Oswego Outbreak Case Study

Oswego Outbreak Case Study

Oswego Outbreak Case Study

Read the “Oswego Outbreak Investigation,” located in the Topic Materials.

Part 1

Complete the following:

1. Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance.
2. Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission?
3. Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale.

Part 2

In a 500-750 word paper, evaluate the situation and present your findings. Including the following:

1. Does this case meet the definition of an “outbreak?” Why or why not?
2. Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful.
3. Discuss the possible routes of transmission for the expected agent.
4. Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies.

COMPLETE TABLE 2

8. What food do you think is responsible for the outbreak? Why?
9. DO NOT SUBMBIT
10. What are some reasons why people who did not eat the implicated food got sick, and people who did eat the implicated food did not get sick?
11. What control measures would you suggest?

12. DO NOT SUBMIT

Table 2:        Food-Specific Attack Rates for Selected Items Consumed,

                    Oswego Church Supper, April 18, 1940, 6:00 p.m. – 11:00 p.m.

APPENDIX A

Steps of an Outbreak Investigation

Listed is a conceptual approach to outbreak investigation.  These steps are not in fixed order.  In practice, several steps may be done at the same time, or carried out in a different order.  Many components are dynamic:  case definitions, line listings, descriptive epidemiology, and hypotheses all can change with additional information.

1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Define and identify cases
   1. Establish a case definition
   2. Identify and count cases (line-listing)
5. Perform descriptive epidemiology (person, place, and time)
6. Develop hypotheses
7. Evaluate hypotheses
8. Reconsider/refine hypotheses
9. Implement control and prevention measures
10. Communicate findings

APPENDIX B

The Epidemic Curve

An epidemic curve is a graph that depicts the distribution of onset times for the initial symptoms of all cases that occurred in a disease outbreak.  To draw an epidemic curve, select an appropriate time unit for the x-axis.  The x-axis represents the time of onset, and covers the entire time course of the epidemic.  Commonly used time units in outbreak investigations are hours, days, and weeks.  The y-axis displays the number of cases.  Time of onset may be unknown for some cases, and these cases cannot be included in the epidemic curve.

The shape of the epidemic curve assists in determining whether the outbreak originated from a common-source, such as food, or person-to-person propagation. A common-source epidemic curve is characterized by a sharp rise to a peak; with the fall usually being less abrupt. The curve continues for a period approximately equal to the duration of one incubation period of the disease. A person-to-person curve is characterized by a relatively slow, progressive rise. The curve will continue over a period equivalent to the duration of several incubation periods of the disease.

Example of an epidemic curve (common-source):

 Example of an epidemic curve (person-to-person):

APPENDIX C

An Abbreviated Compendium of

Acute Foodborne Gastrointestinal Diseases

Source:  CDC, 1992 Epidemic Intelligence Service Course

An Abbreviated Compendium of Acute Foodborne Gastrointestinal Diseases

*B=bloody stools; C=cramps; D=diarrhea; F=fever; H=headache; N=nausea; V=vomiting
An Abbreviated Compendium of Acute Foodborne Gastrointestinal Diseases

*B=bloody stools; C=cramps; D=diarrhea; F=fever; H=headache; N=nausea; V=vomiting
An Abbreviated Compendium of Acute Foodborne Gastrointestinal Diseases

*B=bloody stools; C=cramps; D=diarrhea; F=fever; H=headache; N=nausea; V=vomiting

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Oswego Outbreak Case Study

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