This document provides an overview of epidemic investigation. It begins with definitions of key terms like epidemic, outbreak, endemic, and pandemic. It describes the objectives of epidemic investigation as defining the scope and identifying the causative agent. The steps in an investigation are outlined as verifying diagnoses, defining the population at risk, analyzing data, formulating hypotheses, and writing a report. Recent outbreaks around the world are briefly discussed.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
This document discusses hospital outbreak investigations. It defines endemic and epidemic infections in hospitals. Common source and propagated epidemics are described. Steps in investigating outbreaks in hospitals and communities are provided, including forming an investigation team, developing a case definition, conducting epidemiological and laboratory analyses. The goals of outbreak investigations are outlined. Methods for confirming and controlling outbreaks are discussed.
The document describes the steps taken to investigate an outbreak of jaundice in Rohtak, India. People first noticed an unusual occurrence of jaundice cases that had not been seen in over 10 years. A house-to-house survey confirmed it was an outbreak. Laboratory tests of water samples found one-third failed orthotolidine tests and 3 of 5 samples had unsafe coliform counts. Additional observations revealed poor sanitation practices in the community that could have contributed to the spread of the disease.
This document discusses healthcare-associated infections (HAIs) and outbreak investigations. It defines key terms like clusters, outbreaks, and epidemics. It also outlines the reasons to investigate outbreaks, how to recognize them, and the goals and steps of investigations. The steps include defining cases, identifying cases, analyzing person, place and time factors, developing and evaluating hypotheses, implementing controls, and communicating findings. The overall purpose is to identify the cause of the outbreak and implement measures to control it.
This document discusses various measures used to quantify mortality and morbidity. It defines key terms like rates, ratios, proportions and describes different types of mortality and morbidity measures including crude death rates, cause-specific mortality rates, life expectancy, years of life lost, and others. It also discusses methods to adjust rates to account for factors like age and sex, and aggregate measures that combine mortality and morbidity data.
1) The document discusses surveillance in public health and describes its key components and purposes. Surveillance involves the systematic collection, analysis, and interpretation of health data to provide information for action.
2) An effective surveillance system is simple, flexible, timely, and produces high-quality data. It addresses an important public health problem and accomplishes its objectives of understanding disease trends, detecting outbreaks, and evaluating control measures.
3) The document outlines how to establish a surveillance system, including selecting priority diseases, defining standard case definitions, and developing regular reporting and data dissemination processes. Both passive and active surveillance methods are described.
outbreak investigation - types of epidemics and investigating themTimiresh Das
This document discusses an upcoming presentation on outbreak investigation. It begins with definitions of key terms like epidemic, outbreak, endemic, and pandemic. It then discusses determinants of disease outbreaks and types of epidemics. The objectives, steps, and examples of outbreak investigation are provided. Various factors related to outbreaks like incubation period, quarantine, herd immunity, and triggers for surveillance are defined.
The unusual occurrence in a community or region of disease, specific health related behaviour (eg. Smoking) or other health related events (eg. Traffic accidents) clearly in excess of “expected occurrence.
This document discusses hospital outbreak investigations. It defines endemic and epidemic infections in hospitals. Common source and propagated epidemics are described. Steps in investigating outbreaks in hospitals and communities are provided, including forming an investigation team, developing a case definition, conducting epidemiological and laboratory analyses. The goals of outbreak investigations are outlined. Methods for confirming and controlling outbreaks are discussed.
The document describes the steps taken to investigate an outbreak of jaundice in Rohtak, India. People first noticed an unusual occurrence of jaundice cases that had not been seen in over 10 years. A house-to-house survey confirmed it was an outbreak. Laboratory tests of water samples found one-third failed orthotolidine tests and 3 of 5 samples had unsafe coliform counts. Additional observations revealed poor sanitation practices in the community that could have contributed to the spread of the disease.
This document discusses healthcare-associated infections (HAIs) and outbreak investigations. It defines key terms like clusters, outbreaks, and epidemics. It also outlines the reasons to investigate outbreaks, how to recognize them, and the goals and steps of investigations. The steps include defining cases, identifying cases, analyzing person, place and time factors, developing and evaluating hypotheses, implementing controls, and communicating findings. The overall purpose is to identify the cause of the outbreak and implement measures to control it.
This document discusses various measures used to quantify mortality and morbidity. It defines key terms like rates, ratios, proportions and describes different types of mortality and morbidity measures including crude death rates, cause-specific mortality rates, life expectancy, years of life lost, and others. It also discusses methods to adjust rates to account for factors like age and sex, and aggregate measures that combine mortality and morbidity data.
1) The document discusses surveillance in public health and describes its key components and purposes. Surveillance involves the systematic collection, analysis, and interpretation of health data to provide information for action.
2) An effective surveillance system is simple, flexible, timely, and produces high-quality data. It addresses an important public health problem and accomplishes its objectives of understanding disease trends, detecting outbreaks, and evaluating control measures.
3) The document outlines how to establish a surveillance system, including selecting priority diseases, defining standard case definitions, and developing regular reporting and data dissemination processes. Both passive and active surveillance methods are described.
outbreak investigation - types of epidemics and investigating themTimiresh Das
This document discusses an upcoming presentation on outbreak investigation. It begins with definitions of key terms like epidemic, outbreak, endemic, and pandemic. It then discusses determinants of disease outbreaks and types of epidemics. The objectives, steps, and examples of outbreak investigation are provided. Various factors related to outbreaks like incubation period, quarantine, herd immunity, and triggers for surveillance are defined.
This document provides an overview of public health surveillance. It defines surveillance as the ongoing collection, analysis, and interpretation of health data to inform public health programs and actions. The document outlines the historical origins of surveillance dating back to ancient Greece. It describes various types of surveillance including community-level surveillance, routine reporting systems, active and passive surveillance, sentinel surveillance, and surveys. It also discusses the integrated disease surveillance program in India and how it aims to strengthen surveillance systems at the state and district levels.
This document provides an overview of basic measurements used in epidemiology. It discusses tools like proportion, rate, and ratio. It also covers various measures of mortality like crude death rate, specific death rate, and proportional mortality rate. Measures of morbidity like incidence and prevalence are explained. The relationship between incidence and prevalence is described. Standardization techniques are introduced to make rates comparable between populations.
The document discusses key concepts related to screening in preventive medicine. It defines screening as tests or examinations applied to apparently healthy individuals to detect disease in early stages. The biggest challenges are distinguishing individuals with and without disease given many diseases exist on a spectrum. An ideal screening test is inexpensive, easy to use, acceptable, valid, reliable and has high yield. The criteria for screening include the disease being an important health problem with a long preclinical stage and treatability. Screening programs must be continually evaluated to ensure benefits outweigh costs.
Life is full of curves and thus the epidemiology. However, some curves are important as Epidemic Curves and Survival Curves. This presentation is an attempt to know about epidemic curves.
This document discusses epidemiological methods for studying the distribution and determinants of health events and applying that knowledge to disease control. It defines descriptive epidemiology as the study of disease occurrence, distribution, and patterns in populations. Descriptive methods are observational and can be cross-sectional or longitudinal. Descriptive epidemiology provides insights into disease frequency, trends, and risk factors to inform public health planning and resource allocation.
The 10-step approach to outbreak investigations involves:
1) Identifying an investigation team and resources.
2) Establishing the existence of an outbreak.
3) Verifying the diagnosis, constructing a case definition, and finding cases systematically.
Descriptive epidemiology is then used to develop hypotheses, which are evaluated through additional studies if needed, before implementing control measures, communicating findings, and maintaining surveillance to confirm the outbreak has ended. Being systematic and following these steps is key to determining the source and controlling outbreaks.
This document discusses disease screening and provides information on various aspects of screening programs and tests. It defines screening as actively searching for unrecognized disease in apparently healthy individuals using simple tests. The key points are:
- Screening is part of secondary prevention and aims to detect diseases early when they may be still curable. It involves testing populations, not individuals with symptoms.
- An ideal screening test is both highly sensitive and specific, but in practice these factors typically have an inverse relationship. Sensitivity and specificity can be adjusted by changing the test cutoff criteria.
- For a screening program to be effective, the disease must be an important health problem that can be detected early and treated effectively to improve outcomes. The screening test
Epidemiology is the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. The basic measurements used in epidemiology include rates, ratios, and proportions to describe the occurrence of mortality, morbidity, disability, and other disease attributes in populations. Rates express the frequency of events over time, proportions express the relationship between parts and the whole, and ratios compare two rates or quantities. These measurements are essential tools for epidemiologists to investigate disease causation, describe population health status, and evaluate interventions.
