANALYSIS

FORMULATION OF HYPOTHESIS

Formulate hypothesis to explain epidemic in terms of Possible source Causative agent Modes of spread Environmental factors

TESTING OF HYPOTHESIS

Compare attack rate in exposed vs attack rate in non exposed.

EVALUATION OF ECOLOGICAL FACTORS

Ecological factors which have made the epidemic possible should be investigated Water and milk supply Breakdown in water supply system Atmospheric changes

FURTHER INVESTIGATION OF POPULATION AT RISK

Medical examination Screening tests Examination of suspected food,faeces or blood sample Biochemical studies Assesment of Immunity status

WRITING THE REPORT

1.
2. 3. 4. 5.

Contents of report Background Historical Data Methodology of Investigation Analysis of Data Control of measures

At commencement of epidemic , on basis of known facts of disease temporary control measures should be implemented which may be modified or replaced in light of new knowledge acquired by epidemic investigation.

SUMMARY: STEPS IN THE MANAGEMENT OF A COMMUNICABLE DISEASE OUTBREAK BY WHO

1. PREPARATION - Health coordination meetings , Surveillance
system , Outbreak response plan for each disease: resources, skills and activities required , Stockpiles: sampling kits, appropriate antimicrobial, intravenous fluids, vaccines , plans for isolation wards in hospitals , Laboratory support

2. DETECTION - By surveillance system 3. RESPONSE -Confirmation ,Investigation , Control 4. EVALUATION- effectiveness of containment measures , timeliness of outbreak detection and response, change public health policy if indicated (e.g. preparedness) , write and disseminate outbreak report.

THANKYOU