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Student ID: 385205

* Passages are put in 11-point font with a 1.5 space gap instead of 12-point font with a 1.15 space gap to
make it clearer to read

The 3 Main Disease Detectives Concepts:

● Background and Surveillance
● Outbreak Investigation
● Patterns, Control, and Prevention

SCIENCE OLYMPIAD TRYOUTS

2023-2024
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Question: Spectrum of Disease (1 D)

Influenza in Bat Country has many cases and treatments linked to the Influenza virus. From the perspective
of having a high-quality healthcare system and above-average quality of life, the worries about Influenza are
the least of their concern, politically. In other countries that have many poor quality and health factors, ones
who catch Influenza aren’t able to get direct medical treatment. The majority of people in the world who
don’t have good health care have many diseases left untreated; Influenza is one of them. Many get left
untreated or don’t have the correct treatment, and a spectrum is seen among those who have health care and
those who do not.

A) Explain the Iceberg Phenomenon that occurred in the passage above.

B) All shown below are examples of the Iceberg Phenomenon except two. Select the two and
explain why they would not fit under the phenomenon.
(1) Influenza
(2) Rabies
(3) Malnutrition
(4) Polio
(5) Rubella
(6) Measles

C) How might the Iceberg Phenomenon in the passage be solved? Provide 1 or 2 solution(s).

D) Why or why not will this phenomenon slowly have a lower spectrum in the next 10 years?

Answer: Spectrum of Disease (1 D)

A) The Iceberg Phenomenon that occurred in the passage was about the Influenza virus,
where only the achievements and results are just the tip of the iceberg. The rest of the
iceberg underneath the ocean horizon is humongous compared to the top, representing the
amount of undiagnosed and low health care in the world. Influenza portrays the iceberg in
this case, having Bat Country and other highly developed countries have strong health care
systems. The unseen big part of the Influenza virus is the number of undiagnosed people
without access to proper health care.

B) Rabies and Measles; have no subclinical cases, where noticing and getting correct help
early is very important and easy. The other 4 contain good amounts of subclinical cases,
having late and unnoticed diseases slowly taking away at the host body. Coverage for both
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Rabies and Measles is also very strong, where people with weak immunity can most likely
get the help they need. The Iceberg Phenomenon differentiates between diagnosed/apparent
and undiagnosed/inapparent cases; mostly subclinical, whereas Rabies nor Meales don’t fit
this category.

C) By spreading the word and early diagnosis checkups, the Iceberg Phenomenon can be
solved. Of course, other reasonable solutions exist, but these two can have a massive effect.
By spreading the word, more people will be aware, causing people to be more careful and
such. Also, early diagnosis checkups will have more records in check; helping people with
prevention. Risk factors will be slowly fixed in areas, making a depreciating line of those
affected by the Iceberg Phenomenon if shown on a graph.

D) The Iceberg Phenomenon will slowly arrive at a lower spectrum in the next 10 years,
because of new technological advances that can single out risk factors. If correct
awareness is spread, undiagnosed cases will decrease when diagnosed people receive the
proper health care. The Iceberg phenomenon puts in perspective the many people who do
not get proper care and ignore self-diagnosis strategies.
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Question: Types of Epidemiological Studies (2 B)

A) Match each type of study with its definition:

Ecological Cohort Quasi Experiments

Case-Control Cross-Sectional Randomized Controlled Trial

1. _____ Compare people with and without exposure to see and collect the data of effects.

2. _____ Experiment in which humans are randomly assigned to a type of two groups.

3. _____ Geographical comparisons among locations.

4. _____ A summary of surveys and questionnaires.

5. _____ Finding similarities between experimental design and randomized controlled trials,
where groups are assigned by non-random criteria.

6. _____ Compare people with and without illness to figure out common exposures

B) Matthew is in charge of collecting data from a clinical trial about the relationship between a diet and
the risk of cancer, where volunteers are randomized to a Block A (placebo) or Block B
(cancer-prevention) diet. In Block A, the participants were told that their diet was fully made up of
the best ingredients to prevent cancer. In Block B, participants were told that their diet was made up
of negatively impactful ingredients to increase their risks of cancer by a small amount. Keep in mind
that all participants have a low risk of cancer; none have gastrointestinal symptoms. The final
analysis included all people who were in their specific group, where it did not matter if they adhered
to the diet or not.

1) What type of epidemiological study is shown in Matthew’s clinical trial?

a) Cohort
b) Quasi Experiments
c) Randomized Control Trials
d) Ecological
e) Cross-Sectional
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2) Block B analysis shows a higher cancer risk than Block A in the experiment.
True or False? Briefly explain why or why not the cancer risk in Block B is
higher than in Block A.
a) True
b) False

Answer: Types of Epidemiological Studies (2 B)

A) 1. Cohort; compare people with and without exposure to see and collect the data of effects.
2. Randomized Controlled Trial; an experiment where humans are randomly assigned to a
type of two groups.
3. Ecological; geographical comparisons among locations.
4. Case-Control; a summary of surveys and questionnaires.
5. Quasi Experiments; finding similarities between experimental design and randomized
controlled trials, where groups are assigned by non-random criteria.
6. Cross-Sectional; compare people with and without illness to figure out common
exposures.

