Course Project Part 2: Preparing for an Investigation
Based on reading in the Introduction to Applied Epidemiology and Biostatistics, what actions should you, as the epidemiologist, consider to determine if EATC has
an outbreak of GI illnesses?
Later in the course you will learn how to develop a hypothesis for the cause of an outbreak. Like a criminal detective investigating a crime, an epidemiologistÂ’s
natural reaction to an outbreak is to theorize the cause(s) of the GI illnesses. What is your theory of the cause of the GI illnesses at this very early stage of the
investigation?
With the information collected thus far, can you make a decision to continue or not to continue with the investigation at EATC? Why or why not should the public
health department continue the investigation?
COURSE PROJECT PART 2: SCENARIO
Preparing for an Epidemiology Investigation on a Possible Disease Outbreak in the Eastern Adult Training Center Background: As the newly hired field epidemiologist at
Yourtown Public Health Department, you have learned that your new responsibilities include: • Monitoring communicable disease trends in the community by using various
means of disease surveillance • Working with health care practitioners and facilities to apply appropriate infectious disease control practices and; encouraging these
groups to report unusual occurrences of disease and disease outbreaks to you. • Leading a team of public health professionals to investigate disease outbreaks. Your
investigations may include a simple review of the facts and consulting with individuals or organizations about disease control, or an investigation could involve an
epidemiology study (cohort, case control, experimental). The team’s mission is to identify the cause and to control outbreak associated morbidity and mortality in the
population. • Communicate disease trends and outbreak investigations to various public health stakeholders. Issue: An infirmary nurse from an adult residential
facility called at 8:00 A.M. to report an increase in the number of residents who had gastrointestinal (GI) illnesses. Nurse Jean explained that due to the medical
conditions of these patients, complaints of GI illness are not unusual. However, beginning in the early morning hours, residents located in separate residential
cottages began to have repetitive boats of explosive diarrhea. Jean requested the health department investigate the abnormal pattern of diarrhea in her facility. You
politely replied that you would contact her with a time you can visit. Before you notified your disease outbreak investigation team about Jean’s call, you knew you
must determine the extent of the problem before committing public health resources to a possible outbreak. For this reason, you decided to visit the facility to
determine the health department’s role, if any, in Jean’s request. Before you left your office you conducted some research on the facility and found the following
information: • The facility, EATC, is a government managed residential training center for 198 adults who receive assistance developing cognitive and independent
living skills. Most residents have learning disabilities combined with complex chronic medical conditions. • The residents’ age range is between 20 years old to 60
years old. • There are up to 10 residents, both male and female, who live in a cottage. Each of the 20 cottages, clustered in five groups of four, have 2-person
bedrooms, a kitchen, den, two bathrooms and a dining area.
• Food is cooked in a central cafeteria-like-kitchen and transported in a cart to each cottage. Each resident has a diet plan whose food is placed on a meal tray
similar to one used for in-patients at a hospital. Residents with digestive complications are tube-fed or their meal is puréed. • Some employed residents eat lunch
off campus. • Family may take residents off campus for entertainment or meals. • Two staff members are assigned to each cottage 24 hours a day, seven days a week. •
EATC has a history of diarrhea outbreaks which may be associated with food or could have resulted from a viral infection that caused multiple cases of illness. There
is a small medical infirmary staffed by a Nurse Practitioner and Registered Nurses. • Ill residents are being treated with anti-diarrheal medication and with fluids.
You also consulted with your office’s public health nurse and health inspector (the health inspector is responsible for certifying food establishments follow safety
regulations) who participated in EATC’S diarrhea outbreak a couple of years ago. You invited them to go on your visit to EATC. After visiting Nurse Jean and the EATC
Director, you reported the following information to the Public Health Outbreak Response Team:
• 31 residents had diarrhea onset in the past 24 hours. Nurse Jean would expect one or two complaints of diarrhea a day o Symptoms included stomach cramps and multiple
(>than three) bouts of explosive diarrhea o Earliest onset of symptoms occurred at 9:00PM on November 2rd with most of the cases starting after 1:00PM o No new cases
of diarrhea after 12:00PM November 3rd • 4 residents were sent to the emergency department. One resident was admitted to the hospital. The emergency discharge
diagnosis was dehydration due to gastritis. The admitted resident also had this diagnosis but was admitted for unrelated reasons. • Six raw stool specimens were
collected and submitted for laboratory testing. • A recent health inspection of the facilities kitchen found five health code violations. The violations included
malfunctioning food preparation equipment, improper temperatures in the food freezer, dishwasher not reaching adequate temperature and improper temperature controls
during food preparation. • No threatening environmental conditions (chemicals, animals, gases, radiation…) were detected within or outside the cottages. • The
facility had a party four days ago in which foods and beverages were brought in by family. No list of the party food was available but included high sugar content
items like candy, cupcakes and fruit punch. • A menu of meals served for the previous month is available and samples of food served in the past week was kept in the
freezer. The menu items rotate every three weeks. • The kitchen manager is on short-term disability leave so a shift supervisor is overseeing kitchen operations in
addition to his normal duties. There are two kitchen shifts that prepare, cook and serve food. • No kitchen, medical or cottage staff have reported having diarrhea in
the past 24 hours • No laboratory diagnosis has been reported • No outbreaks of diarrhea have been reported in the community
• The facility is managed and funded by the State Government’s Department for Human Services and Rehabilitation • The facility receives significant financial
reimbursement from Medicaid • The facility is regulated by a branch of the State health department for medical facility licensing • The mass media is not yet aware
of the outbreak
