1. Line Listing Lesson Objectives: –Create and maintain a line listing –Explain why a line listing is an important part of an epidemiological investigation –Explain how line listing techniques change according to the specific outbreak investigation

2. Introduction: Line Listing

3. What is a Line Listing A line listing is a method of organizing, storing, and analyzing potential cases that appear throughout the investigation. A line listing allows information about time, person, and place to be organized and reviewed quickly.

4. When and Why

5. Using Line Lists to Plan for the Next Step of an Investigation Find missing data Explore trends –Gender –Age –Date of Onset –Geographic location Create an Epi curve

6. Items to Include in a Line Listing Identifying information –Full Name or ID number of potential cases Clinical information –Symptoms –Date of symptom onset –Date of diagnosis Demographic information –Gender, age, race, occupation Geographic information –Place of residence, place of work Exposure information –Potential sources of disease exposure Other items could include: –Dietary habits, sexual behavior, recreational activities, or hobbies

7. Sources of Information for a Line Listing Interview with patients/health care providers School attendance sheets Medical records Business receipts Party guest lists Surveys Questionnaires Etc…..

8. Tools Used to Create a Line Listing By hand: –Pen and Paper Electronically: –Microsoft Excel –Microsoft Access –EpiInfo (www.cdc.gov/epiinfo/index.htm)

9. How to Make a Line Listing Develop a table Each row identifies a single case Each column describes a variable of interest Update the line listing as new information becomes available Use abbreviations or codes to keep the line listing simple

10. Example 1 Example Line List for acute Hepatitis A* Signs/Symptoms Labs Demographics Case # Report DateOnset Physician DiagnosisNVAFDJHAIgMOtherSexAge 110/12/0710/2/07Hepatitis A1111111 Low SGOTM37 210/15/0710/5/07Hepatitis A1011111Low AltM35 310/16/0710/6/07Hepatitis A1011111 Low SGOTM38 410/16/0710/6/07NA0010?0 F44 510/17/07 Hepatitis A1111001Hbs/Ag-M17 610/17/0710/7/07Hepatitis A0011111SGOT=24F33 N=nausea V=vomiting A=elevated aminotransferase F=fever D=discreet onset J=jaundice HAIgM=hepatitis AIgM antibody test SGOT=serum glutamic oxaloacetic transaminase ALT=alanine aminotransferase Hbs=hepatitis B surface antigen 1=“yes”, 0=“no”

11. Dengue Fever Line Listing NameDate of Birth Onset Date RashFever? If yes, temp Other symptoms Lab results Elizabeth Hatch 21 Jun, 1970 July 6YesYes – 39°Vomiting, muscle aches Yes Mary Ridgeway 12 Dec, 1971 July 6NoYes - 38°Headache, muscle ache Yes Stephen Mara 3 Jul, 2004 July 7YesNoHeadache, vomiting No Rajnesh Ram23 Sep, 2000 July 2YesNoVomitingYes Lauan Korovavala 4 Apr, 1995 July 10NoYes – 38.5° HeadacheNo Example 2

12. Example 3 Line Listing regarding the Outbreak of Serious Birth Defects, 2002

13. Conclusion Line listing is integral to an outbreak investigation Allows investigator to organize, store, and analyze information Provides information about the source of the outbreak, the disease involved, and populations most likely to have been affected Helps create an epi curve for the outbreak Line listing is an important skill that can be applied to a wide range of epidemiological investigations

14. Question 1.Why is it important to make a line listing? (check all that apply) a)To organize information coming from different sources b)To better understand the nature and path of an outbreak c)To refine a case definition d)To enable data sharing between different investigators

15. Answer 1.Why is it important to make a line listing? (check all that apply) a)To organize information coming from different sources b)To better understand the nature and path of an outbreak c)To refine a case definition d)To enable data sharing between different investigators Answer: All of the above are reasons why it is important to make a line listing.

16. Question 2.When would it be appropriate to use an identification (ID) number instead of a full name? a)When the line listing will only be used internally b)When the line listing will be shared with other agencies

17. Answer 2.When would it be appropriate to use an identification (ID) number instead of a full name? a)When the line listing will only be used internally b)When the line listing will be shared with other agencies Answer: (b) It is appropriate to use an ID number instead of a full name when the line listing will be shared with other agencies. This is to protect the confidentiality of the case whose information is presented.

18. Question 3.What are some common sources of information for a line listing? (check all that apply) a)Patient records b)School attendance lists c)Party guest lists d)Survey data e)Interviews

19. Answer 3.What are some common sources of information for a line listing? (check all that apply) a)Patient records b)School attendance lists c)Party guest lists d)Survey data e)Interviews Answer: All of the above are common sources of information for a line listing.

20. Question 4.In a line listing, the data should be organized with: a)Individual cases in each column and variables in each row b)Individual cases in each column and other cases in each row c)Variables in each column and other variables in each row d)Individual cases in each row and variables in each column

21. Answer 4.In a line listing, the data should be organized with: a)Individual cases in each column and variables in each row b)Individual cases in each column and other cases in each row c)Variables in each column and other variables in each row d)Individual cases in each row and variables in each column Answer: (d) In a line listing, the data should be organized with individual cases in each row and variables in each column.

22. Question 5.To keep line listings simple a)Eliminate variables b)Include fewer cases c)Use abbreviations or coding, with accompanying key

23. Answer 5.To keep line listings simple a)Eliminate variables b)Include fewer cases c)Use abbreviations or coding, with accompanying key Answer: (a,c) To keep line listings simple, use abbreviations or coding, with accompanying key. Some variables may be eliminated as the case definition is further refined, but it may be necessary to keep the line listing broad in the beginning so that potential contributors to the outbreak are not overlooked. As many cases as possible should be included in the line listing to enable better tracing or the disease and to better understand potential sources of the outbreak.

24. References Torok, M. and the FOCUS Workgroup. Case finding and line listing: a guide for investigators. Focus on Field Epidemiology. 1(4):1-6. Available at: http://nccphp.sph.unc.edu/focus/issuelist.htm. Accessed December 5, 2007. Nair, Alison. Public health measurement. PowerPoint presentation for the CDC Ambassador Program; June, 2004.