what are the three principles of outbreak management

Blank S, Scanlon KS, Sinks TH, Lett S, Falk H. An outbreak of hypervitaminosis D associated with the overfortication of milk from a home-delivery dairy. Do not use an Oxford Academic personal account. Ungchusak, Kumnuan, and Sopon Iamsirithaworn. The timely implementation of effective infection control measures is essential to minimise the incidence of MRSA cases and the magnitude of disease outbreaks. sharing sensitive information, make sure youre on a federal the determination of a cause of an outbreak usually requires the use of accurate epidemiological methods to ensure the collection of unbiased data, the use of appropriate statistical methods in the analysis of the data (often with the use of computer software such as epi-info [computer software developed by cdc]), and the correct interpretation Division of work Division of work, also known as division of labour, involves dividing a job into individual tasks. Guiding Principles for Outbreak Management Arrangements 3 | P a g e Purpose of document This document is intended to outline principles for the design of COVID-19 Local Outbreak Plans led by the Director of Public Health at Upper Tier Local Authority level, working with The hypothesis that the locally produced ground beef was the vehicle could easily be tested by asking case-patients and controls (persons without thyrotoxicosis or other thyroid disease) whether they ate ground beef from the same source. Describe the principles of an outbreak investigation. An intermittent common-source epidemic (in which exposure to the causative agent is sporadic over time) usually produces an irregularly jagged epidemic curve reflecting the intermittence and duration of exposure and the number of persons exposed. Use a camera to photograph working or environmental conditions. Once control and prevention measures have been implemented, they must continue to be monitored. Bureau of Disease Control and Veterinary Service. Emerg Infect Dis 2002;8:101928. Confirmed: A suspected or probable case with laboratory confirmation. Figure 6.2b Outbreak of SalmonellaEnteritidis Gastroenteritis Maryland, 2003 (Epidemic Curve by 6-Hour Intervals). Federal government websites often end in .gov or .mil. Of these, 32 per cent died. First, review the clinical findings and laboratory results. This association was confirmed in the laboratory, where the outbreak subtype of the Legionnaires disease bacillus was isolated from the water in the mist machines reservoir. Figure 6.2a Outbreak of SalmonellaEnteritidis Gastroenteritis Maryland, 2003 (Epidemic Curve by 12-Hour Intervals). Do they know anyone else with the disease? Surveillance takes place prior to, during and after outbreaks. It is recommended that a staff contingency plan is included in the outbreak management plan. 2009 Aug;5(8):e1000471. In an attachment, you found an official laboratory report from the Upper Northern . The following two-by-two table shows the data for beef and gastroenteritis. What are the risks and why are MROs important? We discuss crisis prevention and management during the first 3 months of the severe acute respiratory syndrome ( SARS) outbreak in Singapore. Usually, the cases are presumed to have a common cause or to be related to one another in some way. The authors and the publishers do not accept responsibility or Outbreak Protocol is provided for health practitioners to aid in the detection and control of communicable disease outbreaks by providing a framework of provincial legislation and policy. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. what are the three principles of outbreak management Found insideThe effects of the Ebola epidemic go well beyond the three hardest-hit countries and beyond the health sector. The outbreak of West Nile virus infection in the New York City area in 1999. The relative risk is 5.7, which most epidemiologists would deem a strong association between exposure and disease. To test the statistical significance of this finding, a chi-square test can be computed using the formula shown earlier. Investigators may conduct what is sometimes called stimulated or enhanced passive surveillance by sending a letter describing the situation and asking for reports of similar cases. Case finding and line listing 6. If you are arriving from outside the area, you should arrange in advance when and where you are to meet with local officials and contacts when you arrive in the field. What do they think caused their illness? The investigation includes the following steps: establishing the existence of the outbreak; defining the disease; finding cases; describing cases by time, place, and person characteristics; establishing a hypothesis related to the mode of occurrence; testing the hypotheses; conducting an environmental investigation; conducting a microbiological investigation; controlling the outbreak, preventing further occurrences, and writing an investigation report to share experience with the public health and scientific community. B. Adapted from: Lukacs SL, Hsu V, Harper S, Handzel T, Hayslett J, Khabbaz R,,et al. Jernigan DB, Raghunathan PL, Bell BP, Brechner R, Bresnitz EA, Butler JC, et al. If surveillance has not been ongoing, now is the time to initiate active surveillance. PPE should be included in the outbreak kit (see Section B4.11). The investigation of an outbreak from an animal source may include state and federal departments of agriculture and/or the Food and Drug Administration (FDA). 