Epidemiology

1. Fall, 2010 Community Health Lillian Wald 1912 Epidemiology The Broad Street Pump J. Carley MSN, MA, CNE Fall, 2010 Reference: Nies, M. & McEwen, M. (2007). Community / public health nursing: Promoting the health of populations, 4th Ed. Saunders-Elsevier: St. Louis, MO

2. Communicable Disease

3. John Snow PubBroad Street, London

4. Introduction to Epidemiology Historical Perspective of Nursing Epidemiology Worldwide Implications Local Implications Group 2-hour Mini-Project: Each group research & prepare 10-15 minute presentation related to epidemiology (broad subject!) See Next Slide Each group prepare two test (assessment questions related to epidemiology) Evaluations required An Outline of Sorts…….

5. About “Statistics….”& Health, Politics • “Demagogue” / “Demagoguery” • a leader who makes use of popular prejudices and false claims and promises in order to gain power • Keep in mind when this is being done, and how so… • Tendency to accept or reject ….depending upon your political point of view…Used to sway the “undecided.” • “Infant Mortality Rate” • “Women are under represented in medical studies” Satel, Sally (2000) Politically correct, M.D. : How political correctness is corrupting medicine. Basic Books: New York

6. From wiki—ways to demigog…

8. Epidemiology Levels of Prevention Primary Prevention Secondary Prevention Tertiary Prevention Epidemic Endemic Pandemic Distribution Determinants Incidence rate Risk Prevalence Prevalence proportion Attack rate Case Fatality Rate Mortality rate Morbidity Attributable Risk Proportionate Mortality Rate Adjusted mortality & morbidity rates Yield Attack Rate Case-Specific Mortality Rate Terminology:

9. 1918 1918 World War I is rapidly drawing to its bloody conclusion. Millions have died in the carnage, including an entire generation of French, English, and Germans. Peace is at hand, the guns have been silenced, yet many more will die. Many more will die.

10. Song sung by children in U.S., 1918 I had a little bird, Its name was Enza. I opened the window, And in-flu-enza.

11. ENDEMIC…………………………………………….…….EPIDEMICENDEMIC…………………………………………….…….EPIDEMIC PANDEMIC WWI Combat Deaths Russell, Kansas Fall, 1917 Asia Summer 1918 Trenton, N.J. Fall, 1917 June, 1917 Trenton, N.J. France Fall, 1917 Nationwide, Spring 1918 Europe, 1918 ***Number of Mortalities to date attributed to Influenza Outbreak: (Each Figure equals one million deaths) Africa, 1918

12. “Phase Shift” ? WHO DIES FROM INFLUENZA ? “Spanish Flu” Deaths World Wide = 20, 000, 000 – 40, 000, 000 Mortalities Typically, The very young and the very old. Spanish flu mortalities selected out the healthiest portion of the population, Those between 20 & 40 years old. 20 18 16 14 12 10 8 6 4 2 Additionally, as with most infectious Disease Outbreaks: HEALTH CARE WORKERS, i.e., NURSES, DIED @ DISPROPORTIONATE RATES. CONTEXT:AIDS Deaths World Wide = ~19, 000, 000 Millions Year 1 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 19 20

13. http://www.pandemicflu.gov/storybook/

14. Pandemic Influenza: The Phie Family All eight family members were admitted to the emergency hospital in Loveland Colorado, and between October 30 and November 9, 1918: Jessie, age 40 (died Oct. 30); Florence, age 19 (died Nov. 1); Charlie, age 45 (died Nov. 2); Bobbie, age 8 (died Nov. 4); Harry, age 10 (died Nov. 5); Willie, age 4 (died Nov. 5). Tommy, age 16 (died Nov. 7); Davie, age 6 (died Nov. 9). All eight died from the flu. They were all buried in Eaton, Colorado where they had lived previously. The Phie Family

15. http://www.fluwikie.com/index.php?n=Main.Multimedia

16. http://www.cdc.gov/nchs/fastats/lcod.htm

17. 10 Leading Causes of Death, U.S. (2004)* • Heart disease (654,092) • Cancer (550,270) • Stroke (150,147) • Chronic lower respiratory diseases (123,884) • Accidents (108,694) • Diabetes (72,815) • Alzheimer's disease ( 65,829) • Influenza/Pneumonia (61,472) • Nephritis, nephrotic syndrome, and nephrosis (42,762) • Septicemia (33,464) *Retrieved from: Center for Disease Control & Prevention’s National Center for Health Statistics FastStats at: http://www.cdc.gov/nchs/fastats/lcod.htm