An epidemic occurs when there is an unusual increase in the occurrence of a disease within a community or region beyond what is normally expected. To determine if an epidemic has occurred, one must consider the magnitude of cases, factors responsible, and cause/mode of transmission. Investigating an epidemic involves 10 steps: 1) verifying diagnoses, 2) confirming the epidemic's existence, 3) defining the at-risk population, 4) rapidly searching for all case characteristics, 5) analyzing data, 6) formulating hypotheses, 7) testing hypotheses, 8) evaluating ecological factors, 9) further investigating the at-risk population, and 10) writing a report of the background, methodology, data analysis, and control recommendations.
Measurements of morbidity and mortality
At the end of the session, the students shall be able to
List the basic measurements in epidemiology
Select an appropriate tools of measurement
Measure morbidity & mortality
Perform standardization of rates
This document provides an introduction to the basic concepts of epidemiology. It defines epidemiology as the study of patterns, causes, and effects of health and disease conditions in populations. The aims of epidemiology are to describe disease distribution and frequency, identify risk factors, and provide data to prevent and control diseases. Epidemiologists make comparisons between groups with and without disease exposure to identify determinants and test hypotheses. Basic measurements in epidemiology include mortality, morbidity, disability, and the distribution of disease and risk factors. Rates, ratios, and proportions are key tools used to measure and express disease frequency in populations.
Vector-borne diseases such as malaria, dengue, and Japanese encephalitis pose major health burdens globally and in India. In India, the National Vector Borne Disease Control Programme (NVBDCP) was launched in 2003 to control six key vector-borne diseases through integrated vector management and other strategies. The NVBDCP aims to reduce mortality from malaria, dengue, and Japanese encephalitis by half and eliminate kala-azar and lymphatic filariasis by targeted years. Japanese encephalitis, transmitted by Culex mosquitoes, poses high risks for children and is a growing problem in India. Chikungunya, transmitted by Aedes mosquitoes, caused over a million cases during an
Screening tests aim to identify unrecognized disease in apparently healthy individuals. They differ from diagnostic tests in that they are applied to groups rather than individuals, use a single criterion, and are less accurate. Validity refers to a test's accuracy while reliability is its precision on repeat tests. Sensitivity measures a test's ability to identify true positives, and specificity measures its ability to identify true negatives. Screening programs must consider factors like disease burden, test characteristics, and whether early detection improves outcomes.
Surveillance involves the systematic collection, analysis, and use of health data for decision-making. It serves as an early warning system and monitors the impact of interventions. There are different types of surveillance including community-based, hospital-based, and active/passive surveillance. Community-based surveillance engages community members to detect and report health events. Hospital-based surveillance relies on regular reporting from hospitals. Active surveillance actively seeks out cases, while passive surveillance waits for cases to be reported. The appropriate surveillance method depends on the context and challenges.
Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare. Epidemiologists help with study design, collection, and statistical analysis of data, amend interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies, and, to a lesser extent, basic research in the biological sciences
This document discusses different measures of morbidity including frequency, duration, and severity. Frequency is measured by incidence and prevalence. Incidence refers to new cases in a defined time period, while prevalence refers to all current cases. Duration is measured by disability rate and severity by case fatality rate. The document provides definitions and formulas for calculating incidence rate, point prevalence, and period prevalence. It also discusses factors that influence prevalence and the relationship between incidence and prevalence.
The document discusses methods for measuring malaria prevalence over time. In the pre-eradication era, measures included spleen rate, average enlarged spleen, and parasite rate in children ages 2-10. During eradication efforts, microscopic diagnosis became primary, and parameters like annual parasite incidence, annual blood examination rate, and slide positivity rate were used. Vector indices employed include human blood index, sporozoite rate, mosquito density, and man biting rate.
This document discusses various epidemiological terms used to measure disease frequency and distribution in a population. It defines rate, ratio, and proportion as different ways of comparing two quantities, with rate expressing the occurrence of an event over time, ratio comparing the relative sizes or values of two quantities without a time component, and proportion expressing one quantity as a percentage of the whole. It also defines various epidemiological measures including incidence, prevalence, attack rate, case fatality rate, and different types of mortality rates.
This document outlines the steps and objectives for investigating an epidemic outbreak. It details verifying diagnoses, confirming the epidemic's existence, defining the at-risk population, rapidly searching for all cases and their characteristics, analyzing the data, formulating hypotheses, testing hypotheses, evaluating ecological factors, further investigating the population at risk, writing reports, and implementing control measures. The overall goal is to determine the cause and transmission modes of the epidemic in order to prevent future occurrences.
The document provides definitions and guidelines for conducting an outbreak investigation, including defining cases, collecting data on time, place and person, developing hypotheses, and implementing control measures. It outlines the 10 steps of an outbreak investigation which include preparing for field work, verifying diagnoses, establishing the existence of an outbreak, and describing data to characterize the outbreak and identify potential causes. The goal is to control ongoing outbreaks, prevent future outbreaks, and advance knowledge of the disease.
The Global Leptospirosis Environmental Action Network: Strengthening the publ...Global Risk Forum GRFDavos
This document discusses leptospirosis, a bacterial disease impacting public health. It provides statistics on estimated global cases and deaths per year. It describes leptospirosis as having a complex natural history and clinical presentation. Climate change may increase its impact. Two typhoons in the Philippines in 2009 resulted in hundreds of leptospirosis cases. It introduces the Global Leptospirosis Environmental Action Network (GLEAN), a multi-disciplinary international group taking a One Health approach to strengthen leptospirosis prevention and control strategies through increased knowledge sharing and improved early warning systems. GLEAN's goals are reducing disease incidence, determining main drivers, developing predictive tools, and improving confirmation testing, outbreak detection, prepared
This document provides an overview of public health surveillance. It defines surveillance as the ongoing collection, analysis, and interpretation of health data to inform public health programs and actions. The document outlines the historical origins of surveillance dating back to ancient Greece. It describes various types of surveillance including community-level surveillance, routine reporting systems, active and passive surveillance, sentinel surveillance, and surveys. It also discusses the integrated disease surveillance program in India and how it aims to strengthen surveillance systems at the state and district levels.
This document provides an overview of basic measurements used in epidemiology. It discusses tools like proportion, rate, and ratio. It also covers various measures of mortality like crude death rate, specific death rate, and proportional mortality rate. Measures of morbidity like incidence and prevalence are explained. The relationship between incidence and prevalence is described. Standardization techniques are introduced to make rates comparable between populations.
The document discusses key concepts related to screening in preventive medicine. It defines screening as tests or examinations applied to apparently healthy individuals to detect disease in early stages. The biggest challenges are distinguishing individuals with and without disease given many diseases exist on a spectrum. An ideal screening test is inexpensive, easy to use, acceptable, valid, reliable and has high yield. The criteria for screening include the disease being an important health problem with a long preclinical stage and treatability. Screening programs must be continually evaluated to ensure benefits outweigh costs.
Life is full of curves and thus the epidemiology. However, some curves are important as Epidemic Curves and Survival Curves. This presentation is an attempt to know about epidemic curves.
This document discusses epidemiological methods for studying the distribution and determinants of health events and applying that knowledge to disease control. It defines descriptive epidemiology as the study of disease occurrence, distribution, and patterns in populations. Descriptive methods are observational and can be cross-sectional or longitudinal. Descriptive epidemiology provides insights into disease frequency, trends, and risk factors to inform public health planning and resource allocation.
The 10-step approach to outbreak investigations involves:
1) Identifying an investigation team and resources.
2) Establishing the existence of an outbreak.
3) Verifying the diagnosis, constructing a case definition, and finding cases systematically.
Descriptive epidemiology is then used to develop hypotheses, which are evaluated through additional studies if needed, before implementing control measures, communicating findings, and maintaining surveillance to confirm the outbreak has ended. Being systematic and following these steps is key to determining the source and controlling outbreaks.
This document discusses disease screening and provides information on various aspects of screening programs and tests. It defines screening as actively searching for unrecognized disease in apparently healthy individuals using simple tests. The key points are:
- Screening is part of secondary prevention and aims to detect diseases early when they may be still curable. It involves testing populations, not individuals with symptoms.
- An ideal screening test is both highly sensitive and specific, but in practice these factors typically have an inverse relationship. Sensitivity and specificity can be adjusted by changing the test cutoff criteria.
- For a screening program to be effective, the disease must be an important health problem that can be detected early and treated effectively to improve outcomes. The screening test
Epidemiology is the study of the distribution and determinants of health-related states or events in populations and the application of this study to control health problems. The basic measurements used in epidemiology include rates, ratios, and proportions to describe the occurrence of mortality, morbidity, disability, and other disease attributes in populations. Rates express the frequency of events over time, proportions express the relationship between parts and the whole, and ratios compare two rates or quantities. These measurements are essential tools for epidemiologists to investigate disease causation, describe population health status, and evaluate interventions.
