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

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

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

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

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

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

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

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

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

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

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

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

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

14. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypotheses 7)Evaluate hypotheses 8)Refine hypotheses and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

15. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypotheses 7)Evaluate hypotheses 8)Refine hypotheses and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

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

17. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypotheses 7)Evaluate hypotheses 8)Refine hypotheses and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

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

19. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypotheses 7)Evaluate hypotheses 8)Refine hypotheses and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

20. SGOT AltSGOT DiagnosticLab Signs and Symptoms Case#Initials Date of Report Date of Onset Physician Diagnosis NVAFDUJHAIgMOtherAgeSex 1JG10/1210/6Hep A+++++++37M 2BC10/1210/5Hep A+-+++++62F 3HP10/1310/4Hep A+-+++ S*S* +30F 4MC10/1510/4Hep A--++?-+ Hbs/ Ag- 17F 5NG10/1510/9NA--+-++ 32F 6RD 10/15 10/8Hep A++++++ + 38M 7KR10/1610/13Hep A+-+++++ SGOT = 240 43M S*=Sclera;, N=Nausea; V=Vomiting; A=Anorexia; F=Fever; DU=Dark urine; J=Jaundice; HAIgm=Hepatitis AIgM antibody test

21. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypotheses 7)Evaluate hypotheses 8)Refine hypotheses and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

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

24. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypothesis 7)Evaluate hypothesis 8)Refine hypothesis and carry out additional studies 9)Implement control and prevention measures 10)Communicate findings

25. CALCULATE AN ODDS RATIO Case Patients ControlsTotal Ate at Restaurant A? Yesa = 30b = 3666 Noc = 10d = 7080 Total: 40106146 (a)(d)/(b)(c) = 5.8

26. Location Visited the Location? Cases (ill) Controls (not ill) Odds Ratio HOMECO Yesa = 9b = 2 Noc = 1d = 8 COFFEE JUNCTION Yesa = 5b = 3 Noc = 5d = 7 VALUE WORLD Yesa = 5b = 6 Noc = 5d = 4

27. Number of people who ate specified item Number of people who did not eat specified item FoodIllWellTotal Attack Rate % IllWellTotal Attack Rate % Baked Ham 2917 466317122959 Spinach26 17 436020123262 Mashed potat oes* 23 14 376223143762 Cabbage salad 18 10 286428194760 Jell-O16 7 237030225258 Rolls2116 375725133866 Brown bread 189 276728204858 Milk22 45044277162 Coffee1912 316127174461 Water1311 245433185165 Cakes2713 406719163554 Ice Cream (van) 4311 54803182114 Ice Cream (choc )* 2522 47532072774 Fruit Salad42 66742276961 Attack Rates by Items Served at a Church Supper, Oswego, New York, April 1940

28. INVESTIGATING AN OUTBREAK Center for Disease Control (CDC) 1)Prepare for field work 2)Establish the existence of an outbreak 3)Verify the diagnosis 4)Define and identify the cases 5)Describe and orient the data in terms of time, place, and person 6)Develop hypothesis 7)Evaluate hypothesis 8)Refine hypothesis 9)Implement control measures 10)Communicate findings

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

30. Activity Summary Data Table ACTIVITY# ILL STUDENTS INVOLVED IN ACTIVITY # ILL STUDENTS NOT INVOLVED # WELL STUDENTS INVOLVED IN ACTIVITY # WELL STUDENTS NOT INVOLVED Football 8764 Café 12382 Fair 9455 Swimming 8764 Cookout 13246

31. Food Number of Students Who Ate the ItemNumber of Students Who Did Not Eat the Item IllWellTotalAttack Rate %IllWellTotalAttack Rate % Chicken 53810717 Hamburger 6399716 Homemade Ice Cream 130 21012 Celery 73108715 Milk 73108715 Hotdog 52710818

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

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