B) 1. Randomized Control Trials; volunteers were randomly placed in a control group

(Block A, placebo) and an experimental group (Block B, cancer prevention). Block A
was testing participants with a placebo diet, whereas Block B was experimenting with a
negatively suggested healthy diet that would outperform a placebo one.

2. True; the cancer risk is higher in Block B than in Block A because of the mighty
power of the placebo effect. The placebo effect is extremely powerful, countlessly helping
many. In Block B, many didn’t eat their diet, whereas the ones who did know the
consequences. Block A’s placebo managed to successfully block having a higher risk of
cancer, having some resulting in an even lower risk.
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Question: Chain of Transmission (2 E)

Bob and Jeffy both are at the Huang Market, planning to buy some meat and vegetables. Bob comes across
Meat Stands E and Z, whereas Jeffy finds Vegetable Stands A and D. Bob sees Meat Stand E’s butcher not
using gloves and has rusting materials. Then he checks out Meat Stand Z’s butcher which has a clean work
area and uses gloves. Bob sees that the quality of meat from Meat Stand E is disgusting, coming from the
questionable P.U. company. Jeffy compared Vegetable Stands A and D, seeing both having a very clean
working environment. He first checks the prices, concluding that Stand D has much better prices than Stand
A. Jeffy sees that Stand D has veggies from the P.U. company.

A) Bob's psychopathic side decides to try out the 60% off meat from Stand E. From the use of
no protection on hands, what type of transmission is shown?
(1) Droplet Transmission
(2) Water-Borne Transmission
(3) Direct Contact Transmission
(4) Indirect Contact Transmission

B) Jeffy chooses to eat from Stand A (good choice), where a nearby hoodie man coughed right
above the veggies Jeffy put in a sandwich. What type of transmission is described in this
situation? Explain why.
(1) Food-Borne Transmission
(2) Direct Contact Transmission
(3) Air-Borne Transmission
(4) Droplet Transmission

C) Where might the portal of entry for disease transmission be if Jeffy ate from Stand D?
Explain what type of vehicle transmission is made if P.U. company’s crops are contaminated
with sewage water.

Answer: Chain of Transmission (2 E)

A) Direct Contact Transmission; the Stand E vendor unsanitary touched the meat with his
no-glove hands, also placing it in dirty areas in the stand. This is an easy-access way to
allow pathogens inside Bob’s body, letting diseases run free within him. The amount of
germs put on the meat is extremely high, likely containing many parasites and salmonella.

B) Droplet Transmission; coughing over something has a close and immediate effect. The
hoodie man was nearby, causing the germs in the cough to still contain a high amount of
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velocity; spreading all around the veggies. If further away, air-borne transmission would’ve
been correct, as to having a lower velocity flying in the air. Jeffy is most likely to receive
respiratory diseases as a result of eating his veggie sandwich.

C) The portal of entry would be his mouth because that is where the start of the digestive
system is. It would then spread pathogens linked with the contaminated sewage leak in the
crops. Gastrointestinal pathogens would be most present, as to be in human feces. This type
of pathogen relies on water-borne transmission; a transmission where contaminations with
water are the biggest factor. Canceling out air-borne and food-borne vehicle
transmissions, water-borne is the most sensible transmission.
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Question: Public Health Approach (1 B)

County X has been facing significant increases in the asthmatic population recently, causing more inhalers to
be bought and used in the area. This abnormality had become one of the leading public health priorities in the
county, and if unsettled, state-wide public health issues are a possibility. From constant usage of priming with
an inhaler, air quality may be negatively affected, where misuse can further lead to more health problems.
Public health professionals in the area are rapidly trying to find risk factors to control and prevent the amount
of inhalers used. The priority focus of the public health approach is the population, where the number of
people who have asthma doesn’t know what’s putting them at risk. Soon, ways to reduce and prevent asthma
symptoms are implemented by public health professionals, causing a drastic decrease in inhalers bought
during the last few months. As a result, County X breathes much better than before, thanks to the public
health approach.

A) From reading the passage above, what is the primary focus of the public health approach?

B) Three main categories are emphasized in the public health approach. Which of the following
is NOT one of these categories?
1) Prevention
2) Whole Community
3) Health Promotion
4) Diagnosis

C) True or false: “What we as individuals do to guarantee the correct health conditions for
ourselves.” is the insightful definition of public health according to the Institute of Medicine
in 1990.