An epidemic occurs when there is an unusual increase in the occurrence of a disease within a community or region beyond what is normally expected. To determine if an epidemic has occurred, one must consider the magnitude of cases, factors responsible, and cause/mode of transmission. Investigating an epidemic involves 10 steps: 1) verifying diagnoses, 2) confirming the epidemic's existence, 3) defining the at-risk population, 4) rapidly searching for all case characteristics, 5) analyzing data, 6) formulating hypotheses, 7) testing hypotheses, 8) evaluating ecological factors, 9) further investigating the at-risk population, and 10) writing a report of the background, methodology, data analysis, and control recommendations.
Measurements of morbidity and mortality
At the end of the session, the students shall be able to
List the basic measurements in epidemiology
Select an appropriate tools of measurement
Measure morbidity & mortality
Perform standardization of rates
This document provides an introduction to the basic concepts of epidemiology. It defines epidemiology as the study of patterns, causes, and effects of health and disease conditions in populations. The aims of epidemiology are to describe disease distribution and frequency, identify risk factors, and provide data to prevent and control diseases. Epidemiologists make comparisons between groups with and without disease exposure to identify determinants and test hypotheses. Basic measurements in epidemiology include mortality, morbidity, disability, and the distribution of disease and risk factors. Rates, ratios, and proportions are key tools used to measure and express disease frequency in populations.
Vector-borne diseases such as malaria, dengue, and Japanese encephalitis pose major health burdens globally and in India. In India, the National Vector Borne Disease Control Programme (NVBDCP) was launched in 2003 to control six key vector-borne diseases through integrated vector management and other strategies. The NVBDCP aims to reduce mortality from malaria, dengue, and Japanese encephalitis by half and eliminate kala-azar and lymphatic filariasis by targeted years. Japanese encephalitis, transmitted by Culex mosquitoes, poses high risks for children and is a growing problem in India. Chikungunya, transmitted by Aedes mosquitoes, caused over a million cases during an
Screening tests aim to identify unrecognized disease in apparently healthy individuals. They differ from diagnostic tests in that they are applied to groups rather than individuals, use a single criterion, and are less accurate. Validity refers to a test's accuracy while reliability is its precision on repeat tests. Sensitivity measures a test's ability to identify true positives, and specificity measures its ability to identify true negatives. Screening programs must consider factors like disease burden, test characteristics, and whether early detection improves outcomes.
Surveillance involves the systematic collection, analysis, and use of health data for decision-making. It serves as an early warning system and monitors the impact of interventions. There are different types of surveillance including community-based, hospital-based, and active/passive surveillance. Community-based surveillance engages community members to detect and report health events. Hospital-based surveillance relies on regular reporting from hospitals. Active surveillance actively seeks out cases, while passive surveillance waits for cases to be reported. The appropriate surveillance method depends on the context and challenges.
Epidemiology is the study and analysis of the patterns, causes, and effects of health and disease conditions in defined populations. It is the cornerstone of public health, and shapes policy decisions and evidence-based practice by identifying risk factors for disease and targets for preventive healthcare. Epidemiologists help with study design, collection, and statistical analysis of data, amend interpretation and dissemination of results (including peer review and occasional systematic review). Epidemiology has helped develop methodology used in clinical research, public health studies, and, to a lesser extent, basic research in the biological sciences
This document discusses different measures of morbidity including frequency, duration, and severity. Frequency is measured by incidence and prevalence. Incidence refers to new cases in a defined time period, while prevalence refers to all current cases. Duration is measured by disability rate and severity by case fatality rate. The document provides definitions and formulas for calculating incidence rate, point prevalence, and period prevalence. It also discusses factors that influence prevalence and the relationship between incidence and prevalence.
The document discusses methods for measuring malaria prevalence over time. In the pre-eradication era, measures included spleen rate, average enlarged spleen, and parasite rate in children ages 2-10. During eradication efforts, microscopic diagnosis became primary, and parameters like annual parasite incidence, annual blood examination rate, and slide positivity rate were used. Vector indices employed include human blood index, sporozoite rate, mosquito density, and man biting rate.
This document discusses various epidemiological terms used to measure disease frequency and distribution in a population. It defines rate, ratio, and proportion as different ways of comparing two quantities, with rate expressing the occurrence of an event over time, ratio comparing the relative sizes or values of two quantities without a time component, and proportion expressing one quantity as a percentage of the whole. It also defines various epidemiological measures including incidence, prevalence, attack rate, case fatality rate, and different types of mortality rates.
This document outlines the steps and objectives for investigating an epidemic outbreak. It details verifying diagnoses, confirming the epidemic's existence, defining the at-risk population, rapidly searching for all cases and their characteristics, analyzing the data, formulating hypotheses, testing hypotheses, evaluating ecological factors, further investigating the population at risk, writing reports, and implementing control measures. The overall goal is to determine the cause and transmission modes of the epidemic in order to prevent future occurrences.
The document provides definitions and guidelines for conducting an outbreak investigation, including defining cases, collecting data on time, place and person, developing hypotheses, and implementing control measures. It outlines the 10 steps of an outbreak investigation which include preparing for field work, verifying diagnoses, establishing the existence of an outbreak, and describing data to characterize the outbreak and identify potential causes. The goal is to control ongoing outbreaks, prevent future outbreaks, and advance knowledge of the disease.
The Global Leptospirosis Environmental Action Network: Strengthening the publ...Global Risk Forum GRFDavos
This document discusses leptospirosis, a bacterial disease impacting public health. It provides statistics on estimated global cases and deaths per year. It describes leptospirosis as having a complex natural history and clinical presentation. Climate change may increase its impact. Two typhoons in the Philippines in 2009 resulted in hundreds of leptospirosis cases. It introduces the Global Leptospirosis Environmental Action Network (GLEAN), a multi-disciplinary international group taking a One Health approach to strengthen leptospirosis prevention and control strategies through increased knowledge sharing and improved early warning systems. GLEAN's goals are reducing disease incidence, determining main drivers, developing predictive tools, and improving confirmation testing, outbreak detection, prepared
The document summarizes the key steps in investigating an epidemic:
1) Verify the diagnosis and confirm the existence of an epidemic by comparing to previous years.
2) Define the population at risk by obtaining maps, counting population size, and initial line-listing of cases.
3) Conduct a rapid search for all cases through medical surveys, case sheets collecting details of identified cases, and searching for additional cases.
4) Analyze the collected data to understand patterns in time, place and person which can reveal the source and spread of disease. Formulate and test hypotheses based on this analysis.
Epidemiological investigations are conducted during outbreak situations to determine the cause and implement control measures. The key steps include: 1) confirming the outbreak, 2) confirming diagnoses, 3) determining the number of cases, 4) organizing data by time, place and person, 5) developing hypotheses, 6) comparing hypotheses to facts, 7) executing control measures, and 8) writing a report. Questionnaires are used to gather information and orient data to identify patterns and associations.
البحث عبارة عن مدى إنتشار تسوس الاسنان بين طلاب المدارس الابتدائيه في مدينة صنعاء-اليمن
إشراف الدكتور/علي المشهداني
رئيس قسم طب المجتمع في جامعة العلوم والتكنولوجيا
Investigation of an epidemic by taking ebola as an example...Grandhe Sumanth
investigation of an epidemic by taking ebola as an example....................................................................................................................................................................................................................................................................
One in every ten people is suffering from kidney related diseases and Approx 1.50 lakh new kidney patients are added every year.Investigating an outbreak and to find the susceptibles in an area 'ii be a great achievement.
who and other public health organisations Bala Vidyadhar
The document provides information on the role of the World Health Organization (WHO) and other health organizations in public healthcare. It discusses the history of international cooperation on healthcare issues dating back to 1851. It then describes the establishment of WHO in 1948 and its objectives to promote public health worldwide. The summary outlines WHO's structure, membership, programs, and collaboration with other international bodies to improve global health.
Scabies is a common skin infection caused by tiny mites burrowing under the skin to lay eggs, causing itchy bumps and blisters. Symptoms often appear between fingers, toes, buttocks, elbows and waist or genital areas as small insect bites or pimples. Scratching can cause redness and sores. An estimated 300 million global cases occur annually, including 6-12 million in the United States. Treatment involves precisely following medication instructions and washing all recently used clothing and linens in hot water.
A short guide to scabies treatment 2016Mike Chapman
Scabies is caused by infestation of the tiny burrowing mite called Sarcoptes scabiei. They enter your skin, form burrows and leads to intense itching. Moreover, the urge to scratch turns stronger at night. It is highly contagious and can spreads easily through close physical contact. Regardless of age, gender and race, it can happen to anyone.
However, it can be treated by right medication. A number of natural, homeopathic and several other medicines are available, which are capable of curing this itchy skin disorder
Prenatal care involves regular checkups during pregnancy to monitor the health of the mother and baby. The nurse plays an important role in prenatal care by registering pregnant women, providing clinical assessments and testing, educating mothers on nutrition, rest, hygiene and warning signs, and making referrals for high-risk mothers. The goals of prenatal care are to ensure a healthy pregnancy and delivery for both mother and baby.
