OUTBREAK!

1. OUTBREAK! Portrait of an Epidemic http://phil.cdc.gov/Phil/details.asp

2. THE BLACK DEATH • 25 million dead over 5 years • One-third of Europe’s population • “Victims often had lunch with their friends and dinner with their departed ancestors”

3. WHAT CAUSES DISEASE • Basically, 4 causes: • Bacteria • Viruses • Parasites • Prions http://phil.cdc.gov/Phil/details.asp

4. BACTERIA http://phil.cdc.gov/Phil/details.asp • Not all cause disease • Koch’s Postulates • Show the bacterium is present in every case of the disease • Isolate the bacterium from the infected individual and grow it outside the individual • Infect a healthy individual with the bacterium and have it produce the same symptoms • Recover the bacterium from the newly sick individual

5. E. coli commtechlab.msu.edu http://www.lbl.gov/ www.nasa.gov www.geocities.com/avinash_abhyankar/ Salmonella

6. www.life.umd.edu/classroom/bsci424 Streptococcus Causes strep throat Round phil.cdc.gov/Phil/ www.uiowa.edu/~cemrf/ Borrelia Causes Lyme disease Spiral-shaped phil.cdc.gov/Phil/

7. phil.cdc.gov/Phil/details.asp Bacillus anthracis

8. Viruses • Not really alive? • Require host to reproduce www.nsf.gov/od/lpa/

9. Influenza Virus Avian Influenza phil.cdc.gov/Phil/

10. www.cdc.gov/ncidod www.aids-info.ch/bilder/schule_aids

11. phil.cdc.gov/Phil/details.asp

12. PARASITES • Protists • Malaria • African sleeping sickness • Other parasites • Hookworms • Wuchereria bancroftii phil.cdc.gov/Phil/

13. PRIONS • Bits of self-replicating protein • Mad cow disease • Creutzfeldt-Jakob • Spongiform encephalitis picasso.ucsf.edu/~ulyanov/Structures/prion.html phil.cdc.gov/Phil

14. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypotheses • Evaluate hypotheses • Refine hypotheses and carry out additional studies • Implement control and prevention measures • Communicate findings

15. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypotheses • Evaluate hypotheses • Refine hypotheses and carry out additional studies • Implement control and prevention measures • Communicate findings

16. Is the incidence of the disease greater than what is normal for the area and time?

17. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypotheses • Evaluate hypotheses • Refine hypotheses and carry out additional studies • Implement control and prevention measures • Communicate findings

18. INITIALS: CASE #:_______ SEX: ILL? (YES/NO)

19. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypotheses • Evaluate hypotheses • Refine hypotheses and carry out additional studies • Implement control and prevention measures • Communicate findings

20. SGOT  Alt SGOT S*=Sclera;, N=Nausea; V=Vomiting; A=Anorexia; F=Fever; DU=Dark urine; J=Jaundice; HAIgm=Hepatitis AIgM antibody test

21. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypotheses • Evaluate hypotheses • Refine hypotheses and carry out additional studies • Implement control and prevention measures • Communicate findings

23. LEGIONELLOSIS • What Is It? A type of pneumonia caused by the bacterium Legionella pneumophila. • Source: Contaminated water sources, such as showers, fountains, cooling systems, humidifiers, hot tubs and spas • Cause of Spread: Spray from contaminated sources • Normal Incidence: For Virginia, a 5-year average of 20 cases per year (about 2/month). • Historical Relevance: 1996 outbreak in the Lynchburg, VA, region. 23 confirmed cases with 2 deaths. phil.cdc.gov/Phil

24. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypothesis • Evaluate hypothesis • Refine hypothesis and carry out additional studies • Implement control and prevention measures • Communicate findings

25. CALCULATE AN ODDS RATIO (a)(d)/(b)(c) = 5.8

27. Attack Rates by Items Served at a Church Supper,Oswego, New York, April 1940

28. INVESTIGATING AN OUTBREAKCenter for Disease Control (CDC) • Prepare for field work • Establish the existence of an outbreak • Verify the diagnosis • Define and identify the cases • Describe and orient the data in terms of time, place, and person • Develop hypothesis • Evaluate hypothesis • Refine hypothesis • Implement control measures • Communicate findings

29. OUTBREAK AT MIDDLIN HIGH • Students are getting sick …. Why? • 15 sick, so far • Began getting sick Sunday. • It’s now Wednesday… is the epidemic over?

30. Activity Summary Data Table

32. YOU ARE A CDC INVESTIGATOR • Your group is a CDC team • Your assignment is to investigate the illness, determine its source, and recommend action • You must follow the proper CDC steps as previously discussed

33. TREATMENTS • Antibiotics • Only for bacteria • Resistance becoming a problem • Innoculations