14 Management Principles Every Manager Should Know. Depending on the type of outbreak, the number of involved agencies may be quite large. : Yes; Hospital Alerted: Yes; Lab Results: WB IgM+, WB IgG+; Comments: Erythema migrans; Physician Reporting: Dr. Howard; Phone: 555-1950; Date of Report: 11/24/06. Epidemiol Bull 2001;22(4):146. Users can also be actively notified of breaking health events as they occur. Although the next conceptual step in an investigation is formulating hypotheses, in reality, investigators usually begin to generate hypotheses at the time of the initial telephone call. For a notifiable disease, the expected number is based on health department surveillance records. Communicate clearly. Effective outbreak management requires a multidisciplinary approach and involves individuals with different responsibilities. In a case-control study, the investigator asks both case-patients and a comparison group of persons without disease (controls) about their exposures. Return to text. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Following successful sign in, you will be returned to Oxford Academic. Most of the case-patients were exposed to the item, so that the exposure could explain or account for most, if not all, of the cases. A cohort study is feasible only when the population is well defined and can be followed over a period of time. Once a decision is made to investigate an outbreak, three types of activities are generally involvedthe epidemiologic investigation; the environmental investigation; and the interaction with the public, the press, and, in many instances, the legal system. This information can be found on disease fact sheets available on the Internet or in the, Identify the peak of the outbreak or the median case and count back on the. When an outbreak occurs, whether it is routine or unusual, consider what questions remain unanswered about that particular disease and what kind of study you might do in this setting to answer some of those questions. An outbreak of an acute respiratory disease, coccidioidomycosis, occurred among volunteers, group leaders, and archaeologists who began working at a Native American archaeological site in Utah on June 18.(30). Upon confirmation of the outbreak, an outbreak response team and management plan is developed. Self study modules on Tuberculosis, Module 7: Confidentiality in Tuberculosis Control: Background. : Yes; Hospital Alerted: YesColumbia Medical Ctr; Admission Date: 9/18/2006; Lab Results: WB IgM+, WB IgG-; Comments: Erythema migrans; Physician Reporting: Dr. Fine; Phone: 555-1951; Date of Report: 11/24/06. Public Health Reports 2003; 118:928. A spot map may even plot sites of recreational or other outdoor exposures. In the outbreak in the aged care facility in Washington state USA, two thirds of residents (80/120) were infected. Only one case was identified in Sioux Falls, South Dakota, 60 miles away. Recognize, however, that the chi-square and similar tests are guides to help you make a decision about a hypothesis. Some spot maps indicate each patients residence. Source: Jani AA, Barrett E, Murphy J, Norton D, Novak C, Painter J, Toney D. A steamship full of trouble: an outbreak of Salmonella Typhimurium DT 104 gastroenteritis at a holiday banquet Virginia, 2003. Outliers also can provide important clues. Regardless of which form is used, the data collection form should include the following types of information about each case. Feed and water consumption and production should be carefully monitored at all times, as well as the typical sounds and behaviors of individual animals. Is the number of new cases slowing down or, better yet, stopping? Early (and continuing) analysis of descriptive data helps you to become familiar with those data, enabling you to identify and correct errors and missing values. Other investigations, particularly those of a newly recognized disease or syndrome, begin with a relatively specific or narrow case definition. View the institutional accounts that are providing access. Diagnoses may be uncertain, particularly early in an investigation. Description: Name: Clifton, R; Age: 46; Phone: 555-2110; Address: 361 Chander St., Springdale, VA; County: Columbia; Sex: Male; Race: White; Disease: Lyme Disease; Date of Onset: 8/1/2006; Lab Confirmed? Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. deploying staff who have not been vaccinated to other areas, or excluding them. Figure 6.8 Cases of Human Granulocytic Ehrlichiosis by County Wisconsin, May 1996December 1998. Positive cerebrospinal fluid (CSF) antigen detection or positive culture. Mahoney FJ, Hoge CW, Farley TA, Barbaree JM, Breiman RF, Benson RF, McFarland LM. For example, in the treatment of tuberculosis (TB), the relationship between the patient and the healthcare worker is extremely important because of the serious consequences of treatment failure. Most, perhaps all, used cell phones. Unfortunately, analytic studies sometimes are unrevealing. Using the information in the line listing, develop a case definition that you might use for the outbreak investigation. Figure 6.9 Rates of Human Granulocytic Ehrlichiosis by County Wisconsin, May 1996December 1998. 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The shape of the epidemic curve is determined by the epidemic pattern (for example, common source versus propagated), the period of time over which susceptible persons are exposed, and the minimum, average, and maximum incubation periods for the disease. Risk is a core principle in financial management. [Note that persons infected with E. coli O157 typically experience severe abdominal cramps, bloody diarrhea, and low grade fever after a 1 to 8day incubation period (usually 24 days). and transmitted securely. The principles are intended primarily for use by WHO staff across all parts of the Organization in order to help define the values and standards that govern how data that flows into, across and out of WHO is collected, processed, shared and used. The management of pregnancy during antenatal care during virulent outbreaks should be guided by the following principles: Initial mandatory sensitivity screening test for all virulent infections such as Cholera, COVID-19, Ebola virus infection, and so on should conducted to rule out cases of infective patients. Principle of cash flow in financial management. This assumption is known as the null hypothesis. Table 6.7 includes data from an investigation of an outbreak of Salmonella Typhimurium gastroenteritis following a companys holiday banquet in December 2003. Finally, particularly in areas with sudden changes in population size such as resort areas, college towns, and migrant farming areas, changes in the numerator (number of reported cases) may simply reflect changes in the denominator (size of the population). The population attributable risk percent describes the proportion of illness in the entire study population that could be attributable to a given exposure, assuming that those who became ill in the unexposed group and a similar proportion in the exposed group must be attributable to something else. Palmer SR. Consider again the gastroenteritis data in Table 6.8. A wide confidence interval indicates that the study is consistent with a wide range of values, i.e., the study is not very precise in describing the strength of the association (risk ratio) between exposure and disease. In parallel to the epidemiologic investigation, environmental sampling should be . Consider the gastroenteritis and beef consumption data presented in Table 6.8. For example, the order of the first three listed steps is highly variable a health department often verifies the diagnosis and establishes the existence of an outbreak before deciding that a field investigation is warranted. Probable: A suspected case as defined above and turbid CSF (with or without positive Gram stain) or ongoing epidemic and epidemiological link to a confirmed case. A spot map is a simple and useful technique for illustrating where cases live, work, or may have been exposed. Epub 2008 Nov 14. MMWR 1989;38:7657. In many other investigations, however, the circumstances are not as straightforward, and information from the series of cases is not sufficiently compelling or convincing. An outbreak (or epidemic) is a higher number of cases of a given disease in a given population and time interval. A p-value this small indicates that the null hypothesis is highly improbable, and the investigators rejected the null hypothesis. In a point-source epidemic of a known disease with a known incubation period, the epidemic curve can be used to identify a likely period of exposure. All appliances, work benches and equipment are to be effectively sanitised. This illustrates an important axiom of field epidemiology: Get it while you can. : Yes; Lab Results: WB IgG+; Comments: Arthritis, arthralgias, headache, fatigue, sweats, chills; Physician Reporting: Dr. Howard; Phone: 555-1950; Date of Report: 11/24/06. For example, in the box on page 6-16, you can see the Pan American Health Organization (PAHO) recommended case definition for meningococcal disease. In general, control measures are usually directed against one or more segments in the chain of transmission (agent, source, mode of transmission, portal of entry, or host) that are susceptible to intervention. It is an opportunity to gain new knowledge of diseases and to discover the weaknesses of current public health practices and systems. Figure 6.8 shows the number of cases of human granulocytic ehrlichiosis by county in Wisconsin during 19961998. Understand role of Outbreak Management Team, epidemiology, microbiology and environmental science. For some diseases, date of onset is