This document discusses epidemics and their management. It defines epidemics and outlines three types: common source, propagated, and slow or modern. The severity of an epidemic depends on environmental conditions, host population characteristics, and human behavior. Managing epidemics involves forecasting, investigating, controlling, and preventing future occurrences. Forecasting allows preparation, while investigation identifies causes and transmission. Control relies on removing infection sources and preventing transmission. Prevention emphasizes hygiene, vaccination, and environmental measures. Preparedness is key to effectively managing epidemics.
The document discusses food poisoning, including its definition, causes, types, symptoms, and prevention. It covers bacterial causes like Salmonella, Campylobacter, Listeria, and Bacillus cereus. It also discusses toxin-mediated food poisoning from Staphylococcus aureus, Clostridium perfringens, and Clostridium botulinum (botulism). The ideal conditions for growth of microorganisms that cause food poisoning are discussed. Prevention methods focus on proper food handling, sanitation, and refrigeration.
1. Diarrhea is defined as having three or more loose or liquid bowel movements per day. The most common causes are viral or bacterial infections of the gut.
2. Symptoms include loose watery stools, abdominal cramps, pain, vomiting, nausea, fever and fatigue.
3. Treatment involves oral rehydration, antidiarrheal medications, and diet modifications. For children, continued breastfeeding and oral rehydration solutions are important.
1. Acute respiratory illness (ARI) is a major cause of mortality and morbidity worldwide, especially in young children under 5 years old. Pneumonia accounts for 90% of ARI deaths and is commonly caused by bacteria.
2. Developing countries have high rates of ARI due to factors like malnutrition, indoor smoke pollution, and overcrowding. Bangladesh, India, Indonesia and Nepal account for 40% of global ARI mortality.
3. Clinical assessment of children with suspected ARI involves checking for symptoms like fast breathing and chest indrawing. Illnesses are classified as very severe, severe pneumonia, pneumonia, or no pneumonia to determine appropriate treatment.
The Mantoux test, also known as the tuberculin skin test, is used to determine if a person has been infected with tuberculosis. It involves injecting a small amount of purified protein derivative into the skin on the lower arm. After 48 to 72 hours, a health care worker measures any induration, or hard, raised area that develops on the arm, which can indicate infection. A positive result is based on the size of the induration and the person's risk factors. While very accurate, the test can sometimes produce false positives or negatives, requiring further evaluation and testing to diagnose active TB disease.
Epidemiology is defined as the study of the distribution and determinants of health-related states in populations. It differs from clinical medicine in that it focuses on groups rather than individuals and uses quantitative tools to study communities. Epidemiology has many uses including healthcare management by making community diagnoses, understanding disease processes, guiding public health practice through disease investigation and surveillance, and informing clinical practice and research through evaluating treatments and assessing effectiveness of diagnostic procedures. Overall, epidemiology provides essential population-level insights that aid in healthcare planning, policy development, and clinical decision-making.
This document lists and provides brief descriptions of several voluntary health agencies in India that were established between 1920 and 1952 to promote public health initiatives. Some of the key agencies mentioned include the Indian Red Cross Society, the Kasturba Memorial Fund, the Hind Kusht Nivaran Sangh, the Indian Council for Child Welfare, and the Bharat Sevak Samaj. It provides high-level details on the services offered and activities conducted by these organizations in areas such as relief work, family planning, and maternal/child welfare.
The document provides guidance on conducting an epidemiological investigation of an epidemic, outlining the objectives, team roles and responsibilities, and steps of an investigation which include establishing the existence of an outbreak, verifying diagnoses, constructing a case definition, systematically finding and recording information on cases, developing and evaluating hypotheses, and implementing control measures. The goal of an epidemic investigation is to understand the factors driving the outbreak in order to control spread and prevent future occurrences.
1. The document defines key epidemiological terms like epidemic, outbreak, endemic, pandemic, herd immunity, incubation period, and quarantine. It also describes different types of epidemics such as point source, propagated, and continuous exposure epidemics.
2. The stages of outbreak investigation are outlined which include verifying the diagnosis, confirming the outbreak, defining the population at risk, conducting a rapid search for cases, analyzing the data, formulating hypotheses, and reporting findings.
3. Trigger levels for different diseases are discussed to determine the appropriate response level based on the number and severity of cases. Line listing of cases is also described as a tool to collect epidemiological information during an outbreak investigation.
Investigation of Acute Gastroenteritis Epidemic (AGE) and its stepsMohsin Ansari
Steps of investigation of any epidemic are illustrated in the given slide especially for acute gastro-enteritis epidemic. Also the prevention of AGE is also given and at the end how to submit a report is also given.
Travel-related infectious diseases on the rise
International travel has an important role in the transmission of emerging and re-emerging infectious diseases across geographical areas.
Since 1980, the world has been threatened by different waves of emerging disease epidemics.
In the twenty-first century, these diseases have become an increasing global concern because of their health and economic impacts in both developed and resource-constrained countries.
It is difficult to stop the occurrence of new pathogens in the future due to the interconnection among humans, animals, and the environment.
As many as 43%–79% of travelers to low- and middle-income countries become ill with a travel-related health problem.
Although most of these illnesses are mild, some travelers become sick enough to seek care from a health care provider.
Here are the key pros and cons of influenza vaccines:
Pros:
- They reduce the risk of catching the flu. While effectiveness can vary, vaccines still provide substantial protection for many people.
- They reduce the risk of serious flu complications. Even if the vaccine isn't a perfect match for circulating strains, it often makes the illness milder.
- They can help prevent spreading the flu to vulnerable groups. Higher vaccination rates in the population help create "herd immunity."
- The side effects are usually mild. Soreness at the injection site and low-grade fever are common temporary side effects.
Cons:
- Effectiveness depends on accurate strain prediction. If the vaccine isn't a good match for
The document discusses communicable diseases, their causes, definitions, outbreaks, transmission, prevention and control. It defines key terms like epidemic, endemic, pandemic, host, carrier, reservoir, vector, immunity and modes of transmission. It outlines steps for managing disease outbreaks including preparation, detection, response and evaluation. It also discusses emerging/reemerging diseases and global disease eradication efforts. Nurses play an important role in communicable disease control through health education, surveillance and working with at-risk communities.
This document outlines the steps for investigating an outbreak. It defines key epidemiological terms and discusses when to investigate an outbreak. The 10 steps of an outbreak investigation are described as: 1) defining the problem, 2) generating hypotheses, 3) testing hypotheses, 4) verifying diagnoses, 5) finding and counting cases, 6) performing descriptive epidemiology, 7) analyzing data, 8) communicating findings, 9) implementing control measures, and 10) preventing future outbreaks. Preparedness, the roles of NGOs, recent outbreak examples, and the importance of surveillance and inter-sectoral coordination are also covered.
This document outlines the steps involved in investigating an epidemic:
1. Verification of diagnoses and defining cases is the first step to understand the scope and characteristics of the epidemic.
2. Confirmation of an actual epidemic involves comparing case numbers to historical data to determine if there is unusual disease occurrence.
3. Defining the population at risk, rapidly searching for all cases, collecting data on characteristics, and analyzing patterns in time, place and person help identify potential causes and transmission routes.
Chikungunya virus is an emerging mosquito-borne virus that causes severe joint pain. It is transmitted between humans by Aedes mosquitoes. The virus was first isolated in Africa in the 1950s and has since caused large outbreaks in Asia, Africa, Europe and the Americas. There is no vaccine or treatment. The document discusses the virus transmission, clinical presentation, diagnosis, epidemiology and control measures. It also outlines the need for further research into vaccines, treatments and predictive models to control future outbreaks.
This document discusses infectious diseases and healthcare-associated infections. It begins with an overview of hospital epidemiology and the roles of epidemiologists in identifying risks of infection and developing strategies to minimize those risks. Common sites of healthcare-associated infections are the urinary tract, respiratory tract, bloodstream, surgical wounds, and gastrointestinal tract. Factors that can promote healthcare-associated infections include prolonged use of medical devices, extremes of age, surgery and other procedures, immune status, understaffing, and poor infection control practices. The document then discusses measures for quantifying disease frequency like prevalence, incidence and case definitions.
This document discusses communicable diseases and focuses on tuberculosis (TB). It provides key statistics on the global and national burden of TB, including that 9.2 million new cases occurred worldwide in 2006, with India accounting for 1/5 of the global burden. India has an annual risk of TB infection of 1.5% and once infected, a 10% lifetime risk of developing active TB. The document also outlines epidemiological indices used to measure the TB problem, describes India's Revised National Tuberculosis Control Programme which uses DOTS, and mentions drug-resistant TB and the relationship between TB and HIV.
