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Thestepsinoutbreakinvestigationincludingtheuseof
relevantepidemiologicalmethods
CommunicableDiseaseControl:OutbreakInvestigation
Thissectioncovers:

Thestepsinoutbreakinvestigationincludingtheuseofrelevantepidemiologicalmethods

TheSevenstepsofanoutbreakinvestigation
Sourcesofoutbreaks
Potentialoutbreakskeyfacts

TheSevenstepsofanoutbreakinvestigation
1.Preliminaryassessmentinoutbreakinvestigation
(toconfirmexistenceofoutbreak)
isthereanoutbreak?Reviewcases,particularlywithregardtotime/place/person(age,sex,occupation),numbers,placeof
residence
confirmnumbers
interviewcasesifpossible
discusslaboratoryresultsandrepeatifnecessary
consultexpertsattheHealthProtectionAgency's:CentreforInfection(CfI)ormorelocallyatHPU
isfurtherinvestigationneeded?
reviewliteratureandsurveillancedata
aretherestillcasesoccurring?Howserious?
formOutbreakControlTeam(OCT)ifprelimassessmentsuggestsactualoutbreak,ensuringthefollowingarerepresented
inthemembership:
ConsultantinCommunicableDiseaseControl(CCDC)
EnvironmentalHealthOfficer(EHO)
microbiologist
pressofficer
secretary
andconsider:
regionalepidemiologist
CDSCSpecialist

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waterboard
InfectionControlNurse(ICN)
NB:

OutbreakType Outbreakcontrolteamconsiderincluding:

foodorwaterborne EnvironmentalHealthOfficer(EHO)

wateralone Relevantwatercompany

NHSpremises InfectionControlNurse/InfectionControlDoctor
SeniorManager

MorethanonePCT CDSCandRegionalEpidemiologist

zoonoticdisease stateveterinaryservice/DEFRA

occupationallookbacks occupationalhealthdepartment

generateinitialhypothesis
initiateimmediatecontrolmeasuresasnecessary,forexample:
EnvironmentalHealthOfficertovisitandsample
stopsymptomaticfoodhandlersfromworking
clean/disinfectpremises
recallproduct
treatpatients
offerprophylaxistocontacts

2.Casedefinitionandidentification

define'cases'intermsoftime/place/person/symptoms/labresults
definepopulationatrisk
caseidentification:
askknowncases
checkroutinesurveillancedata,notificationsandlaboratoryresults
emailotherCCDC's
otherhealthworkers/EnvironmentalHealthOfficers(EHOs)
publicalert

3.Descriptivestudy

collectdata
analysedata
drawepidemiccurve
generatehypothesistryandlinkinsomewaytosourcee.g.use'trawling'questionnaire

4.Analyticalstudyofanoutbreak

cohortstudyforfoodoutbreakswherethepopulationisknowne.g.weddingreception=>attackrateandrelativerisk(RR)
casecontrolstudytosamplelargeexposedpopulation=>oddsratio(OR)usetrawlingquestionnaire
Purpose:
totest'hypothesis'

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toattempttoovercomebias

5.Verifyhypothesis

bymicrobiologyusingfoodandenvironmentalsamples:EnvironmentalHealthOfficertovisitsitetosampleandeducate
byveterinaryinvestigation

6.Institutecontrolmeasures

removesource:
considerclosingoutlet
isolateandtreatcases
destroy/treatfood
protectpersonsatrisk:
improvehygiene
prophylaxis
preventrecurrence
recommendations
guidelines

7.Communicate

Duringoutbreak:informationtopublicandprofessionals
Afteroutbreak:report,forthoseinvolvedandwideraudience,alsomakerecommendationsforthefuture
NB:alwaysrecordoutbreakdetailswithtimesanddates

mayneedtodomultiplelevelsofinvestigationatthesametime

Sourcesofoutbreaks
Pointsourceexplosive(primarycaseswillclusterwithintherangeoftheincubationperiod)e.g.Salmonellaoutbreakat
weddingreception

Continuingsourcee.gcasesofS.agonaPT15byweekofonsetinEnglandandWales

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Pointsourceandpersontopersonspreade.g.E.Coli0157innursery

Potentialoutbreakskeyfacts
Food/waterbornegastroenteritis

involveEnvironmentalHealthOfficerininvestigatione.g.tofindsource
collectstoolspecimensifpossiblefromallsporadiccasesasmanyaspossibleinoutbreak
Prevention
handwashingandnotowelsharing
disposalofsoiledmaterial(useofplasticgloves/sealingwashingtowelsandlinenona'hot'cycle)
disinfecttoiletareaandtapsdaily
educationofpersonalhygieneandhygieneinpreparationoffood
Exclusions
Allcasesmustbeexcludedfromworkorschooluntilfreefromdiarrhoeaandvomitingfor48hoursasaminimum
Inthecaseofan'atrisk'group,excludeforlongerespeciallyiftheyareandreviewtheneedformicrobiologicalclearance:
foodhandlers
staffofhealthcarefacilities
childrenunderfiveyears
peoplewithlearningdisabilities
Inthecaseof'nonrisk'groupsthereisnomicrobiologyfollowup
mostfoodpoisoningnoscreeningofcontactsnecessary,exceptinthecaseofTyphoidandE.coliOI57

Exposurestoinfectedwater

Check:

occupationalexposure
recreationalexposure
domesticexposure
consumptionofwater,vegetables,fish(inareasofinfectedwater)

SarahAnderson,GayatriManikkavasagan2008
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Choicesindevelopinganimmunisationstrategy up Knowledgeofnaturalhistory,clinicalpresentation,
methodsofdiagnosisandcontrolofinfectionsof
localandinternationalpublichealthimportance
(includingemergingdiseasesandthosewith
consequencesforeffectivecontrol)

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