Question

1. The official pathways and chain for reporting a possible outbreak.
2. What it is like to work with the interprofessional team in an outbreak investigation following the 10 steps.
3. How to interpret a sample epidemic curve or incidence chart / graph for your assigned disease. (You must obtain this prior to your meeting.)
4. How to effectively work with the media to avoid public panic.
5. What scripted message you would give to the media for public education on an outbreak addressing how to avoid becoming ill, how to recognize signs and symptoms, what to do if illness is suspected, where to go for treatment, etc.
6. What ongoing community surveillance is being done in your area to monitor the status of the Healthy People goals

Answer 1

a. The occurrence of disease cases than normal expected number is called an outbreak. The outbreak of disease are usually by an infection, person to person contact, transmit through animal contact or from environment etc. The exposure to chemicals or radioactive elements can also cause outbreaks.

The practice of effective communication of outbreak is a dialogue between technical experts and the public.:
1. build trust: build maintain and restore public trust in those managing the outbreak and issuing information about it.
2.Early announcement: this is important as it leads to early containment . also this helps to win public confidence. delayed announcement creates an impression that authorities are concealing information.
3. Transparency: Being transparent means being candid, easily understood, complete and accurate. being transparent promotes high trust.
4. Public concerns should be respected: Public have the right to get information on their health and whatever affects their health.
5. Advance planning: Plan properly what to communicate, how to communicate and how to clarify when the questions are asked.

b. Investigating an outbreak is a step by step process.

1. Field work preparation: The investigators usually search for the cause and course of the illness from the clinic itself. If they feel a field investigation is essential, then they make ready for one.

Before starting field work, the investigator must have clear idea about the possible cause, risk and course of illness. They must discuss on the scientific aspects and lab studies with the concerned people and also regarding the personal protective equipments. The investigators must make a team and a leader must be there to co ordinate , manage and collaborate the activities.

2. Make sure its an outbreak: The cases may be an outbreak or just a cluster of cases of unrelated origin. The investigator has to establish it as an outbreak
3. Verify the diagnosis: The diagnosis are to be verified in order to identify the correct diagnostic and treatment measure for the disease. Also make clear lab investigations of the reported cases were done correctly, without error.
4. Define the case: This is done with the clinical criteria of the case, the time, location and person.
5. Orderly identify case and record them: Passive and active surveillance are made use and the cases are recorded with clear identification of case criteria. The identity of cases, demographic information, clinical information, risk factors identified, and reporter data.
6. Perform descriptive epidemiology: The systematic description of the key characteristics of the people affected with time, place and person is called descriptive epidemiology. Summarize the key characteristics of the people, identify at risk people from the data, getting clues on the etiology, source and modes of transmission, are done. descriptive epidemiology hints at where to start interventions and preventive actions.
7. Develop hypotheses: The hypothesis is formulated addressing the source agent, the mode of transmission and the exposures that caused the disease.
8. Epidemiologically evaluate hypotheses: This is done using the epidemiology, laboratory science and environmental evidence. The hypothesis can be compared with the facts and also relationships between variables can be quantified using analytic epidemiology.
9. Re evaluate hypothesis: The analytic studies may not reveal the causes sometimes. In such situation, the investigator may have to revisit the cases, their environments and the situations that caused the illness.
10. Comparison with environmental and lab studies : The lab reports can confirm the findings and the epidemiological studies can guide to appropriate action.
11. Implement control and prevention measures: Prevention is the primary control measure in most outbreaks. If appropriate control measures are available , that should be initiated, as soon as possible.
12. Initiate or maintain surveillance: Continuous monitoring along with the prevention and control measures has to be done. this makes sure the efficiency of control and prevention methods as well the reduction of new cases is happening.
13. Communicate findings: The task of summarizing the investigation, its findings and its outcome in a report and communicate it effectively.

c.

A graph (used here interchangeably with chart) displays numeric data in visual form. It can display patterns, trends, aberrations, similarities, and differences in the data that may not be evident in tables. As such, a graph can be an essential tool for analyzing and trying to make sense of data. In addition, a graph is often an effective way to present data to others less familiar with the data.

When designing graphs, the guidelines for categorizing data for tables also apply. In addition, some best practices for graphics include:

• Ensure that a graphic can stand alone by clear labeling of title, source, axes, scales, and legends;
• Clearly identify variables portrayed (legends or keys), including units of measure;
• Minimize number of lines on a graph;
• Generally, portray frequency on the vertical scale, starting at zero, and classification variable on horizontal scale;
• Ensure that scales for each axis are appropriate for data presented;
• Define any abbreviations or symbols; and
• Specify any data excluded.

c. the epidemiological graphs mostly have two axes, horizontal and vertical. The horizontal or x -axis shows the values of the independent variable and the vertical or y- axis shows a frequency measure such as number of cases or rates of disease. Each axis must be labelled to show what it represents (the name of the variable and the units in which it is measured) and marked by a scale measurement along the line.

A graph is visual representation of numerical data. It displays pattern, trends, similarities, differences etc. The graph is essential for analyzing and make sense of the data.

The graph must be able to stand alone with clear labelling of title, sources, axes, scales and legends.

Clearly identify the variables with the units of measure of the variables.

Define any abbreviations or symbols. Also specify any excluded data.

d. Media is mostly interested in sensationalizing the news than conveying the facts to the public. At the same time they are able to report the facts as early as possible to the public and make them adopt measures of control and prevention.

The early communication by the experts is a critical aspect in avoiding panic.

• The experts must go public to the media , even if the information is incomplete. Don't wait for written public release.
• Communicate what you know, what you don't know, and what you are doing . This transparency attracts public support as well as media help
• Inform that there will be updates on the information
• communicate often and update regularly.
• The expression of the experts must be calm and reassuring, which gives more support to the public than words.
• Don't be overconfident with delicate information and always be careful of the words used.