MPH 510

Demon in the Freezer

Discussion Guide

As you read the book, simply and briefly cite at least 1-2 examples or evidence of the

A)Steps of the Field Investigation Process /Cluster Investigation – as evident both in the smallpox and anthrax investigations

B)Purposes/Roles/Activities of Epidemiology and Epidemiologists

C)Descriptive Epidemiology

D)Analytic Epidemiology

E)Procedures and techniques used in the investigation of small pox and anthrax

F)Epidemiological Measures (including measures of effect)/ Potential Data Interpretation Issues

G)Five Principles of Morality – application/dilemmas

H)Ethics Guidelines for Epidemiologists – fulfillment and conflicts

  1. STEPS OF THE FIELD INVESTIGATION PROCESS
  1. Establish the existence of an epidemic (or outbreak)

An outbreak was established when a patient in the hospital was correctly diagnosed with smallpox after being treated for an unknown illness. Others in the hospital soon began coming down with symptoms of smallpox.

  1. Confirm the diagnosis

After tests were run on the patient’s blood and the discharge from the pox, a smallpox diagnosis was confirmed.

  1. Establish criteria for case identification

Cases were identified by the formation of puss filled pox on the exterior of the skin, in some cases the skin did not develop pox but became very red and inflamed instead.

  1. Search for missing cases

After one case was confirmed in the hospital, all persons in the hospital, employees and patients alike, were held for 18 days to ensure they would not spread the virus if they did indeed contract it.

  1. Count cases

There were a total of 17 cases that came from the single infected man in the hospital. Not all of these persons had direct contact with the infected patient.

  1. Orient the data according to person, place, and time

The doctors made sure to document all cases from the time they first began showing symptoms until they were cured or death due to the virus. All cases were placed in a quarantined facility to help protect the rest of the public.

  1. Classify the epidemic

Smallpox is an airborne transmitted virus. This case was a controlled outbreak.

  1. Determine who is at risk of becoming a case

Any of the persons who were at the hospital during the time that the infected patient was at the hospital had the potential of also becoming infected.

  1. Analyze the data

The doctors made sure to protect the public by watching for newly emerging cases and getting them quarantined as well as providing vaccinations to all persons in the public.

  1. Formulate a hypotheses

The doctors hypothesized that the single patient was the one who spread the virus to the others. At first they thought it was by face to face contact, so they brought in a smoke machine to test how the droplets of the virus traveled through the air.

  1. Test hypotheses

Doctors used a smoke machine to re-enact the droplets of smallpox traveling from the patient up to the third floor to infect people.

  1. Develop reports and inform those who need to know

The doctors made sure the public knew of the outbreak so they could be given vaccines in case any of then had come in contact with an infected person. This helped to stop the virus in its tracts and ensure the spread of the virus was contained and taken care of.

  1. Execute control and prevention measures

In order to control the outbreak the doctors placed any person who had contracted the virus into a quarantined building until the virus had run its course. All other members of the public were given smallpox vaccines whether they truly needed it or not, it was a precaution to help prevent further spread of the virus.

  1. Administration and planning activities

The group of doctors planned to give vaccines in an efficient manner using the US vaccine instead of the German vaccine which was not as reliable.

EVIDENCE/EXAMPLES OF DISEASE CLUSTERS/INVESTIGATION

A disease cluster is when two or more cases of a relatively uncommon event or disease related in time and/or place perceived to be greater than expected by chance. This is exactly what happened in this instance with the smallpox outbreak. As far as everyone was concerned smallpox had been eradicated. This one case soon led to 17 cases. If this was not caught there could have been a outbreak leading to more devastation. Much larger epidemic was avoided since the doctors who responded to the first case knew what they had to do to contain this deadly virus. Without their fast response this virus could have produced many more cases. These doctors quickly quarantined the one case and held all hospital personnel and patients for observation for 18 days to ensure possibly infected persons were not out in the general public spreading the virus further. A later investigation involving a smoke machine provided the doctors with the proof they needed to show that all of the cases stemmed from that first patient on the first floor of the hospital.

  1. PURPOSES/ROLES/ACTIVITIES OF EPIDEMIOLOGY/EPIDEMIOLOGISTS:
  1. Identifying risk factors for disease, injury, and death

Epidemiologist followed the case to find who may have come into contact with the infected person, putting them at risk for contracting the virus. They found out that if they had not quarentined those who were will the virus would have spread t a rapid rate, 17 new cases for every exsisting case.

