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Outbreak investigation report

Outbreak investigation report. Agnes Hajdu EpiTrain III, 25.08.2006 Jurmala, Latvia. Based on EPIET material. Steps of an outbreak investigation. Confirm outbreak diagnosis Define a case Identify cases and obtain information Descriptive data collection and analysis Develop hypothesis

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Outbreak investigation report

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  1. Outbreak investigation report Agnes Hajdu EpiTrain III, 25.08.2006 Jurmala, Latvia Based on EPIET material

  2. Steps of an outbreak investigation • Confirm outbreak diagnosis • Define a case • Identify cases and obtain information • Descriptive data collection and analysis • Develop hypothesis • Analytical studies to test hypothesis • Communication – Outbreak report Control measures

  3. First: What are they? Why write them? Who writes them? Who reads them? Then: Structure Frequent problems Confidentiality Legal issues Outbreak reports

  4. What are outbreak reports? • Formal outbreak reports • Preliminary, interim, final report • Reports to colleagues • national bulletin, Eurosurveillance, conference/ seminars • (Inter)national outbreak reporting systems • Journal publications

  5. Why write them? • To document the outbreak • Present investigation methods, control measures • Potential legal issue • To verify recommendations • To enhance quality of investigations In order to prevent future outbreaks and assist in investigation&control of similar incidents

  6. Who writes them? • ”The outbreak control team” (OCT) • Named authors • Each participating agency must agree with what is said • Who ”owns” the report?

  7. Who reads them? • All agencies represented on the OCT • Policy making bodies • Professional colleagues • The public • The lawyers

  8. Structure of the report • Summary • Introduction and Background • Outbreak description • Methods • Results • Discussion • Lessons learned • Recommendations • References • Appendices

  9. 1. Summary • Key • Features, setting of the outbreak: Who – What – Where – When? • Lessons learned • Recommendations • Ongoing action • Further action required

  10. 2. Introduction and Background • Population demographics • Surveillance data • Previous similar outbreaks • Description of the are/site/facility • e.g. Healthcare system • e.g. Industries involved • Any unusal point

  11. 3. Outbreak description • ”The initial story” • How was the outbreak reported? • Steps taken to confirm it? • What was known to date? • Why was an investigation undertaken? • Management of the outbreak • OCT members, objectives, assistance, control measures • Media relations

  12. 4. Methods • Epidemiological • Case definition, case finding, study design (descriptive-analytical) • Laboratory • Clinical and environmental specimens (types, how they were collected) • Environmental studies • Site visit and risk assessment, traceback • Other studies

  13. 5. Results • Epidemiological • Number of responses and participation rate • Number of cases • Overall attack rates and by age, sex, exposure • Symptoms, duration and outcomes of illness • Description (time, place, person) • Epidemic curve (incubation period) • Laboratory findings • Environmental study findings • Inspection report • Other studies

  14. 6. Discussion • Main hypotheses (likely causative agent and mode of transmission) • Justify conclusions and actions • Clear interpretation of results • Explain how results confirmed/disproved hypothesis • Limitations, possible biases • Explain action to protect public health • Highlight any problems

  15. 7. Lessons learned • Lessons for participating agencies • Problems encountered • Mistakes made • Suggestions for improvement • Lessons that may be useful for others • Key points from internal/external audit

  16. 8. Recommendations • What should be done • To control this outbreak • To prevent future outbreaks • To improve management of future outbreaks Be specific: to whom? Be realistic: feasible actions

  17. 9. References Vancouver referencing system http://www.soton.ac.uk/library/subjects/references/vancouver.html

  18. Chronology of events General background OCT (members, terms of reference) Detailed results Maps Epidemiological questionnaire Letters to patients/physicians Press releases Costs of the outbreak Acknowledgements 10. Appendices

  19. Problems • Confidentiality • What should not be included? • Legal issues • Delay in writing the report • Not writing the report at all..

  20. Confidentiality • To individual patients • To commercial businesses • Details may remain in meeting minutes • Media disclosure • Legal disclosure

  21. Legal issues • Who ”owns” the report / the data? • Prosecuting agencies may deem the information to be confidential but… … health authorities have a duty to provide the public with information

  22. Report published • Jan. 1997: outbreak report on MMWR: • Legionaire’s disease (LD) associated with whirlpool spa on display, USA • Febr. 1999: major outbreak LD, Holland • Source: whirlpool spa on display • Lawsuit against government: failure to act on available knowledge (MMWR)

  23. Conclusion • Duty to • document the outbreak • inform the colleagues • prevent and control future outbreaks • Good report = half publication • Write article, case study

  24. Some reports stay alive John Snow, 1843, Broad Street Pump Outbreak - Cholera

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