Answer: Public Health Approach (1 B)

A) Populations; the primary focus is to control and prevent diseases occurring in the
public. Public health is approached more from the perspective of populations, keeping
conditions in the public contained. The focus is more on society as a whole, instead of
diving into your healthcare issues. From the passage mentioned for question A, public health
professionals figure out how to prevent the risks of asthma by researching the main focus of
asthma in the population. Health care availability, preventing further risks/causes, and effect
on the population are all significant parts of the public health approach.
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B) 4, Diagnosis; diagnosis doesn’t strongly contribute to the primary focus, as to the effect
of prevention. This word comes to mind when seeing evidence from medical testing,
meaning the identification of an illness and such by examination. Public health is more sided
toward the forestalling of many diseases, as prevention, community efforts, and promotion
of health all effectively manage to have emphasis put on in the imposing public health
approach

C) False; neither the quote nor the year stated was accurate, not looking at a public
standpoint. The quote was wrong to express the public health approach from an individual
standpoint. 1998, the same year Steven Hawking published A Brief History of Time, was the
same year the Institute of Medicine defined public health. The true answer would be: “What
we as a society collectively do to ensure the conditions for people to be healthy,” was
accurately defined as public health by the infamous Institute of Medicine enticingly in 1988.
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Question: Clinical Approach (1 A)

Artititis is commonly seen in patients who are old of age, which is why some oldies use a walking stick.
Rheumatoid arthritis is an auto-immune and inflammatory disease, where your body accidentally attacks
healthy cells, resulting in painful swelling in areas in the body. Clinical professionals help by focusing on
your health issues and finding ways to solve them. They suggest special types of therapy so you can
eventually be healed.

A) What is the primary focus of the clinical health approach according to the passage?

B) Explain the main difference between the Public Health Approach and the Clinical Health
Approach. Include one similarity between the two.

C) What types of therapy are most effective for patients with Rheumatoid arthritis for restoring
range of motion?

Answer: Clinical Approach (1 A)

A) The primary focus shown is how clinical professionals help you with your health
problem. In the passage, a patient who’s been diagnosed with arthritis (more specifically
rheumatoid arthritis), is suggested by their clinical health professional to try special types of
therapy. They condemn your arthritis, helping you every step of the way until you are fully
in the clear.

B) The main difference between the two is that the Public Health Approach is directed
towards a group or population, whereas the Clinical Health Approach is seen to help
your diseases. Another way to think of it is that Public health is helping the major public
problems that require a lot of intense data. Clinical Health is focused on your personal
medical needs that don’t require much data. A similarity that may stand out is that they
both have a main goal of promoting world health and helping the lives of many across
the world.

C) The types of therapy that are most effective for Rheumatoid arthritis would be
stretching and exercise. Stretching can improve the flexibility and physical function of
your joints and body. Also, exercise can regain muscle strength and function, so you can
slowly move more easily. Patients who do this regularly have a much higher chance of
recuperating than those who don’t.
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Question: Outbreak Analysis (2 A)

Data shows that City A has a population of 10 million and City B has a population of 23 million. The new
COVID-23 disease has become moderately contagious throughout the country where City A and City B
exist. Scientists needed help figuring out a possible solution, and Jacky volunteered to help. Jacky was
assigned to create and analyze data that would support the scientists.

A) Jacky deduced coincidentally that 15 people in both cities were already infected. How may
Jacky calculate the percentage of people that COVID-23 is infected if the R0 (daily) is
initially 1.6 over 25 days?

B) Jacky needs to contrast the results between Cities A and B. How might Jacky differentiate
the percentage of people infected with COVID-23 between the two cities?

Answer: Outbreak Analysis (2 A)

To find the percentage infected, the formula (((Initial Amount * (R0 ^ Time)) / Population) * 100) is
used.

A) For City A, (15 * (1.6 ^ 25)) gives us the total number of infected people on day 25, which
equals 1901476. 1901476/10000000 = 0.19014769, finally multiply by 100 and arrive at
around 19%. COVID-23 infected 19% of City A during 25 days.
For City B, (15 * (1.6 ^ 25)) gives us the total number of infected people on day 25, which
equals 1901476. 1901476/23000000 = 0.082672862323, finally multiply by 100 and arrive
at around 8.3%. COVID-23 infected 8.3% of City B during 25 days.

B) Jacky concludes from calculations that City A has a much higher percentage of
COVID-23 than City B. More importantly, the only variable that changed throughout the
experiment was population. As it has a higher population, City B has a lower percentage
than City A; 19%. COVID-23 results appear to have a much more negative effect on City A,
excluding more complex factors.
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Question: Strategies for Disease Control (3 C)

Studying the diagnoses of clinical state diseases, Boris decides to gather some data about Polio. He finds out
that between 5 to 10% of Polio cases recorded in the clinical stage were fatal. His friend Laura was studying
the diagnosis of subclinical state Polio. She found out that the incubational period took 3 to 21 days
depending on the severity of the infectious virus. Polio vaccination shots work, where they both try to find
ways to control diseases based on their data. Also, they knew that Influenza and COVID-23 both were solved
by immunization.

A) The disease will result in ranges from ___1___ to severe or fatal, where the disease process
ends in a smooth recovery, a disability, or ___2___.

B) How may Laura and Boris find a way to control Polio based on what they know currently
about infectious diseases?

C) What prevention methods could be used by the public, looking at the data given that Boris
and Laura have concluded in their research of clinical and subclinical data about Polio?