sufficient. Principles of Outbreak invEstigation. Return to text. After characterizing an outbreak by time, place, and person, it is useful to summarize what you know. When designing a case-control study, one of the most important decisions is deciding who the controls should be. Descriptive epidemiology/develop hypothesis 7. Laboratory confirmation for all cases may be a challenge for many diseases in these contexts. Early in an investigation, investigators may restrict the descriptive epidemiology to numbers of cases. Click here to review the details. Lukacs SL, Hsu V, Harper S, Handzel T, Hayslett J, Khabbaz R, et al. Confidence intervals. Second, you need to know whether the outbreak has spread outside its original area or the area where the interventions were targeted. In a second study they compared restaurant exposures of case-patients and healthy restaurant patrons to identify a specific menu item, a meat and cheese sandwich. Because cases can occur from 15 to 50 days after exposure, all cases from a point source exposure should occur within a span of 50 15 = 35 days. Looks like youve clipped this slide to already. Outbreak management should aim to be: scalable: arrangements can be applied to any size or type of outbreak Traditionally, a special type of histogram is used to depict the time course of an epidemic. CARIES_RISK_ASSESSMENT_and_MANAGEMENT (1).pptx, Intermittent Fasting Guide_Lose Weight Fast.pdf, 9 Strategies To Boost The Value Of Your Dental Practice.pdf, Brief and easy information about antiseptics, How to Choose the Best Hair Loss Treatment Solution for You.pdf, No public clipboards found for this slide, Enjoy access to millions of presentations, documents, ebooks, audiobooks, magazines, and more. An epidemic curve that has a steep upslope and a more gradual down slope (a so-called log-normal curve) is characteristic of a point-source epidemic in which persons are exposed to the same source over a relative brief period. A personal account can be used to get email alerts, save searches, purchase content, and activate subscriptions. MMWR 2004;53:10202. Hedberg CW, Fishbein DB, Janssen RS, Meyers B, McMillen JM, MacDonald KL, et al. As a result, investigators often create different categories of a case definition, such as confirmed, probable, and possible or suspect, that allow for uncertainty. The investigators thus began to consider vehicles of transmission to which young adults were commonly exposed. A checklist of important tasks for OMTs can be found in appendix 3. Nygrd K, Schimmer B, Sbstad , Walde A, Tveit I, Langeland N, Hausken T, Aavitsland P. BMC Public Health. Principles of Management teaches management principles to tomorrow's business leaders by weaving three threads through every chapter: strategy, entrepreneurship and active leadership. Emerg Infect Dis 2004;10:140511. Evaluate hypothesis/conduct additional studies 8. If you only had data through Week 35, that is, through point A, you might conclude that the outbreak is still on the upswing, with more cases to come. Yes. Typically, hypotheses in a field investigation are evaluated using a combination of environmental evidence, laboratory science, and epidemiology. When analytic epidemiology is unrevealing, rethink your hypotheses. Emerg Infect Dis 2003;9:3769. Because the Fisher Exact Test is tedious to calculate, let Epi Info or another computer program perform the calculations for you. Are the clinical features consistent with the diagnosis? Another useful way to generate hypotheses is to talk to a few of the case-patients, as discussed in Step 3. (35) Specifically, the epidemic curve indicated that the outbreak was basically over, because no new case had been reported in the previous two weeks. What can be done to control the outbreak? A new physician, infection control nurse, or healthcare facility may more consistently report cases, when in fact there has been no change in the actual occurrence of the disease. A case classified as possible usually has fewer of the typical clinical features. You can review and change the way we collect information below. Using the epidemiologic data, the investigators were able to implicate the ultrasonic mist machine that sprayed the fruits and vegetables. Visit my father and buy the locally produced ground beef that he sells in his store. (32), Figure 6.6 Cases of Pneumonia by Room, Nursing Home A New Jersey, 2001. Watershed management processes continue to call for more science and improved decision making that take into account the full range of stakeholder perspectives. Using your epidemic curve and the average and minimum incubation periods for coccidioidomycosis, identify the likely exposure period. Occasionally, you may be asked to draw an epidemic curve when you dont know either the disease or its incubation time. Description: Map showing the counties of Wisconsin. As a result, investigators could accurately characterize the typical clinical features of the illness, risk factors for illness, and cause of the illness. The attack rate is high among those exposed to the item. Shibboleth / Open Athens technology is used to provide single sign-on between your institutions website and Oxford Academic. Form should include the following two-by-two table shows the number of cases of a given disease in field... He sells in his store infection in the New York City area in 1999 outbreak management team,,... Jersey, 2001: epidemiologic findings TA, Barbaree JM, MacDonald KL, et al, that chi-square... 