Natural History and Spectrum of Disease lecture 4.pptsamwel18
The document discusses the natural history and spectrum of disease. It explains key concepts like latent period, infectious period, incubation period, infectivity, pathogenicity, and virulence. It also discusses the challenges these concepts pose for clinicians and public health workers. The baseline level of a disease in a community is explained, as well as different patterns like endemic, epidemic, and pandemic levels. Factors that can cause epidemics are outlined.
This document provides an overview of COVID-19 for EMS providers, including terminology, the origins and spread of the virus, clinical presentation, screening and risk assessment, treatment considerations, infection control protocols, and recommendations for interacting with the public. Key points covered include how the virus is transmitted, projected disease course, limitations of current testing and treatment options, importance of PPE and prenotification, and dispelling common myths. The goal is to equip EMS with up-to-date facts and best practices for responding safely and effectively during the pandemic.
This document provides an overview of nursing management of communicable diseases in emergency situations. It discusses the major causes of morbidity and mortality in emergencies like diarrheal diseases, respiratory infections, measles, and malaria. It outlines the fundamental principles of communicable disease control, including rapid assessment, prevention, surveillance, outbreak control, and disease management. It also summarizes the prevention and control of specific communicable diseases like respiratory infections, tuberculosis, measles, cholera, and diarrhea.
Week 4: Week 4 - Epidemiology—Introduction
Epidemiology—Introduction
The study of epidemics is epidemiology. Its primary focus is on the distribution and causes of disease in populations. Epidemiology involves developing and testing ways to prevent and control disease by studying its origin, spread, and vulnerabilities.
As a discipline, epidemiologic research addresses a variety of health-related questions of societal importance. Epidemiologic research methods are used by clinical investigators and scientists who conduct observational and experimental research on the prevention and treatment of disease.
The Cholera epidemic, a case from the 19th century, was enabled by the global movement of people. Having appeared in India in 1817, it spread throughout Asia and the Middle East within a decade. It was reported in Moscow in 1830 and then spread to Warsaw, Hamburg, Berlin, and London in 1831 (Snow, 1855, 2002). When it crossed the Atlantic to reach North America, Cholera gained the notoriety of the first truly global disease.
The modern day world is dominated by free trade and rapid transportation. An unprecedented rate of global interchange of food, consumer products, and organisms—including humans—is occurring. The threat of pandemics in the 21st century has heightened the importance of epidemiology at national and international levels.
Although diseases such as Influenza A (H1N1), Severe Acute Respiratory Syndrome (SARS), Acquired Immunodeficiency Syndrome (AIDS), West Nile Virus, Salmonella, are commonly recognized as epidemics, as they cause large scale disruption of health in populations. The field of epidemiology also addresses epidemics of obesity (Ogden et al., 2007), diabetes (Zimmet, 2001), mental health (Insel & Fenton, 2005), and any other disease that may cause large scale disruption of health in populations.
In general, there are ten stages to an outbreak investigation:
1. Investigation preparation
2. Outbreak confirmation
3. Case definition
4. Case identification
5. Descriptive epidemiology
6. Hypothesis generation
7. Hypothesis evaluation
8. Environmental studies
9. Control measures
10. Information dissemination
Investigation preparation requires a health crisis manager to identify a team of professionals who will lead the outbreak investigation, review the scientific literature, and notify local, state, and national organizations of the potential outbreak.
Outbreak confirmation requires actual laboratory confirmation of the disease, which may involve the collection of blood, urine, and stool samples from ill people and performing bacteriologic, virologic, or parasitic testing of those samples.
Case definition is the process by which we establish a set of standard criteria to determine who is and is not infected with respect to a specific outbreak; that is, a protocol is developed to determine case patients.
Case identification requires the health crisis manager and team of professionals to conduct a systematic and organize.
Epidemiology and cycle of microbial diseasesChhaya Sawant
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This PPT comprises of entire unit III ie. Introduction to epidemiology.
The content includes definition,aims,scope,uses of epidemiology, epidemiological triad, dynamics of disease transmission, measurement of mortality and morbidity, levels of prevention, epidemiological methods. incidence and prevalence, descriptive epidemiology, analytical epidemiology
This document discusses epidemiology and provides definitions, aims, uses, scope and sources of epidemiology. It defines epidemiology as the study of distribution and determinants of health and disease in populations. The aims are to describe health problems, identify causes, and provide data to plan and evaluate prevention services. Epidemiology is used to study disease historically, diagnose communities, plan and evaluate programs, assess individual risk, identify disease syndromes, and search for causes. The scope includes infectious diseases, cancers, genetics and various environmental exposures. Sources of disease include human carriers and reservoirs, animal reservoirs, and the environment. Modes of transmission and requirements for susceptible hosts are also described. Measurement of disease frequency through rates, ratios and proportions is
The document provides an introduction to epidemiology, defining it as the study of health-related states and events in populations and the application of this study to control health problems. It describes the purposes and uses of epidemiology, the 5Ws (who, what, when, where, why), categories of descriptive and analytic epidemiology, and levels of disease occurrence such as endemic, epidemic, sporadic, and pandemic. The document aims to outline key concepts in epidemiology for learning objectives.
Allopurinol, a uric acid synthesis inhibitor acts by inhibiting Xanthine oxidase competitively as well as non- competitively, Whereas Oxypurinol is a non-competitive inhibitor of xanthine oxidase.
Storyboard on Acne-Innovative Learning-M. pharm. (2nd sem.) CosmeticsMuskanShingari
Acne is a common skin condition that occurs when hair follicles become clogged with oil and dead skin cells. It typically manifests as pimples, blackheads, or whiteheads, often on the face, chest, shoulders, or back. Acne can range from mild to severe and may cause emotional distress and scarring in some cases.
**Causes:**
1. **Excess Oil Production:** Hormonal changes during adolescence or certain times in adulthood can increase sebum (oil) production, leading to clogged pores.
2. **Clogged Pores:** When dead skin cells and oil block hair follicles, bacteria (usually Propionibacterium acnes) can thrive, causing inflammation and acne lesions.
3. **Hormonal Factors:** Fluctuations in hormone levels, such as during puberty, menstrual cycles, pregnancy, or certain medical conditions, can contribute to acne.
4. **Genetics:** A family history of acne can increase the likelihood of developing the condition.
**Types of Acne:**
- **Whiteheads:** Closed plugged pores.
- **Blackheads:** Open plugged pores with a dark surface.
- **Papules:** Small red, tender bumps.
- **Pustules:** Pimples with pus at their tips.
- **Nodules:** Large, solid, painful lumps beneath the surface.
- **Cysts:** Painful, pus-filled lumps beneath the surface that can cause scarring.
**Treatment:**
Treatment depends on the severity and type of acne but may include:
- **Topical Treatments:** Such as benzoyl peroxide, salicylic acid, or retinoids to reduce bacteria and unclog pores.
- **Oral Medications:** Antibiotics or oral contraceptives for hormonal acne.
- **Procedures:** Such as chemical peels, extraction of comedones, or light therapy for more severe cases.
**Prevention and Management:**
- **Cleanse:** Regularly wash skin with a gentle cleanser.
- **Moisturize:** Use non-comedogenic moisturizers to keep skin hydrated without clogging pores.
- **Avoid Irritants:** Such as harsh cosmetics or excessive scrubbing.
- **Sun Protection:** Use sunscreen to prevent exacerbation of acne scars and inflammation.
Acne treatment can take time, and consistency in skincare routines and treatments is crucial. Consulting a dermatologist can help tailor a treatment plan that suits individual needs and reduces the risk of scarring or long-term skin damage.
Fexofenadine is sold under the brand name Allegra.
It is a selective peripheral H1 blocker. It is classified as a second-generation antihistamine because it is less able to pass the blood–brain barrier and causes lesser sedation, as compared to first-generation antihistamines.
It is on the World Health Organization's List of Essential Medicines. Fexofenadine has been manufactured in generic form since 2011.
Understanding Atherosclerosis Causes, Symptoms, Complications, and Preventionrealmbeats0
Definition: Atherosclerosis is a condition characterized by the buildup of plaques, which are made up of fat, cholesterol, calcium, and other substances, in the walls of arteries. Over time, these plaques harden and narrow the arteries, restricting blood flow.
Importance: This condition is a major contributor to cardiovascular diseases, including coronary artery disease, carotid artery disease, and peripheral artery disease. Understanding atherosclerosis is crucial for preventing these serious health issues.
Overview: We will cover the aims and objectives of this presentation, delve into the signs and symptoms of atherosclerosis, discuss its complications, and explore preventive measures and lifestyle changes that can mitigate risk.
Aim: To provide a detailed understanding of atherosclerosis, encompassing its pathophysiology, risk factors, clinical manifestations, and strategies for prevention and management.