Answer: Strategies for Disease Control (3 C)

A) For question 1, low to mild risk, and for question 2, death. The spectrum of disease can
range from low-risk to fatal according to the intensity of the disease and how quickly was
the patient able to be analyzed. This process can result in a good recovery, disability, or
death. The controlling has many factors, where early diagnosis is very helpful in not making
the spectrum reach fatal/death.

B) Laura and Boris find the way by immunization, just like other popular viruses. The
reason for how it works is that antibodies are injected into the body. Booster doses for Polio
have an immense chance of fully controlling the virus if ever detected by the body.

C) Prevention methods the public could use would include cheap access to reliable health
care, so the illness will be identified before too late. Polio percentages in the clinical state
would soon decrease when the virus is fully controlled throughout the world. Robust
surveillance of the Polio virus can result in a rapid response, hopefully lowering the
subclinical incubation period; and getting the right amount of help and attention. When
implemented, a core aspect of GPEI, immunization may be best fitted.
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Question: Bradford Hill Criteria (2 G)

A) i. Match each type of study with its definition:

Strength Consistency Specificity Alternative

Temporality Dose-Response Relationship Plausibility

Coherence Experimental Evidence

1. _____ Replicated results in different studies with different methods.

2. _____ Prevented or ameliorated changes from an applicable exploratory regimen.

3. _____ If a factor Z causes an illness, it always precedes the outcome of the illness.

4. _____ The size of the association when statistically significant calculations are
measured.

5. _____ Always consider alternate hypotheses before concluding relationships among

items under examination.

6. _____ When a cause produces a specific type of effect (weakest criteria).

7. _____ The current understanding of pathological processes is accepted by the

association.

8. _____ Evaluating claims of causality within knowledge in many different fields.

9. _____ The higher the exposure, the more likely the higher the risk.

ii. Place each of the numbers above in the appropriate order (ascending to descending)
according to Bradford Hill.

__ , __ , __ , __ , __ , __ , __ , __ , __
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B) Roshin needs to determine some data in his school causation project of why to use
sunscreen. He decides to use the nine Bradford Hill criteria to assess the association between
sun exposure concerning skin cancer.

1. The Bradford Hill criteria is meant to find the causation among many
associations. True or False? Explain.
a) True
b) False

2. Step by step explain the Hill criteria between sun exposure and skin cancer.

Answer: Bradford Hill Criteria (2 G)

A) i.
1. Consistency; replicated results in different studies with different methods.
2. Experimental Evidence; prevented or ameliorated changes from an applicable
exploratory regimen.
3. Temporality; if a factor Z causes an illness, it always precedes the outcome of the
illness.
4. Strength; the size of the association when statistically significant calculations are
measured.
5. Alternative; always consider alternate hypotheses before concluding relationships
among items under examination.
6. Specificity; when a cause produces a specific type of effect (weakest criteria).
7. Coherence; the current understanding of pathological processes is accepted by the
association.
8. Plausibility; evaluating claims of causality within knowledge in many different
fields.
9. Dose-Response Relationship; the higher the exposure, the more likely higher the
risk.

ii. 3 , 4 , 9 , 1 , 8 , 5 , 2 , 6 , 7 is the correct order by the Bradford Hill criteria.

B) 1. False; the Bradford Hill criteria is used to find the causation between two
associations. This is because Hill first made this causation method to determine a causal
link between a factor and a disease. Using the nine criteria, we can thoroughly analyze the
relationship between the two associations. The most famous example of causation with the
Hill criteria is smoking concerning lung cancer.
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2. Using the Bradford Hill criteria of nine steps, Roshin can easily assess the
information needed for his project. First, sun exposure is the factor that must always
precede the disease, which is skin cancer. Second, the higher the UVA and UVB rays that
are in contact with your skin, the stronger the relationship between the sun and skin cancer.
Third, increasing the amount of UV ray exposure from the sun makes the risk factors for
skin cancer increase, whereas having low UV ray exposure lowers the chances of skin
cancer. Fourth, among conducting different studies by public health epidemiologists, results
show similar, where the higher exposure of the base factor has higher chances of the disease.
Fifth, a theory that may be plausible would be that exposure to skin cancer is much more
prominent on the beach than in a woody area with lots of shade. Sixth, another possible
hypothesis is that light exposure negatively affects your skin, breaking the protective barrier.
Seventh, you can prevent skin cancer with high UV ray exposure by using a good type of
sunscreen SPF 30+. Eighth, a cause would be the UV rays destroying the melanin in your
skin, resulting in a higher risk factor for cancer. Lastly, this theory is compatible with the
knowledge we have today by extremely advanced technology that sees the effects of
ultraviolet light. Finishing the criteria, we can make an analogy that sun exposure
without sunscreen can result in skin cancer.
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Question: Steps of Outbreak Investigation (2 C)

A) Tim studies a Hepatitis B outbreak case definition with the following information:
● Person: An illness involving liver functioning tests
● Place: Symptoms started to occur immediately after moving to the House T
● Time: Around February to July, 2014

How do the person, place, and time in the case definition provided help epidemiologists in the
outbreak in the next step? Describe what will happen.
a. Descriptive epidemiology
b. Epi curves histograms
c. Find line list
d. Hypothesis evaluation

B) Explain each of the 10 steps of an outbreak investigation in epidemiology.