  1. Describing the natural history of disease

Follow the disease and note cases and symptoms as well as location in order to track the disease.

  1. Identifying individuals and populations at greatest risk for disease

Once the disease is a little better understood, epidemiologists can then find the target population of the disease and make sure these people know how to protect themselves from getting ill. Smallpox seemed to effect everyone from young to old, male and female.

  1. Identifying where the public health problem is greatest

In the case of the book it was Germany where the new outbreak was located

  1. Monitoring diseases and other health-related events over time

Since sallpox had been eradicated it was hard to believe there was outbrek. This outbreak needed to be followed for the safety of everyone who came into contact with the virus.

  1. Additional activities

Keeping the public informed about the outbreak and helping those at risk protect themselves. Also helping to keep the public calm.

  1. Evaluating the efficacy and effectiveness of prevention and treatment programs

Follow up on all programs that are put into use and ensure they are being carried out correctly and helping those who need it most. Keep doing ongoing research to find better, more effective programs to continually build on your knowledge and help keep illness at bay.

  1. Providing information useful in health planning and decision making for establishing health programs with appropriate priorities

Once an outbreak had been established vaccine sites were set and the at risk population recieved the vaccine regardless of contact with the infected individual to help slow and stop the spread of the virus.

  1. Assisting in carrying out public health programs

Epidemiologists help by ensuring programs are being carried out correctly so the public is getting the information and help they need to protect themselves and their families.

  1. Being a resource person

Always staying up to date with vital information and passing that information along to the public in an effective way that they can understand and utiize. Also be available to answer questions and concerns.

  1. Communicating public health information

Being sure to effectively communicate new information so the public can understand and utilize the information to protct themselves and their families.

  1. DESCRIPTIVE EPIDEMIOLOGY – Examples and/or Evidence (should be in bulleted form)

Person - persons who are infected should be noted along with their gender, ethnicicty and any other descriptive factors that will be related to the illness

Place - pecific place of the outbreak and any place infected perons travels to

Time - time of onset of illness, incubation period, time between new cases

  1. ANALYTIC EPIDEMIOLOGY – Examples and/or Evidence [use bulleted format]

Disease does not occur randomly but rather in describable patterns that reflect the underlying etiology

The smallpox virus spread due to the transfer of droplets

The droplets moved up the outside wall into rooms on the third floor

The only people who became ill were the ones who had contact with the ill patient or the droplets in the air

  1. PROCEDURES AND TECHNIQUES USED IN THE INVESTIGATION OF SMALL POX AND ANTHRAX

(procedures and techniques are discussed in Chapter 12 of the textbook) – [Use bulleted format]

Define the problem - in both cases a deadly outbreak

Appraise existing data - collect data concerning persons, places and time of outbreak.

Case identification - track down all cases

Clinical observation - Make records of the cases including symptoms associated with the disease

Tabulation and spot maps - plot cases on map to show clustering

Identification of resonible agent - determine agent causing the outbreak

Formulate a hypothesis - naming possible sources of the infection, how it is spreading and best approach for control

Test the hypothesis - collect data from infected persons to help confirm or refute initial thoughts, continue to search for new cases

Draw conclusion and formulate practical application - implement policies, programs and procedures to help prevent the same

outbreak in the future.

  1. EPIDEMIOLOGICAL MEASURES(including measures of effect) and POTENTIAL DATA INTERPRETATION ISSUES(e.g. bias and confounding) [Use bulleted format]

Sampling variability leading to fluctuations arpund a true value of a parameter (rate or a relative risk)

Poor precision

Sampling error showing different values for the sample and parent population

Variability in measurement - data collected need to be objective, reliable, accurate and reproducible

Selection bias occuring when the relation between exposure and disease is different for those who participate and those who are

eligible for study

Information bias as a result of measurment error in the assessment of both exposure and disease

Confounding due to a distortion of the estimate of the effect of an exposure of interest because it is mixed with the effect of an

extraneous factor

  1. FIVE PRINCIPLES OF MORALITY: [Evidence/examples where these principles were applied and/or moral dilemmas arose]
  1. ETHICS GUIDELINES FOR EPIDEMIOLOGISTS AND HEALTH EDUCATION PROFESSIONALS

[Refer to Part II of the Ethics Guidelines as well as the Code of Ethics for Health Professionals, note examples/evidence of either adherence to these guidelines/code or where the actions were in conflict with them] [Use bulleted format, not all elements of the guidelines and code need to be addressed]