18. http://www.cdc.gov/mmwr/PDF/wk/mm5553.pdf

19. Collaborative Learning / Research in Epidemiology & Communicable Disease • For the assigned ‘reportable’ communicable disease describe the disease, e.g., pathophysiology. Describe and ‘plug-in’ the components of the disease as related to the epidemiological triangle (agent, host, environment, vector). • Is the disease vaccine preventable? • Using MMWR provided, discuss the total monthly and yearly total reported cases for 2006. • Discuss how the disease is diagnosed. • Discuss treatment for the disease. • Discuss morbidity & mortality for disease for year 2006. • Discuss incidence of the disease by: • Geographical region • Age group • Sex / gender • Race • Discuss reported cases of the assigned disease process for Clark County, NV this year (to date). • Discuss primary, secondary, and tertiary prevention as it relates to assigned disease process. • 5 Minute report by each group starting with group 11—10—9—8—7—6—5—4—3—2--1

20. Epidemiology • Introduction • Definitions • Epidemiology– “The study of the distribution and determinants of health-related states or events in specific populations, and the application of this study to control of health problems”. (Last, 2001, pp. 62) http://www.waldenu.edu/c/Schools/Schools_6955.htm

21. Epidemiology • Introduction • Definitions • Distributions – the patterns of health events in specific populations http://www.cdc.gov/mmwr/ • Determinants – factors or variables that affect patterns and health events Example: analysis of how and why a population has different health trends, financial factors, diet, sanitation, recent catastrophes, etc….

22. Epidemiology • Introduction • Definitions • Incidence rate – the rate of health problems that are developing in new cases • Risk – the probability that the health event will occur within a specific time, i.e. the risk of breast cancer over a lifetime in the United States

23. Epidemiology • Introduction • Definitions • Prevalence – the actual measurement of existing disease at a particular time in a specific group • Prevalence Proportion – the proportion of the group which has the existing disease at a particular time

24. Epidemiology • Introduction • Definitions • Attack rate– The proportion of people who are exposed to the disease and get the illness. • Mortality Rate – a rate that indicates the proportion of a population who has died from any cause in a certain period of time, i.e. one year.

25. Epidemiology • Introduction • Definitions • Morbidity = RATE of which an illness or health event occurs in a specific population, usually expressed as a proportion; determined by dividing the affected population by the total number of population in that group.

26. Epidemiology • Introduction • Definitions • Epidemic – an incidence of disease that is more than usual in a specific population – see example of West Nile Virus on CDC site

27. Epidemiology • Introduction • Definitions Pandemic – a worldwide incidence of disease that is more than usual in world populations

28. Epidemiology • Introduction • Definitions • Pandemic – WHO Organization has six stages of alert for pandemics and a global preparedness plan. • The stages range from Level I, which is the lowest risk of human cases to - • Level VI – Efficient and sustained “human – to – human transmission.

29. Epidemiology • History of Epidemiology • Moses – wrotethe laws for Exodus • 4th Century B.C.E. = Hippocrates, defined symptoms of disease, prevalence, and cure rates ( descriptive epidemiology – the who, where, and when) • 1400’s – Turkish women inoculated children with a needle and pieces of dried smallpox scabs to vaccinate them against future plagues.

30. Epidemiology • History of Epidemiology • 1853 -William Snow – the father of Epidemiology, mapped the incidence and locality of cholera in relationship to the location of the water source, first use of a comparison group, above the city, or downstream from the city. • 1870’s – Robert Koch – discovered the causative bacteria anthrax, T.B., and cholera • 1952s -– Dr. Jonas Salk’s Production of Polio Vaccine Salk Snow Pasteur Koch

31. The Broad Street Pump

32. Miasma Theory

34. Intervention Which Stopped the Cholera Outbreak:

36. Epidemiology • History of Epidemiology • World War I – the Public Health Nurse Corp was formed by the Red Cross in answer to the 1919 worldwide influenza pandemic. • World War II – as nurses were called overseas in the Navy and Army Nurse Corps, Public Health nursing became the back up for the rural Americans with a local public health department for any population >50,000.