C) Which is NOT one of the 5 major factors that start professional investigations?
a. Identifying the source
b. Develop future prevention strategies
c. Evaluate prevention strategies that already exist
d. S.O.C.O
e. Address public concern

D) Marc and his team investigated the outbreak of a new infectious disease named Bepatitis H
in City Y. He contacted local epi teams and hospitals in City Y if they could help with the
investigation, which was a yes with the approval of the CDC. It was then confirmed an
outbreak from the spike in the number of small children and elderly in hospitals across the
city. Public health epidemiologists in hospitals send monitoring data immediately, so he has
access to needed health surveillance. The case definition is presented as:
● Person: A disease that involves attacks to the immune system and liver tests
● Place: Outside of a house, illegally transmitting blood from two people
● Time: Around September 11th, 2023 to October 1st, 2023
Line Listing
Case Case Age Sex Onset Curren Locati Case Epi Underl
ID Initials Date t on Categ Links ying
Status ory Condit
ions

46920 BH 65 Male Septe Clinic City Confir BA Immu

mber al Y, med ne
15th, Hospit system
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2023 al , Liver

46920 BH 63 Femal Septe Clinic City Suspe BA Immu

e mber al Y, ct ne
11th, Hospit system
2023 al , Liver

46920 BH 4 Femal Octob Clinic City Confir BA Liver

e er 1st, al Y, med
2023 Hospit
al

Relative Risk = 3.5 in Cohort study Odds Ratio = 3.5 in Case-Control study
Control measures of isolation and quarantining are implemented throughout the city. Then,
send data to other public health professionals and the government, also responding to SOCO
duties. When duties and necessary actions are performed, they decide the outbreak will be
over in about a month.

Are correct health measures being taken and monitored? Provide a step-by-step explanation
of the entire outbreak analysis process in City Y.
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Answer: Steps of Outbreak Investigation (2 C)

A) c. Line Listing; this is the next step of the investigation, as to then having multiple
different criteria for many more people identified. The illness will first have significant
impacts on the patient’s clinical health, where soon after much data is published, many
vaccinations will be available to cure.

B) There are 10 steps in epidemiology, which all contribute to solving an outbreak by

different types of immunization methods. Step 1: gather a local and/or state help team
with approval from the CDC. Step 2: have certain trusts and connections to prove the
existence of the outbreak. Step 3: verify the given information by health care services, both
clinical and public health. Step 4: make an accurate case definition of person, place, and
time. Step 5: use clinical, demographic, and exposure data to create line lists, which are
much more descriptive than the initial case definition. Step 6: summarize known and
existing data by epi curve histograms or frequency polygons. Step 7: make multiple
hypotheses from different types of epidemiological studies, and find the relative risk of the
study and/or the odds ratio of the study. Step 8: start implementing the public health
measures across certain areas. Step 9: communicate the newfound data across to other public
health professionals and the government. Step 10: maintain the surveillance, deciding if the
outbreak is over or not.

C) d. SOCO; is not one of the major factors included but is used in the final steps of the
outbreak data collection. The other factors are mostly needed to start outbreak
investigations, having both types of epidemiological data.

D) Yes, the correct and efficient health measures are being taken and monitored during
the analysis. Step 1: Marc contacted local epi teams and hospitals in City Y, which are
beneficial health relations, also approved by the CDC. Step 2: the hospitals gave monitoring
data and information that led to the proof of the outbreak investigation. Step 3: the spike in
cases in that certain period was proof of the outbreak in the city. Step 4: a well-constructed
case study that theorizes the cause of Bepitis H. Step 5: a data-filled line listing of three
people from the outbreak develops new information. Step 6: the epi curve showed a massive
spike during a period, where it slowly goes down from clinical measures and approaches.
Step 7: Marc and his team conducted cohort and case-control studies, where the relative risk
is 3.5 and the odds ratio is also 3.5. Step 8: the control and quarantine decisions are being
implemented throughout the entire City Y. Step 9: Marc’s findings and actions have been
reported to other public health professionals and the government, also performing the SOCO
duties. Step 10: it is estimated that if correct measures are being implemented, the outbreak
will be over in about a month. Concluding the findings, the 10 steps of outbreak
investigations have been fully implemented by Marc and his team, saving City Y.
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Question: Disease Risk and Frequency Ratio (2 G) S.H.

From public health practice, Tyson tries to find the risk factors for developing scurvy. After
conducting a few surveillance studies, he found that not drinking enough dairy products with vitamin
C can develop scurvy. Also, not eating enough food and having mental disorders put the person at a
higher risk than other diseases. Approximately 100 of the population of Town D have scurvy, mostly
old. The population of Town D is 11000, and it has a high percentage of older people. 10% of the
population that does not have vitamin C deficiency is exposed to scurvy, where none of them
developed scurvy. Tyson monitors the data of Town D for 30 days.