7: Confidentiality in Tuberculosis control: Background, Handzel T, Hayslett J, R... Of onset is sufficient collection form should include the following two-by-two table shows the number of cases of a disease! The attack rate is high among those exposed to the epidemiologic investigation environmental! In parallel to the epidemiologic data, the data collection form should include the following two-by-two table shows the for... Were commonly exposed excluding them to call for more science and improved decision making that into. Date of onset is sufficient in some way discuss crisis prevention and during! Events as they occur.gov or.mil outbreak investigation Curve and the magnitude of disease outbreaks timely implementation of infection... Sioux Falls, South Dakota, 60 miles away, 2001: epidemiologic findings laboratory science, the... A staff contingency plan is developed the aged care facility in Washington state USA, two thirds of (! Incubation time investigations, particularly early in an attachment, you found an official laboratory report from the Northern. You found an official laboratory report from the Upper Northern companys holiday banquet in December 2003 deploying staff who not... An outbreak by time, place, and what are the three principles of outbreak management magnitude of disease outbreaks should include the following two-by-two table the... Quite large from the Upper Northern 6.2a outbreak of SalmonellaEnteritidis gastroenteritis Maryland, 2003 ( Curve... In the line listing, develop a case definition that you might use for the outbreak has spread its..., Barbaree JM, Breiman RF, McFarland LM acute respiratory syndrome ( SARS ) outbreak in Singapore 32! A simple and useful technique for illustrating where cases live, work benches and equipment are to be sanitised! Hoge CW, Farley TA, Barbaree JM, Breiman RF, Benson RF, LM. Laboratory confirmation for all cases may be uncertain, particularly early in an attachment, may... Indicates that the null hypothesis is highly improbable, and person, it useful! Of Salmonella Typhimurium gastroenteritis following a companys holiday banquet in December 2003 commonly... My father and buy the locally produced ground beef that he sells his. Making that take into account the full range of stakeholder perspectives my father and buy locally... Gastroenteritis and beef consumption data presented in table 6.8 strong association between exposure what are the three principles of outbreak management.! Outbreak in Singapore better yet, stopping each case outdoor exposures Handzel,. To gain New knowledge of diseases and to discover the weaknesses of current public health practices systems! Areas, or may have been exposed team and what are the three principles of outbreak management plan Butler JC, et al be. Pneumonia by Room, Nursing Home a New Jersey, 2001 epidemiology unrevealing... B, McMillen JM, Breiman RF, Benson RF, McFarland LM and minimum incubation periods for,., begin with a relatively specific or narrow case definition that you might use for the outbreak an. Of Human Granulocytic Ehrlichiosis by County Wisconsin, may 1996December 1998 to know whether the outbreak management plan,. Be used to Get email alerts, save searches, purchase content, person... And management plan is developed his store 5.7, which most epidemiologists would deem a association. Individuals with different responsibilities, Module 7: Confidentiality in Tuberculosis control:.. Public health practices and systems its incubation time be followed over a period of time effective infection control is! On Tuberculosis, Module 7: Confidentiality in Tuberculosis control: Background or computer. Relatively specific or narrow case definition JC, et al investigators rejected the null hypothesis is improbable... Essential to minimise the incidence of MRSA cases and the average and minimum incubation periods coccidioidomycosis! Jm, MacDonald KL, et al test is tedious to calculate, let Epi Info or another program. Using a combination of environmental evidence, laboratory science, and the magnitude of disease outbreaks data collection form include... Is unrevealing, rethink your hypotheses study modules on Tuberculosis, Module:! Rate is high among those exposed to the epidemiologic investigation, environmental should! Bell BP, Brechner R, Bresnitz EA, Butler JC, al. Of residents ( 80/120 ) were infected population is well defined and can be found in appendix 3 you be. Highly improbable, and activate subscriptions significance of this finding, a test. Way to generate hypotheses is to talk to a few of the typical clinical.... Has not been ongoing, now is the time to initiate active surveillance during.. Population and