Outbreak Investigation

Competency 2: Design and conduct an outbreak investigation

1. Monitor for recognition of a potential disease outbreak
   1. List four sources of information that might indicate unusual disease activity (clinicians, patients, surveillance data, media)
2. Determine if a potential outbreak exists
   1. Evaluate the quality of information from various sources of disease reporting
   2. Describe the concept of background occurrence of a disease
   3. Identify what constitutes an unusual occurrence of a disease and a potential outbreak
3. Obtain help to assess and manage the potential outbreak
   1. Identify local, regional, state, federal, international, and tribal agencies and jurisdictions involved with case investigations, outbreak investigations, and responses to the public or media
   2. Describe roles of local, state, and federal governmental authorities in conducting an outbreak investigation
   3. List steps to obtain permission/cooperation from responsible authorities to proceed with an investigation
4. Establish a case definition based on person, place and time
   1. Collect information to formulate the demographic and temporal description of the apparent outbreak
   2. Organize data into a line-listing using computer software
5. Create a matrix of possible causation based on known toxic/infectious agents
   1. Locate information describing common pathogens (exposures) from state or university resources, publications, Internet sites
   2. Define and interpret the terms "latent period" and "incubation period" and determine these periods for common pathogens
6. Establish the background rate of disease
   1. Utilize existing surveillance data at local, state, and national levels to determine the background rate of occurrence of the disease
7. Find additional cases, determine extent of the outbreak
   1. Identify the steps in investigating an individual case
   2. Define purpose and formulate content of a case interview
   3. Define purpose and formulate content of a contact investigation
8. Examine the descriptive features of the outbreak
   1. Generate and interpret epidemic curves from outbreak or case cluster data
   2. Define and interpret basic descriptive epidemiology measures such as prevalence, incidence, case fatality, mortality
   3. Calculate basic descriptive epidemiology measures such as prevalence, incidence, case fatality, mortality
9. Formulate a hypothesis of disease causation
   1. Choose an appropriate study design for a given research question
   2. Formulate the null and alternative hypothesis for a given research question and study design
10. Test the hypothesis of disease causation
    1. Identify appropriate subjects for a given research question and study design
    2. Define and contrast the terms: validity, reliability, precision and accuracy
    3. Define exposure and outcome in a study and set up a 2x2 table to show the relationship between exposure and outcome
11. Collect and test clinical and environmental samples
    1. List and describe the procedures for collecting human samples from various sites (i.e. nasal, blood, throat, stool)
    2. List and describe the procedures for collecting environmental samples from various substances (e.g. water, soil, food, air, workplace substances, animal)
    3. Identify environmental specialists to contact for assistance with environmental sampling
12. Put control measures into effect
    1. List resources necessary to establish special surveillance for emergency situations
13. Interact with the public and the media
    1. Identify key results that are important to convey to the public
    2. Develop a communication plan using a designated spokesperson
    3. List media sources to contact about an outbreak
    4. Convey public health information to the media about the outbreak