1. In the passage above, what is the cumulative incidence rate of scurvy? What is the
difference between cumulative incidence and incidence rate?

2. From Tyson’s data, what may be concluded about the 100 people in Town D who
developed scurvy?

3. 10% of the population in Town D that were exposed to people having scurvy never
developed the disease. Which of the following may BEST reason why they failed to
develop scurvy despite being exposed?
a. Immunization
b. Drinking enough water
c. Vitamin C deficiency
d. Scurvy is not contagious

4. Suppose the frequency ratio of the data collected by Tyson is 1. Knowing this, what
can we infer about the relationship between the exposure and the outcome?

Answer: Disease Risk and Frequency Ratio (2 C)

1. The cumulative incidence rate of scurvy in Town D is around 100 people in 30
days, which also corresponds to 3.334 people per day. The cumulative incidence
rate is the number of people infected designated in a certain period mentioned, which
was 30 days in this case. The difference between cumulative incidence and incidence
rate is that cumulative incidence presents a significant compassion between people
and time. The incidence rate is the number of times people have been exposed to
this, which shows that 1100 (10% of 11000 = 1100) people have been exposed to
scurvy.
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2. From Tyson’s data, the 100 people who developed scurvy in Town D had severe
vitamin C deficiency and likely very old. This is because scurvy is a result of the
lack of vitamin C, mostly caused by dairy products. Apart from the main risk factor,
surveillance studies on scurvy show that people coming of age are more likely to
develop the disease.

3. d. Scurvy is not contagious; the best reason why this may be is because scurvy is
not a disease that has multiple host-spreading traits. After 30 days, scurvy was
not successful using exposure for spread because of not having any infection traits.
The major reasoning behind the other options is that immunization may not be
present in all, dehydration is not a risk factor for scurvy, and vitamin C deficiency is
the cause of the disease; not developed by exposure.

4. From Tyson’s data, we can infer that there is no relationship between exposure
and the outcome because of the frequency ratio being 1. If the frequency ratio>1,
the exposure has a positive relationship with the risk factor in the outcome. If
frequency ratio = 1, the association between exposure and outcome does not exist in
any criteria. When the frequency ratio<1, exposure develops an association of
lowering risk factors in the outcome. In this case, the frequency ratio = 1, concluding
that exposure has no association with the outcome.
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Question: History and Development of Epidemiology (1 C)

A) Hippocrates, the first epidemiologist, advises searching the ______ for the cause of many
diseases around 463 B.C.E. Which answer best fits the blank and why?
(1) Internet
(2) Moon
(3) Tidal Waves
(4) Environment
(5) Royal Palace

B) Which of the following were NOT part of the four humors Hippocrates theorized about the
aim of medicine?
1) Yellow Bile
2) Purple Bile
3) Phlegm
4) Black Bile
5) Blood

C) During the 1960s and 1970s, health professionals used epidemiological methods to eliminate
the infectious disease smallpox across the world. How beneficial was this achievement in
epidemiological studies during the time?

Answer: History and Development of Edipemiology (1 C)

A) Environment; this is because he theorized that many diseases originate from the air,
land, and water. He addressed these theories of diseases with the setting of the season, day,
and element. This goes on to support the theory of four humors in medicine, keeping the
balance within the body.

B) Purple Bile; was never hypothesized by Hippocrates, while also not being a humor of
balance. The humor theory suggests four critical balances that symbolize and control
diseases and illnesses. Present illnesses were theorized as an imbalance of the four humors,
seen as a change in the body’s constitution.

C) This was a massive achievement in epidemiological studies at the time, causing the
number of deaths to drastically decrease when the vaccine was released. Deaths from
this disease decreased by over 90%, making the average child during the time much more
healthy. Recurring symptoms in adulthood will be a mild fever and red spots, not presenting
fatal or very harmful symptoms.
 22

Question: Attack Rates, Relative Risks, and Odds Ratio(2 F)

A) What type of studies are the Odds-Ratio used in? What about Relative Risk? Attack Rate?

The A.P. company collected data and presented this table to Dafule, Emelia, and Xiang. Their objective is to
conduct different epidemiological experiments from this table over one year.

2 x 2 Table: Amount Smoking of Exposure and/or Disease (1 year)

Disease No Disease

Exposure 50 30

No Exposure 20 40

B) Dafule conducts a cohort epidemiological experiment. What is the Risk Ratio of those
among exposure, no exposure, and both exposures shown from smoking?

C) Emelia conducts a case-control study. What is the Odds Ratio shown from smoking?

D) Xiang is unwilling to conduct an epidemiological study, so he instead decided to look at the

Attack Rate and Chi-Square.

1) What is the Attack Rate for the exposed? The unexposed?

2) Find the Chi-Square of the entire table and check if the data is significant.

Answer: Attack Rates, Relative Risks, and Odds Ratio (2 F)

A) Odds-Ratio is used in case-control studies, Relative Risk is used in cohort studies, and
Attack Rate can be for any 2x2 study given. These three are part of four main (the other is
Chi-Square) calculations used in the 2x2 tables on the topic of epidemiology.