Purpose: The primary purpose of this presentation is to raise awareness about atherosclerosis, highlight its impact on public health, and educate individuals on how they can reduce their risk through lifestyle changes and medical interventions.
Educational Goals:
Explain the pathophysiology of atherosclerosis, including the processes of plaque formation and arterial hardening.
Identify the risk factors associated with atherosclerosis, such as high cholesterol, hypertension, smoking, diabetes, and sedentary lifestyle.
Discuss the clinical signs and symptoms that may indicate the presence of atherosclerosis.
Highlight the potential complications arising from untreated atherosclerosis, including heart attack, stroke, and peripheral artery disease.
Provide practical advice on preventive measures, including dietary recommendations, exercise guidelines, and the importance of regular medical check-ups.
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
Breast cancer :Receptor (ER/PR/HER2 NEU) Discordance.pptxDr. Sumit KUMAR
Receptor Discordance in Breast Carcinoma During the Course of Life
Definition:
Receptor discordance refers to changes in the status of hormone receptors (estrogen receptor ERα, progesterone receptor PgR, and HER2) in breast cancer tumors over time or between primary and metastatic sites.
Causes:
Tumor Evolution:
Genetic and epigenetic changes during tumor progression can lead to alterations in receptor status.
Treatment Effects:
Therapies, especially endocrine and targeted therapies, can selectively pressure tumor cells, causing shifts in receptor expression.
Heterogeneity:
Inherent heterogeneity within the tumor can result in subpopulations of cells with different receptor statuses.
Impact on Treatment:
Therapeutic Resistance:
Loss of ERα or PgR can lead to resistance to endocrine therapies.
HER2 discordance affects the efficacy of HER2-targeted treatments.
Treatment Adjustment:
Regular reassessment of receptor status may be necessary to adjust treatment strategies appropriately.
Clinical Implications:
Prognosis:
Receptor discordance is often associated with a poorer prognosis.
Biopsies:
Obtaining biopsies from metastatic sites is crucial for accurate receptor status assessment and effective treatment planning.
Monitoring:
Continuous monitoring of receptor status throughout the disease course can guide personalized therapy adjustments.
Understanding and managing receptor discordance is essential for optimizing treatment outcomes and improving the prognosis for breast cancer patients.
A congenital heart defect is a problem with the structure of the heart that a child is born with.
Some congenital heart defects in children are simple and don't need treatment. Others are more complex. The child may need several surgeries done over a period of several years.
congenital GI disorders are very dangerous to child. it is also a leading cause for death of the child.
this congenital GI disorders includes cleft lip, cleft palate, hirchsprung's disease etc.
3. Introduction
Historical Background
Definitions
Objectives of epidemic investigation
Steps in Epidemic Investigation
Recent Outbreaks & Measures around the World
Conclusions
References
Previous Year References
4. It is an emergency situation and provides opportunities to use
epidemiological knowledge for immediate control of disease.
Sometimes investigation is done after the epidemic has burnt out
or disease has resumed endemic level.
Cholera, food poisoning, influenza, malaria, chikungunya fever,
Hepatitis A and anthrax are extensively documented as causes of
epidemics.
The primary motivation of any epidemic investigation is to control
the spread of disease within the population at risk.
5.
6. ca. 75,000 -
100,000
Greece 429–426 BC
Known as Plague of Athens,
because it was primarily in
Athens.
unknown, similar
to typhoid
ca. 40% of
population
Europe 541–542
Known as Plague of
Justinian, due to the name
of the Byzantine emperor in
power at the time.
Bubonic plague
ca. 30% of
population
Europe,
Western Asia,
Northern
Africa
165–180
Known as Antonine Plague,
due to the name of the
Roman emperor in power at
the time.
unknown, symptoms
similar to smallpox
>>9,000
India,
Germany
1881–1896 fifth cholera pandemic Cholera
>>800,000
Europe, Asia,
Africa
1899–1923 sixth cholera pandemic Cholera
>>100,000 Asia, Europe 1816–1826 first cholera pandemic Cholera
>>100,000
Asia, Europe,
North America
1829–1851 second cholera pandemic Cholera
>50,000 Balkans 1738 Great Plague of 1738 Plague
>50,000 Russia 1770–1772
Russian plague of 1770–
1772
Plague
>30,000,000 Congo Basin 1960–present HIV/AIDS pandemic HIV/AIDS
7. Epidemic : The “unusual” occurrence in a community or
region of the disease, specific health related behavior or other
health related events clearly in excess of “expected
occurrence”.
Outbreak: It is used for a small, usually localized epidemic.
Endemic : The constant presence of a disease or infectious
agent within a given geographical area or population group,
without importation from outside. e.g. Hepatitis A, cholera
8. Sporadic: The word sporadic means scattered about, cases occurs
irregularly, haphazardly & infrequently from time to time. e.g.,
polio, tetanus, herpes zoster.
Pandemic: An epidemic usually affecting a large proportion of the
population, occurring over a wide geographic area. e.g., HIV/
AIDS, Influenza.
Primary case: It refers to the first case of a communicable disease
introduced into the population unit being studied.
9. Index case: It refers to the first case to come to
the attention of the investigator.
10. Attack Rate : The number of new cases in a
population at risk during specified time interval.
The number of new cases during
specified time interval.
Attack rate= X 100
Total population at risk during the
same interval
Influenza: annual global attack rate estimated at 5 – 10% in
adults and 20 – 30% in children
11. Secondary Attack Rate
Number of exposed persons developing the disease within the range of
the incubation period following exposure to the primary case.
No. of exposed persons developing
the disease with in the range of the I.P
SAR = X100
Total No. of exposed/susceptible contacts
Secondary cases were defined as household contacts with influenza like
illness (ILI) or laboratory-confirmed influenza A(H1N1)2009, occurring
at least one day after but within seven days following symptom onset in
the index case.
ILI developed in 231 of the 1,589 household contacts, a secondary attack
rate of 14.5% (95% confidence interval (CI): 12.9–16.4).
12. Case fatality Rate
It is the ratio/Proportion of deaths to cases of a
particular disease.
Total number of deaths due to
particular disease
CFR= X100
Total number of cases due to
same disease
Case Fatality rate for Influenza was < 0.1% when treated.
13. An epidemic investigation calls for inference as well as
description.
Frequently, epidemic investigations are called for after the
peak of the epidemic has occurred;
In such cases, the investigation is mainly retrospective.
However, in investigating an epidemic, it is desired to have an
orderly procedure or practical guidelines as outlined below
which are applicable for almost any epidemic study.
14. The objectives of an epidemic investigation are
a. To define the magnitude of the epidemic or outbreak
involvement in terms of time, place and person.
b. To determine particular conditions and factors responsible
for the occurrence of the epidemic.
c. To identify the causative agent, sources of infection, and
modes of transmission.
d. To make recommendations to prevent recurrence
15. 1. Verification of diagnosis
2. Confirmation of the existence of an epidemic
3. Defining the population at risk
4. Rapid search for all cases and their characteristics
5. Data analysis
6. Formulation of hypothesis
7. Testing of hypothesis
8. Evaluation of ecological factors
9. Further investigation of population at risk
10. Writing the report
16. First step in the investigation.
The report may be spurious due to misinterpretation of signs
or symptoms by public or health worker.
It is not necessary to examine all the cases.
A clinical examination of a sample of cases is sufficient.
Laboratory investigations wherever applicable, are most
useful to confirm the diagnosis but control measures should
not be delayed until laboratory results are available.
17. Confusion often made between food poisoning, cholera and
gastroenteritis.
All continuous fever cases may not be of typhoid fever even during an
epidemic of typhoid fever.
Simultaneous occurrence of different conditions can also be
confusing.
E.g. an outbreak of smallpox was reported in a village near Pune but
later the cases turned out to be scabies after verification of diagnosis.
It is necessary to establish objective criteria for labeling persons as
cases.
18. Case definition:
Is needed to identify and count the cases in order to determine who
may be affected by the epidemic.
Components of the case definition may include information about
time and place of exposure, clinical signs & symptoms and lab
findings.
Suspect: A case with specific signs and symptoms during specific
period of time
Confirmed: A suspected case with laboratory confirmation.
Probable: A case which has unique clinical or preliminary lab test
results during that period.
19.
20. It is a case definition for outbreak of viral hepatitis A in
Rohtak urban slums in sept 2000.
“Acute febrile illness with malaise, anorexia, followed by
jaundice, hepatomegaly and abdominal tenderness in the right
upper quadrant, increase in the ALT>8 times the normal and
serum bilirubin>2mg%.”
21. Done by comparing the number of cases with disease frequencies
during the same period of previous years.
In case of endemic diseases like cholera, typhoid hepatitis A, it is
expected that some cases (few hundreds) always present throughout
the year. So these diseases to be consider as epidemic several
hundreds or thousands of cases have to occur in India.