37. Epidemiology • History of Epidemiology • 1960’ CDC was formed as a government institution separately from the military biological warfare labs. • 1983 – cause of AID’s was discovered

38. Epidemiology • Epidemiological Concepts in Nursing • Epidemiologic Triangle Changes in any one triangle component will either increase or decrease your risk of disease

39. Epidemiology • Epidemiological Concepts in Nursing • Agents – infectious diseases; bacterium, fungi, viruses or parasites. May also be toxic chemicals or physical agents which create illness or injury. • Host –a host is the person or subject that is susceptible to an agent • Vector – a carrier or source that transmits the agent to or from the host. Example: the vector for the West Nile virus is the mosquito, the agent is the virus, and the host can be human, horse, or bird. The environment requires standing water

40. Epidemiology The New Mothers Project • Epidemiology Levels of Prevention • Think outside of the Box – International! • Example: AID’s in Africa: • Primary Prevention: counseling young females and school children on STD prevention and use of condoms. • Secondary Prevention: Screening pregnant females for HIV. • Tertiary Prevention – Providing AZT and instructions to pregnant mothers with HIV so that they do not transmit the disease

41. Levels of Prevention • Prevalence: • the actual measurement of existing disease at a • particular time in a specific group Incidence: the rate of health problems that are developing in new cases • Primary Prevention • We use primary prevention methods before the person gets the disease. • Primary prevention aims to prevent the disease from occurring. • So primary prevention reduces both the incidence and prevalence of a disease. • Encouraging people to protect themselves from the sun's ultraviolet rays is an example of primaryprevention of skin cancer.

42. Epidemiology Primary, Secondary, Tertiary • Epidemiology Levels of Prevention • Give an example of Primary Prevention for this Influenza? • Give an example of Secondary Prevention for this Influenza? • What are some of the Tertiary Prevention interventions that could be used to prevent influenza?

43. PEWSS (Pediatric Early Warning Sentinel Surveillance )Southern Nevada Health District (2009). Statistics, surveillance, and reports: PEWSS Reports. Retrieved from http://www.southernnevadahealthdistrict.org/stats-reports/influenza.php • The Pediatric Early Warning Sentinel Surveillance (PEWSS) program was initiated in June 2010. This innovative respiratory surveillance program monitors the level of respiratory virus activity within the community year round. • The PEWSS program provides laboratory surveillance data of four influenza viruses (Influenza AH1, Influenza 2009 A (H1N1), Influenza AH3, and Influenza B), and six non-influenza viruses (Adenovirus, Human metapneumovirus, Human parainfluenza virus 1, Human parainfluenza 2, Human parainfluenza virus 3, and Respiratory Syncytial Virus).

44. Epidemiology Current Epidemics in the United States • HIV • STD’s / STI’s • Smoking • Heart Disease • Hepatitis B & C • Lyme’s Disease • West Nile Virus • Obesity

45. Epidemiology Current Epidemics of the World: • AIDS – number one – 38,000,000 people were infected as of 2005 • Avian Flu • West Nile virus • Tobacco use • SARS • Starvation • TB

46. Epidemiology • Current Epidemics in Clark County – from the CCHD • http://www.southernnevadahealthdistrict.org/epidemiology/disease_statistics.htm • Chlamydia/Gonorrhea • HIV/AID’s • Syphilis • Smoking & Lung Disease • West Nile Encephalitis • Rotavirus

47. Epidemiology Environmental Health from Healthy People 2010 Clark County Priorities • Cultural programs • Access to health care • Bioterrorism response improvement • Reduce second hand smoke exposure • Increase food safety education • Drowning in toddlers • Reduce Suicide rate • Decrease in low birth weight rate • Use of seatbelts and child car restraints

48. Challenges for Public Health Nursing: • Promote the health of communities • Need for a bimodal focus on prevention, health promotion, and home care • Education to meet the needs of the aggregate • Concern for cost-benefit ratios • Population approach for nursing care

49. Disease Detective http://library.thinkquest.org/06aug/01865/index.html

50. Outbreak at Water’s Edge • http://www.mclph.umn.edu/watersedge/play.html