B) (The total amount of people is 140) To find the Risk Ratio of those exposures, use the
equation a/(a+b) to get 50/(50+30) = 50/80 = 5/8 = 87.5 per 140 in 1 year. To find the Risk
Ratio of those no exposures, use equation c/(c+d) to get 20/(20+40) = 20/60 = 1/3 = 46.667
per 140 in 1 year. The Risk Ratio of both is found by (a+c)/(a+b+c+d) = 70/140 = 1/2 = 70
per 140 in 1 year. The three answers are 87.5, 46.667, and 70.
 23

C) To find the Odds Ratio of the case-control study, use the equation (a * d)/(b * c) = (50 *
40)/(20 * 30) = 2000/600 = 10/3 = 3.334 = the odd rates were 3.334 times as high in the
comparison of people who smoke and people who don’t smoke.

D) 1. Finding the Attack Rate of those exposed is a/(a+b) and those not exposed is c/(c+d),
where it is the same as finding the Risk Ratio of the exposed and not exposed. Exposed
answer = 87.5 per 140 in 1 year, and not exposed answer = 46.667 per 140 in 1 year.

2. To find the Chi-Square for a certain group, the first step is a formula multiplying the
column and row total, dividing by the whole total afterward.
((30+50)(50+20))/20+50+40+30 = 5600/140 = 40. It then continues for every group in the
table, giving us the expected values of 40, 12.86, 19.286, and 14.286. The degree of freedom
is then shown as 4. We use sigma, multiplying it by observation and expected values, using
the order of operations.
∑ (((observation-expected)^2)/expected) = Chi-Square value. As a result, from the
equation, we get 2.5+22.8444+0.0264+46.2838 = 71.6546. The p-value is calculated to be
a little greater than 0.01 and much under 0.05, meaning that the data is significant.
 24

Question: CDC Principles of Epidemiology in Public Health

Practice (1 E)

A) What does this shoe symbolize in public health epidemiology? Explain what shoe-leather
epidemiology is.

B) An enormous amount of people arrive in the hospital, because of a new virus around the
country. What would be the most likely scenario performed by the CDC public health
department before people become virulent?
1) Evaluation
2) Clinical Approach
3) Investigation
4) Conducting Studies

C) Jon’s tomato sauce brand has been investigated because of many clinical reports claiming that the
tomato sauce brand contains ingredients that lead to infectious disease mostly in little children and
grandparents. In a month, the average percentage infected in Country W was 13% before
quarantining. After a thorough investigation, it was found that Jon’s tomato sauce contained trace
amounts of Toxin H, and Infectious Parasites E and F from factory defects. The tomato sauce was
only shipped across Country W, and a national-level recall of Jon’s tomato sauce was decided,
causing all cans to be destroyed or sent back to the factory. As a result, the amount of clinical cases
of this infectious disease has significantly declined.

Many other events in the passage were not included. Make an analytical study showing the
events of the epidemiological public health principles shown in the passage above. Then
evaluate the study with both effectiveness and efficiency.
 25

Answer: CDC Principles of Epidemiology in Public Health

Practice (1 E)
A) This shoe symbolizes the Epidemic Intelligence Service, also known as EIS.
Investigations that need to find the source or learn about the source are called shoe-leather
epidemiology. Identifying clues and the source to find the transmission is also
commemorated by the EIS symbol for CDC’s epidemiologists; a hole near the sole of the
shoe.

B) Investigation; the CDC will first investigate using descriptive epidemiology to examine
cases or outbreaks of the disease. They will try to examine the incidence, calculate specific
rates such as R0, and find information between exposure and disease. After finding these
different types of information, they create hypotheses about the infectious disease. They then
proceed to create studies, narrowing down the risk factors in the scenario.

C) The four steps of analytic studies in epidemiology are study design, conducting studies,
analysis, and interpretation. In the study design, the main objectives are to write protocols,
basic calculations, criteria, and more concerning information. Conducting studies requires
approval from participants, getting records, interviewing the participants, conducting a
demonstration, and collecting data. The analysis describes the characteristics and rates,
making 2x2 tables, risk ratios, odds ratios, chi-square, intervals, and many other techniques.
Lastly, interpretation includes the results from the studies, properly recommending the
action to be taken. The study design in the passage contains the plan for quarantining,
needing further information to initiate. Public health reports are skyrocketing, having
children and grandparents being the top. The studies show that Country W has 13% of the
average population infected. After studies have been conducted, Toxin H and Infectious
Parasites E and F have been detected. Analysis shows that the odds ratio and risk ratio are
high in the beginning and end amounts in a two-tailed population graph. Cases are
exponentially being diagnosed, where ideologists have almost enough analytical data. This
clearly shows that the infectious parasites are extremely effective in Country W. Putting
the findings in perspective, the information shows that the public health call for quarantine is
fully recommended, having those infected with parasites have clinical health care. In
around a month, the data was efficiently produced and the nation-level quarantine call
was quickly initiated afterwards.
 26

Question: Spectrum of Disease (1 D)

A) Does the picture on the left show a high spectrum of disease for malnutrition? Where might
malnutrition reside on the spectrum?

