Investigation of An Epidemic

INVESTIGATION OF AN
EPIDEMIC
OBJECTIVES
 To define the magnitude of the epidemic outbreak
or Involvement in terms of time, place and person
 To determine the particular conditions and factors
responsible for the occurrence of the epidemic
 To identify the cause, source of infection, and
modes of transmission to determine measures
necessary to control the epidemic and
 To make recommendations to prevent recurrence
VERIFICATIONS OF DIAGNOSIS
 It is the first step ,do as quickly as possible. It is not

necessary to examine all the cases to arrive at a
diagnosis. clinical examination of a sample of cases
may well suffice. Lab investigations are most
useful to confirm the diagnosis but the
epidemiological investigations should not be
delayed until the lab results are available
CONFIRMATION OF THE EXISTENCE OF AN
EPIDEMIC
 Second step. Done by comparing the disease

frequencies during the same period of previous
years. An epidemic is said to be exist when the no.
of cases is in excess of the expected frequency for
that population based on past experience
DEFINING THE POPULATION AT RISK
A.Obtainig a map of the area.

Before beginning the investigation it is necessary to have a detailed
and current map of the area. It should contain information
concerning natural landmarks, roads and location of all dwelling
units in each road or in isolated areas. Area may be divided into
segments, using natural landmarks as boundaries. This may again
divided into smaller sections. Within each section the dwelling
units may be designated by numbers.
B.Counting of the population
A complete census of the population by age and sex by house to
house visits(if the general population affected)
RAPID SEARCH FOR ALL CASES AND THEIR
CHARECTERISTICS
A. Medical survey
To identify all cases including those who have not
sought medical care and those possibly exposed to
risk. Complete survey will pick-up all affected
individuals with symptoms or signs of disorder.
CHARECTERISTICS
B.Epidemiological case sheet

This includes:
Name,Age,Sex,Occupation,Socialclass,Travell,
History of previous expossure,Time of onset of
disease,Signs&Symptoms of illness,Personnel contact at
home,work,school and other places,Special events such as
parties attended, Foods eaten, and exposure to common
vehicles such as water, food and milk, visits out of the
community, History of injections, or blood products,
attendance at large gatherings. If the out break is large-
random sample.
CHARECTERISTICS
C.Searching for more cases:

Patient may be asked if he knew of other cases in the
home,family,neigbourhood,school,workplace,
having an onset within the incubation period of
the index case, cases admitted to local hospitals should
also be taken into consideration. Search should be
carried out every day till the area is declared free of
epidemic. This period is usually taken as twice the
incubation period of the disease since the occurrence
of last case
DATA ANALYSIS
A . Prepare a
chronological distribution
of dates of onset and
construct an epidemic
curve
DATA ANALYSIS
B. Place
prepare a spot map of cases(geographic distribution)
and if possible their relation to possible sources of
infection eg:water supply, air pollution, foods
eaten, occupation etc.Clustering of cases may
indicate a common source of infection
DATA ANALYSIS
C.Person
Analyze the data by age,sex,occupation and other
possible risk factors. Determine the attack rate/
case fatality rate
FORMULATION HYPOTHESES
 On the basis of time-place-person/agent-host-
environment model, formulate hypotheses to
explain the epidemic in terms of
A. Possible source
B. Causative agent
C. Possible mode of spread and
D. The environmental factors which enabled it to
occur
TESTING OF HYPOTHESES
 All possible hypotheses need to be considered and
weighed by comparing the attack rates in various
groups for those exposed, those not exposed to
each suspected factor
EVALUATION OF ECOLOGICAL FACTORS
Evaluation of the circumstances involved should be

carried out to undertake appropriate measures to
prevent further transmission
Sanitary status of eating establishments, water and
milk supply, breakdown in the water supply system,
movements of the human population, atmospheric
changes such as temp.,humidity and air pollution,
population dynamics of insects, and animal reservoir
Source-reservoir-modes of transmission
FURTHER INVESTIGATION OF POPULATION
AT RISK
Medical examination, Screening tests, examination of

suspected food,faeces or blood samples,
biochemical studies,assesment of immunity status
WRITING THE REPORTS
The report should be complete and

convincing.
CONTENTS OF REPORT
1. Back ground
2. Historical data
3. Methodology of investigation
4. Analysis of data (clinical data,Epideiological data,
modes of transmission, Lab data, Interpretation of
data)
5. Control measures
6. Evaluation
7. Preventive measures
BACK GROUND
 Geographical location
 Climatic conditions
 Demographic status(Population pyramid)
 Socio-economic situation
 Organization of health services
 Surveillance&early warning systems
 Normal disease prevalence
HISTORICAL DATA
 Previous occurrence of epidemics
1.Of the same disease
2.Locally or elsewhere
Occurrence of related diseases if any
In the given area
In other area
Discovery of first case of the present outbreak.
METHODOLOGY OF INVESTIGATION
 Case definition,
 Questionnaire used in epidemiological investigation
 Survey teams
a. House to house
b. Retrospective
c. Prospective
Collection of Lab. Specimens
Lab techniques
ANALYSIS OF DATA
A. Clinical data
1.Frequency of signs&symptoms
2. Course of disease
3. Different diagnosis
4. Death or sequelae rates
B.Epidemiological data
1.Mode of occurrence
2. In time
3.By place
4. By population groups
ANALYSIS OF DATA
C. Modes of transmission
1. Source of infection
2. Route of excretion and portal of entry
3. Factors influencing transmission
D. Lab data
1. Isolation of agents
2. Serological confirmation
3. Significance of results
ANALYSIS OF DATA
E. Interpretation of data
1. Comprehensive picture of the outbreak
2. Hypotheses on causes
3. Formation and testing hypotheses by statistical
analysis
CONTROL MEASURES
 Definitions of strategies and methodology of
implementation
 Constraints
 Results
EVALUATION
 Significance of results
 Cost/Effectiveness
 Preventive measures
THANK YOU
SUGUNAN.KR
HEALTH INSPECTOR
PHC PINDIMANA&PUNNEKKAD
MOB:9446024671

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INVESTIGATION OF AN

 It is the first step ,do as quickly as possible. It is not

 Second step. Done by comparing the disease

A.Obtainig a map of the area.

B.Epidemiological case sheet

C.Searching for more cases:

Evaluation of the circumstances involved should be

Medical examination, Screening tests, examination of

The report should be complete and

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