22. In case of yellow fever, bubonic plague and polio even a
single case will constitute an epidemic in India.
But in the US single case of cholera constitute epidemic.
Thus the number that constitute an epidemic vary from
place to place.
23. States or districts should establish criteria on the number of
cases that constitute an epidemic based on their local situation.
The criteria are:
A 25% increase in the number of cases reported as compared
to corresponding period of previous year. This may not, be
sufficiently sensitive in the year that follows an outbreak.
A 25% increase in the number of cases reported as compared
the average number of cases over last four non-epidemic years
for the corresponding period.
24. Information may be collected from routine health service
records e.g. OPD registers, in-patient registers etc.
Information should be collected not only from modern
medicine practitioners but also from other systems.
“Over 96 cases of gastroenteritis were reported during period
of 6 days (from 17th Oct to 22nd Oct 98) in Ramorally
village.”
25. 1. Obtaining the map of the area
It should contain information about natural landmarks, roads and
location of all dwelling units along each road.
The area may be divided into segments, using natural landmarks as
boundaries.
This is again divided into smaller sections. Within each section, the
dwelling units may be designated by numbers.
26. 2. Counting the population
By doing census by house to house visits. The composition should
be known by age and sex.
Eg: For population at risk. In case of food poisoning- those who ate
the food. In case of outbreak of cholera- those who were using
water from the suspected well.
27. Surveillance:
It has been defined as "the continuous scrutiny of all aspects of
occurrence and spread of disease that are pertinent to effective
control“.
The ultimate objective of surveillance is prevention.
Surveillance, if properly pursued, can provide the health agencies
with an overall intelligence and disease-accounting capability.
Surveillance is an essential prerequisite to the rational design and
evaluation of any disease control programme.
28. (a) Individual surveillance : This is surveillance of infected persons
until they are no longer a significant risk to other individuals,
(b) Local population surveillance : e.g., surveillance of malaria,
(c) National population surveillance : e.g., surveillance of smallpox
after the disease has been eradicated,
(d) International surveillance : At the international level, the WHO
maintains surveillance of important diseases (e.g., influenza,
malaria, polio, etc.) and gives timely warning to all national
governments.
29. 1. Medical survey
It should be carried out in the defined area to identify all
cases including those who have not sought medical care,
and those possibly exposed to risk.
By the administration of epidemiological case sheet.
30. 2. Epidemiological case sheet
This should be carefully designed to collect relevant
information.
If the epidemic is large it may not be possible to examine
all the cases. In such cases random sample should be
examined.
31. Serial no. : Date:
Investigator :
Name of the person :
Age/sex :
Occupation :
Place of work :
Residential address :
H/o cholera vaccination within
1 year : yes/no
If yes date and place of vaccination: .
For previous 7 days
Place visited :
Places where food and drink was taken:
Contact with similar cases :
If yes name and places of person :
h/o similar illness in the family :
Water supply: Main source : piped/public well/private well/dug
well/bore well /other
Occasional source :
Contd...
32. Is water supply disinfected? : yes/no
If yes, method, name of person disinfecting and date of disinfection in last
7 days:
Presence of houseflies : yes/no
History from patient
Whether suffering/cured:
Date and hour of onset of symptoms:
Clinical manifestations :
Nausea :
Vomiting : if yes number and day
Loose motion : if yes number and day
Blood/mucus in stool : yes or no
Sunken eyes Dry tongue
Muscular cramps Inelastic skin
Treatment received : Yes/no
If yes place : private doctor/VHG/MPW/MO/PHC
ORS/IV fluids given : Yes/no Details:
Contd...
33. Laboratory tests
Specimen Date of collection Results
Stool
Rectal swab
Vomitus
Food
Water for
chemical tests
bacteriological tests
Outcome of case:
Recovered/died
In case of death: Date and hour of death
If attended by MO: Yes/No
34. 3. Searching for more cases
The patient is asked about the
similar cases at home, family,
neighborhood, school, work place
having an onset within the
incubation period of index case.
The search for new cases should be
carried out everyday till the area is
declared free of epidemic.
35. It has to be done using the parameters – Time, Place And Person.
a. Time
Prepare a chronological distribution of dates of onset of cases
and construct an “epidemic curve”. An epidemic curve
suggests :
Pattern of spread
Magnitude
Outliers
Exposure and/or disease incubation period
39. b. Place
Prepare a ‘spot map’ of cases and if possible their relation
to the sources of infection e.g. water supply, air pollution,
foods eaten, occupation etc..
The map shows the boundaries and patterns of disease
distribution. Clustering of cases indicate a common
source of infection.
39
40. 40
Original map by Dr. John Snow showing the clusters of Cholera cases
in the London epidemic of 1854
41. c. Person
Analyze the data by age, sex, occupation and other possible risk
factors.
Determine the attack rates/case fatality rates.
The purpose of data analysis is
1. To determine modes of transmission and the source and the vehicle
of the agent, so that the most effective measures can be initiated.
2. To determine the risk factors for disease.
41
42. Hypothesis is a proposition or a tentative theory designed to
explain the observed distribution of the disease in terms of causal
association of the direct nature.
The hypothesis should explain the epidemic in terms of
1. Causative agent
2. The possible source
3. Possible modes of spread
4. The environmental factors which enabled
it to occur.
42
43. All reasonable hypotheses need to be considered and weighed by
comparing the attack rates in various groups for those exposed and
those not exposed to the each suspected factor.
This will enable the epidemiologist to ascertain which hypotheses is
consistent with all the known facts.
Sometimes the hypothesis needed to be tested by the analytical study
design (case control study) to the statistical significance.
43
44. An investigation of the circumstances involved should be carried out
to undertake appropriate measures to prevent further transmission of
the disease.
The ecological factors which have made the epidemic possible should
be investigated such as sanitary status of eating establishments,
breakdown in the water supply system, changes such as temperature,
humidity, and air pollution, population dynamics of insects and animal
reservoirs etc..
In case of water-borne transmission is suspected(gastroenteitis) a
sanitary survey of water supply system from source to consumer
should be done. 44
45. Needed to obtain further information.
This may involve medical examination, screening tests,
examination of suspected food, feces or food samples,
biochemical studies, assessment of immunity status etc.
This will permit classification of all members as to
1. Exposure to specific potential vehicles
2. Whether ill or not
45
46. 1. Background
Geographical location
Climatic conditions
Demographic status (population pyramid)
Socioeconomic situation
Organization of health services
Surveillance and early warning systems
Normal disease prevalence
47. 2. Historical data
Previous occurrence of epidemics
- of the same disease
- locally or elsewhere
Occurrence of similar diseases
- in the same area
- in other areas
Discovery of the first cases of the present outbreak
48. 3. Methodology of investigations
Case definition
Questionnaire used in epidemiological investigation
Survey teams
Household survey
Collection of laboratory specimens
Laboratory techniques
49. 4. Analysis of data
Clinical data
- frequency of signs and symptoms
- course of disease
- differential diagnosis
- sequelae or death rates
Epidemiological data
- Mode of occurrence
- In time
- By place
- By population groups
50. Modes of transmission
- sources of infection
- routes of excretion and portal of entry
- factors influencing transmission
Laboratory data
- isolation of agents
- serological confirmation
- significance of results
Interpretation of data
- comprehensive picture of the outbreak
- hypothesis as to the causes
- formulation and testing of hypothesis by statistical analysis
51. 5. Control measures
Definition of the strategies and methodology of
implementation
- constraints
- results
Evaluation
- significance of results
- cost/effectiveness
Preventive measures
52. It may be necessary to implement temporary control
measures at the commencement of an epidemic on the basis
of known facts of the disease.
These measures may be modified or replaced in the light of
new knowledge acquired by the epidemic investigation.
53. a. Health Administrator/Manager: for planning and
implementation of control/ eradication strategies.
b. Clinician: to update clinical knowledge & make alterations in
case management & diagnostic methods.
c. Research: For clues & basis for further need oriented research
programmes.
d. General Population: for sense of security, health educational
tool and to develop confidence in the health care delivery
system.
54.
55. Given by:
GOVERNMENT OF INDIA
NATIONAL INSTITUTE OF COMMUNICABLE
DISEASES
(Directorate General of Health Services)
Ministry of Health & Family Welfare
56.
57.
58.
59. Complex emergencies require rapid and coordinated response in
order to deliver essential services to the affected population and
reduce the likelihood of increase in morbitiy, mortality and outbreaks.
NGOs can be local or international and they play a crucial roll in
delivering various forms of services in complex emergencies. They
vary greatly in terms of financial, technical and operational capacities.
Local NGOs with their limited resources but great knowledge of local
situation can have as much or greater impact in terms of delivering
services to displaced populations
60. NGOs have other strengths that make them ideal actors in
emergencies.
