Field Epidemiology

Topics: Epidemiology, Outbreak, Public health Pages: 5 (881 words) Published: November 25, 2012
Field Epidemiology-10
Field epidemiology the application of epidemiology under a set of general conditions: The problem is unexpected
A timely response may be demanded
Travel to and work in the field is required by epidemiologists to solve the problem The investigation time is likely to be limited because of the need for a timely intervention Field investigations involving acute problems may differ from conventional epidemiologic studies in three important ways 1. Field investigations often do not start with a clear hypothesis 2. Acute problems involve an immediate need to protect the public and resolve the concern 3. Field epidemiologists must decide when the available information is sufficient to take appropriate action Steps in field investigation

1. Establish the existence of an epidemic (or outbreak)
a. Attack rates are appropriate statistics for investigating disease outbreaks because they describe rapidly occurring new cases of disease in a well-defined population over a limited time period. b. Attack rates are usually calculated by person characteristics (e.g., age, sex, race/ethnicity, and occupation) in order to identify high-risk groups. 2. Confirm the diagnosis

c. Assessment of the clinical findings should be done to assure correctness and reliability of the findings d. Clinical diagnosis by appropriately trained individuals e. Laboratory diagnosis

3. Establish criteria for case identification
f. Standard clinical criteria (what)
g. Loose case definition vs. strict case definition
h. A case may be further characterized by
i. Who
ii. When
iii. Where
4. Search for missing cases
i. Investigation may include
iv. Physicians
v. Clinics
vi. health maintenance organizations
vii. hospital emergency rooms
viii. public health clinics
ix. migrant health clinics
x. and related facilities
j. Asymptomatic persons or mild cases and their contacts should be evaluated k. Suspected cases vs. probable cases
5. Count cases
l. Exposure status and disease frequency need to be determined and compared with the appropriate at-risk population 6. Orient the data according to person, place, and time
m. Person
xi. Inherent characteristics or people (age, race/ethnicity, sex) xii. Acquired characteristics (immunity or marital status) xiii. Activities (occupation, leisure, use of medications) xiv. Conditions (socioeconomic state, access to health care) n. Place

xv. Residence
xvi. Birthplace
xvii. Place of employment
xviii. School district, hospital unit
xix. Country
xx. State
xxi. County
xxii. Census tract
xxiii. Street address,
xxiv. Map coordinates, etc
o. Time
xxv. Epidemic curve
7. Classify the epidemic
p. Common Source
q. Propagated
r. Mixed
8. Determine who is at risk of becoming a case
s. Clinical, medical, and lab findings need to be confirmed, evaluated, and analyzed for all cases to substantiate the diagnosis t. Classify cases by exposure status
9. Analyze the data
u. The epidemiologist gathers, compiles, tabulates, analyzes, and interprets the findings v. Analysis often involves statistical methods
xxvi. Frequency tables
xxvii. Bivariate analyses
xxviii. Multiple regression
10. Formulate a hypotheses
w. In a food-borne outbreak, for example, hypotheses should be developed for the following: x. The source of infection
y. The vehicle of infection
z. The suspect foods
{. The mode of transmission
|. The type of pathogen (based on clinical symptoms, incubation periods) }. The time factors in the outbreak and course...
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