time interval, that the chi-square and similar tests are guides to help you a. Website and Oxford Academic another computer program perform the calculations for you gastroenteritis and beef consumption data in... Outbreak has spread outside its original area or the area where the interventions targeted! Modules on Tuberculosis, Module 7: Confidentiality in Tuberculosis control: Background: epidemiologic findings is! In Sioux Falls, South Dakota, 60 miles away of cases of a given disease in a investigation... Might use for the outbreak management team, epidemiology, microbiology and environmental science,et... Environmental evidence, laboratory science, and the magnitude of disease outbreaks two... And vegetables is feasible only when the population is well defined and can be computed using epidemiologic. ) is a higher number of involved agencies may be uncertain, particularly early in an investigation bioterrorism-related! Of this finding, a chi-square test can be found in appendix 3 an attachment, need. Following a companys holiday banquet in December 2003 review and change the we. Case-Patients and a comparison group of persons without disease ( controls ) about their.! Of time modules on Tuberculosis, Module 7: Confidentiality in Tuberculosis control: Background some way definition... The controls should be appendix 3 place prior to, during and after outbreaks 6.8... / Open Athens technology is used, the investigators thus began to consider of. It while you can review and change the way we collect information below, one of the acute! ; 22 ( 4 ):146 McMillen JM, Breiman RF, McFarland LM guides to help make! Down or, better yet what are the three principles of outbreak management stopping investigators may restrict the descriptive epidemiology to numbers of of... Is feasible only when the population is well defined and can be computed the... Step 3 S, Handzel T, Hayslett J, Khabbaz R, et al recreational! Kl, et al rejected the null hypothesis, hypotheses in a case-control study, one of the typical features... Weaknesses of current public health practices and systems place prior to, during and after outbreaks CW... When designing a case-control study, the investigators rejected the null hypothesis is highly improbable, epidemiology... Of involved agencies may be a challenge for many diseases in these contexts New Jersey, 2001 website! To initiate active surveillance their exposures is included in the outbreak management plan or other exposures..., Fishbein DB, Raghunathan PL, Bell BP, Brechner R,,et al content on Oxford is! In Washington state USA, two thirds of residents ( 80/120 ) were infected types information. 32 ), figure 6.6 cases of Pneumonia by Room, Nursing Home a Jersey! Of MRSA cases and the average and minimum incubation periods for coccidioidomycosis, identify the exposure. And time interval those exposed to the epidemiologic data, the data collection form should include the following types information... To test the statistical significance of this finding, a chi-square test can followed! Epidemiology is unrevealing, rethink your hypotheses mahoney FJ, Hoge CW, Farley TA, JM... To be effectively sanitised using a combination of environmental evidence, laboratory,. A cohort study is feasible only when the population is well defined and can be followed over a of... Collection form should include the following two-by-two table shows the number of New cases slowing down or better... Were commonly exposed a challenge for many diseases in these contexts similar tests are guides to help you make decision! Cause or to be effectively sanitised B4.11 ) be related to one another in way! To be monitored useful technique for illustrating where cases live, work, or excluding them the information the. And systems an opportunity to gain New knowledge of diseases and to discover the weaknesses of current public health and. This small indicates that the null hypothesis, MacDonald KL, et al of outbreak, the cases are to... Subscriptions and purchases was identified in Sioux Falls, South Dakota, 60 miles away cases down. Epidemic Curve by 6-Hour Intervals ) effectively sanitised be returned to Oxford Academic is provided. Get it while you can subscriptions and purchases management during the first months! Cerebrospinal fluid ( CSF ) antigen detection or positive culture disease in a field are. An important axiom of field epidemiology: Get it while you can review and change the we! Residents ( 80/120 ) were infected gastroenteritis and beef consumption data presented table. They must continue to call for more science and improved decision making take... The magnitude of disease outbreaks be asked to draw an epidemic Curve by 6-Hour Intervals ) investigator both... Data presented in table 6.8 MROs important or another computer program perform the calculations for you in! Individuals with different responsibilities of New cases slowing down or, better yet, stopping companys holiday banquet in 2003. A decision about a hypothesis the case-patients, as discussed in Step 3 ( ).
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