Epidemiological Exercises

EPIDEMIOLOGICAL EXERCISES
EPIDEMIC – The unusual occurrence of disease, health related

behavior(eg-smoking) or health related events(eg- traffic accidents)in a
region in a specified time period clearly in excess of expected
occurrence.
Outbreak – when epidemic is small and localized
Common Outbreaks in Nepal - Diarrhea, Viral fever, Dengue, Food

poisoning, mushroom poisoning, alcohol adulteration, hepatitis A & E
Steps in Epidemic investigation
1. Verification of diagnosis: Clinical examination, lab investigations -
transport media for stool specimen in cholera- alkaline peptone
water
2. Confirmation of the existence of an epidemic: Compare the disease
frequencies during same period of previous years
3. Defining the population at risk: Obtain map of the area, entire
population or subgroups (denominator)
4. Rapid search for all cases
a. Medical survey to identify all cases
b. Epidemiological case sheet relevant to the disease under study
c. Searching for other cases
5. Data analysis in terms of
a.Time : Construct an epidemic curve, look for clustering of cases, is it a
common source or propagated epidemic, is it due to seasonal or
cyclical fluctuation
b.Place: Prepare spot map of cases, relation to possible sources of
infection eg. Water supply, air pollution, foods eaten, occupation
c.Person: Analyze data by age, sex, occupation, other possible risk
factors. Determine attack rate, case fatality rate for exposed and non
exposed.
d.Identify common event or experience and the group involved
6. Formulation of hypothesis: To explain the epidemic in terms of
a. possible source/ causative agent
b. possible modes of spread
c. environmental factors which enabled it to occur
7. Testing of hypothesis
8. Evaluation of ecologic factors: Sanitary status of eating establishments,

water/ milk supply, population movement, atmospheric changes
temperature, humidity, vector density, animal reservoirs
9. Further investigation of population at risk: Medical examination,
screening, examination of suspected food, feces, blood samples,
biochemical studies, assessment of immunity
10. Report writing which includes control measures - Treatment,

Prophylaxis, Chemoprophylaxis, Vaccination, Environmental
sanitation, Food hygiene
Secondary Attack Rate (SAR)
Number of exposed persons developing the disease within the range
of the incubation period, following exposure to the primary case
– important measure of communicability
SAR = (No. of exposed persons developing disease within the
incubation period) / (Total number of susceptible contacts) X 100
Primary case excluded from numerator & denominator
Other indicators – Incidence, Case Fatality rate
1. 16 cases of cough and rashes were reported among children from a
school in Kathmandu. Initially one boy developed fever and within 4
days, 15 other children reported similar symptoms. About 60 children
had been exposed to the ill child. 2 of the total cases died
•What is an epidemic and outbreak?
•What is primary case and index case?
•What is the secondary attack rate in this situation and what does it
measure? – (16-1)/60 = 15/60= 0.25 = 25%
•Calculate CFR. What does it measure?
2. In a hostel of 51 students 1 boy developed fever and cough and after
few days 25 other boys developed same features. Calculate SAR .
Epidemiology – The study of distribution and determinants of health
related states or events in a specified population and application of
study to the control of health problems. – John M Last
Epidemiologic methods/studies
1.Observational – Descriptive Analytical – Case control , Cohort
2. Experimental/ Intervention studies – Randomized Control
trials(RCT) , Community trials
Epidemiological Exercises
In a study, 40 men with lung cancer and 50 men with no
apparent disease were contacted and asked whether they were chain
smoker. 30 men with lung cancer and 10 men without disease gave a
positive history for chain smoking.
a. What kind of study design is this and why?
b. Draw a 2x2 table for this study.
c. Calculate the exposure rates.
d. Measure the strength of association between chain smoking & lung
cancer.
e. Write 2 advantages & disadvantages of this type of study
1.In a study begun in 1985, a group of 2000 adults in Kathmandu were
asked about alcohol consumption. 1000 adults consumed alcohol. The
occurrence of cases of liver cancer was studied in this group. 400
adults who drank alcohol developed liver cancer and 50 adults who did
not drink developed liver cancer over a 20 year follow up.
a)What kind of study design is this?
b)Calculate Relative Risk(RR), Attributable risk(AR) & interpret your
result
c)Write 2 advantages & disadvantages of this type of study
2
• If incidence of skin allergy amongst people exposed to a chemical is
400 per 1000 and that amongst non exposed is 100 per 1000
population at risk, calculate RR & AR.
The results of a comparison of disease status with results of a
biochemical investigation is as follows:
Screening Disease +ve Disease -ve Total
Test Positive 40 20 60
Test Negative 10 30 40
50 50 100
a. Define & calculate Sensitivity & Specificity

b. Calculate predictive values of negative and positive
c.Interpret your results.
• Thank you

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EPIDEMIOLOGICAL EXERCISES

EPIDEMIC – The unusual occurrence of disease, health related

Common Outbreaks in Nepal - Diarrhea, Viral fever, Dengue, Food

8. Evaluation of ecologic factors: Sanitary status of eating establishments,

10. Report writing which includes control measures - Treatment,

a. Define & calculate Sensitivity & Specificity

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