These strengths include:
1. Ability to respond fast
2. Flexibility
3. Manoeuvrability
4. Creating public awareness
61. Some of the key public health services provided by NGOs in
emergencies include:
1. Curative services
2. Assist in disease surveillance.
3. Vector control.
4. Training and health education.
5. Water and sanitation.
62.
63.
64. The most widespread epidemic of Ebola virus disease (commonly
known as "Ebola") in history is currently ongoing in two West
African countries.
It has caused significant mortality, with reported case fatality rates of
up to 70% and specifically 57–59% among hospitalized patients.
The outbreak began in Guinea in December 2013 and then spread
to Liberia and Sierra Leone.
On 8 August 2014, the World Health Organization declared the
outbreak a public health emergency of international concern.
65. On 31 July 2015, the WHO announced "an extremely promising
development" in the search for an effective vaccine for Ebola
disease.
While the vaccine up to now shows 100% efficacy in
individuals, more conclusive evidence is needed on its capacity
to protect populations through herd immunity.
66. As the epidemic appeared to be coming to an end in August 2015, the
WHO held a meeting to work out a "Comprehensive Care Plan for
Ebola Survivors" and identify research needed to optimize clinical care
and social well-being.
Saying "the Ebola outbreak has decimated families, health systems,
economies, and social structures", the WHO called the aftermath "an
emergency within an emergency."
Of special concern is recent research that shows some Ebola survivors
experience so-called Post-Ebola Syndrome, with symptoms so severe
that survivors may require medical care for months and even years.
67. Parts of Eastern India are still reeling under a sudden spurt of
Encephalitis cases. India’s Health Minister, Dr.Harsh Vardhan said
that more than 100 children in Bihar state have succumbed to the
virus this season.
India has faced annual outbreaks of Encephalitis with 500-600
people, mostly young children, dying in the northern state of Uttar
Pradesh.
This year over 100 people have died in West Bengal.
68.
69.
70. Health experts say 70 million children are at risk across
India. Japanese Encephalitis can be prevented by vaccination and the
use of mosquito control measures.
India launched an indigenously developed vaccine, JENVAC, for
Japanese Encephalitis in 2013.
Japanese Encephalitis is found in most Asian countries, where it is
endemic in the rainy season.
It is also found in areas where flood irrigation is common. Over
three billion people live in areas where Japanese Encephalitis is
endemic.
71. Middle East Respiratory Syndrome (MERS), a newly emerged viral
disease, was first detected among travellers to the Middle East in
2012.
Countries where MERS cases have been identified are: Lebanon,
Jordan, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab
Emirates, and Yemen.
MERS is caused by a corona virus that results in the rapid
development of a severe respiratory disease. If a person already has
an underlying respiratory condition, the disease is particularly severe.
72.
73. In Pakistan in 2011, over 14,000 people were infected with Dengue fever
and over 350 people died due to this viral disease.
Most of the outbreaks were concentrated in and around Lahore, in Punjab
province, in Pakistan.
There have been at least a dozen major Dengue outbreaks around the world
since the year 2000.
There are 5 types of the Dengue virus, but an infection with one does not
grant immunity to the others.
74. The Dengue epidemic continues till date in Pakistan, though
the government and medical charities are fighting the disease
with the support of international medical bodies.
75. The year 2009-2010 witnessed a global flu pandemic as a new versions of
the H1N1 influenza virus emerged and affected people worldwide. This was
the second global flu pandemic after 1918.
A combination of bird flu, swine flu, and human flu viruses combined with a
European Pig Flu virus led to the disease being known as Swine Flu.
Subsequently in June 2009, both the WHO and the US Centers for Disease
Control stopped recording count of new cases and the outbreak was declared
a pandemic. The disease was labelled Swine Flu by the American media,
whereas the WHO refers to it as pandemic H1N1/09 virus.
76.
77.
78. The H1N1 pandemic was declared ended on 10 August 2010 by the
then Director-General of the WHO, Margaret Chan.
According to the WHO, more than 18,000 people died worldwide
since H1N1 emerged in April 2009.
However, other research has shown that the global death toll was
much higher since many cases were unreported, particularly in Asia.
Revised estimates show that as many as 284,500 people were killed
by the H1N1 pandemic.
79. 2015 Indian swine flu outbreak refers to a outbreak of the 2009 pandemic
H1N1 virus in India, which is still ongoing as of March 2015.
The states of Gujarat and Rajasthan are the worst affected.
India had reported 937 cases and 218 deaths from swine flu in the year
2014.
By mid-February 2015, the reported cases and deaths in 2015 had
surpassed the previous numbers.
The total number of laboratory confirmed cases crossed 33000 mark with
death of more than 2000 people.
80.
81. The H1N1 virus outbreak had previously occurred India during
the 2009 flu pandemic.
The virus killed 981 people in 2009 and 1763 in 2010.
The mortality decreased in 2011 to 75.
It claimed 405 lives in 2012 and 699 lives in 2013.
In 2014, a total of 218 people died from the H1N1 flu, India recorded
837 laboratory confirmed cases in the year.
Every year, there was a rise in number of cases and deaths during
winter as temperature affects virus.
During 2014–15 winter, there was a spurt in cases at the end 2014.
In 2015, the outbreak became widespread through India.
On 12 February 2015, Rajasthan declared an epidemic.
82. On 13 February 2015, the Health Ministry began the procurement
process of 60,000 units of Oseltamivir (Tamiflu) and 10,000 units of
N-95 masks.
A tender for 10,000 diagnostic kits was floated.
The Health Ministry on 18 February 2015 said in a press release that
there was no shortage of drugs or logistics problems.
By 22 February 2015, more than 13688 had been infected and death
toll was reported to be 812 in the year 2015.
83. 2014 Odisha jaundice outbreak (initially known as the 2014 Sambalpur
jaundice outbreak) refers to an outbreak of mainly Hepatitis E and
also Hepatitis A which began in the town of Sambalpur in Odisha, India.
The cause of the outbreak was suspected to be the contamination to
drinking water supplied by the Public Health Engineering Department
(PHED).
By February 2015, it had spread and cases were being reported
from Bolangir district near Sambalpur, and some coastal districts
like Cuttack, Khurda and Jajpur.
The epidemic is still to be brought under control as of February 2015.
84. By 16 February 2015, the state had declared the districts Sambalpur,
Bolangir, Cuttack, Khurda, and Jajpur as jaundice affected.
By now Sambalpur had reported 2,945 and Cuttack had reported 116
cases, with there being total 3,966 cases from the state.
The official death toll was 36 but unofficially it was estimated to be
50.
A separate ward was set up in Shri Ramachandra Bhanj Medical
College, Cuttack to treat the victims.
85. The 2009 Gujarat hepatitis B outbreak was a cluster of Hepatitis
B cases that appeared in Modasa, northern Gujarat, India in 2009.
Over 125 people were infected and up to 49 people died.
Several doctors were investigated and arrested after the outbreaks.
The doctors were accused of re-using syringes, which had been
contaminated with hepatitis B virus, to treat other patients. Eight
medical practitioners were arrested under the Indian Penal
Code for culpable homicide not amounting to murder after allegedly
re-using infected syringes
86.
87. 224 medical teams, including some from All Indian Institute of
Medical Sciences and National Institute of Virology have set up
camps in Modasa, and remained there for at a month.
According to the officials 25,000 vaccines were sent to the most
affected area and 600,000 more vaccines are being arranged from
Hyderabad.
In addition, the government distributed 30,000 pamphlets and
mounted a campaign to inform residents about the disease.
The Health Department of the Gujarat government have sent 600,000
doses of vaccine to the area.2
88.
89.
90.
91.
92. Essential function of public health professionals
Opportunity to gain new knowledge of diseases and to discover the
weaknesses of the current public health practices and systems
The world today is especially prone to epidemics or outbreaks
because of rapid urbanization, migration of the people, poor sanitary
conditions, tourism etc..
92
93. Co-ordination between district health authority, public health and
engineering, ICDS sector, medical college, media and people is
needed during investigation.
Circulation of the report is necessary to spread the information so that
no such episodes occur in other areas in future.
94. K.Park, Park’s Text Book of preventive and social Medicine., 20th
edition.
P.V.Sathe and A.P.Sathe, Text book of Epidemiology and management
for health care for all, 2nd edition.
Sunderlal et al, Text book of community medicine, first edition, 2007.
Notes on surveillance, preventive and communicable disease,
directorate of health and family welfare services. Government of
Karnataka; January 2004.
Oxford text book of Public health, 4th edition,2002.
94
96. Importance of Time Place & Person in Epidemiology:
RGUHS May 2007- 10 mks
Major Epidemic Outbreaks since last 10 years & measures
taken at Public & Private Sector for the same: Saveetha
University: March 2011-10 mks.
Steps in Outbreak Investigation & its Epidemiology:
Sumandeep University: December 2009- 20 mks.
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