B) Both pictures show that South Asia has the highest concentration of underweight kids across
the globe. Why might this be the case?

C) List 3 countries that have a 25+ share of children underweight, lower than the age of 5. What
comparisons can you make about the nutritional status of these children?

Answer: Spectrum of Disease (1 D)

A) Yes, the picture does show a high spectrum for malnutrition in many areas. This is
mainly because of the overpopulation and low supply in areas of those countries. On the
spectrum in the western half of the globe, malnutrition is a little above the average. Money
and poverty a high factors in this, especially if not have the necessary needs and goods
around malnutritioned areas like the slums.

B) South Asia may have the highest poverty and malnutrition rate on the spectrum
because of the high amount of slums and population. As slums are hard to build up to a
well-provided area, many needed goods and services are hard to receive. Living conditions
can be an extremely important factor, where lack of education may be proven common.
Many need to provide for themselves; not have enough food and water for their children.
 27

C) All the countries highlighted in dark blue have slums and high poverty rates in certain
areas. Angola, India, and Laos are 3 examples of children under 5 not getting enough
nutrition for their bodies. Other countries that could be included are Mali, Burkina Faso,
Niger, Nigeria, Chad, Sudan, Eritrea, Somalia, Djibouti, DRC, Madagascar, Afghanistan,
Pakistan, Nepal, Bangladesh, and Myanmar. The many comparisons these may share, the
food systems in certain areas of each country fail to provide their people with a nice,
sustainable diet.
 28

Question: Epi Curves, Line Listing, Cluster Maps, and Pulse

Net (2 D)
A) 1.
Mouse Virus Infection (days) in City S

The Mouse Virus has started to spread in City S, where public health epidemiologists quickly saved
the day after an entire month of quarantine. It supposedly came from a frog that was eaten
downtown, causing it to quickly spread across the city, causing a rise in clinical cases.

In the 30 days, the major decline was because of the _____.

a. Quarantine
b. Clinical Approach
c. Frog
d. Frequency Polygon

2. The Chese infectious disease started to spread across City G, where after a month of surveillance
and quarantining, the infectious disease had fully been treated by clinical health specialists. It
supposedly came from a yellow-looking pika, where it was transmitted across the city.

Make a histogram if given values: 1 2 3 4 5 6 7 8 (9, 2) (10, 3) (11, 3) (12, 5) (13, 7) (14, 8)
(15, 22) (16, 55) (17, 92) (18, 28) (19, 25) (20, 15) (21, 11) (22, 7) (23, 5) (24, 3) (25, 2) 26
27 28.
 29

B) Knowing that cluster maps are a bunch of connected ideas (many put into shapes), what are the
main uses of cluster maps in healthcare? In the picture, why might some countries have higher
emergency grades than others?

C) Using PulseNet, whole genome sequencing had a remarkable effect on improving disease
detection. It helped cure many terrible bacteria and toxins that were part of food outbreaks, doing a
great service to epidemiological research.

1. What is the purpose of whole genome sequencing on PulseNet?

2. According to conducting scientists on PulseNet, what are the 4 main steps of whole
genome sequencing?
 30

D)

Based on the line listing shown above, what does the onset date refer to for dengue fever?
a) Date of convalescence
b) Date of mechanical modulation
c) Date of when clinical symptoms first appear
d) Time left in epidemiology practice

Answer: Epi Curves, Line Listing, Cluster Maps, and Pulse

Net (2 D)
A) 1. Clinical Approach; this is because the clinical approach helped their needs by
making and giving the vaccine to the ones in the City who need them. The frog started
the virus and the frequency polygon is the type of graph used, which is similar to a
histogram. Quarantining is a public health approach strategy for no one to leave and infect
people from other cities, causing more chaos. When meeting the patient's needs for the
vaccine, the clinical professionals are the ones who take action, also sending public health
information from surveillance results.
 31

2.

The histogram shows the correct amount of people infected with the Cheese infectious
disease over the 30-day quarantine period.

B) Cluster maps help health professionals with significant information about diseases in
certain areas that contain population. With this information, it promotes the public health
of everyone, slowly gaining more data towards a healthier society. The picture informs of
the emergency grade of countries around the world, having red being the highest. Countries
like the D.R.C. and Somalia are shown to have a weak public healthcare system, which is a
result of poor monitoring and surveillance. Other countries in orange or yellow show
developing signs of better public healthcare throughout their populous.

C) 1. The purpose of whole genome sequencing is to determine the order of the genome of
a living organism in a single process. Every single living organism on the planet has its
genetic code, which is also known as the genome. These are composed of the A, T, C, and G
nucleotide bases, which can identify the DNA fingerprint. Finding the order of bases is
known as sequencing, where PulseNet provides correct CDC resources to figure out whole
genome sequencing processes.

2. The 4 main steps of whole genome sequencing according to PulseNet are DNA
sharing, DNA bar-coding, DNA sequencing, and data analysis. DNA shearing is when
 32

scientists use molecular scissors to cut DNA, which is composed of millions of bases A, T,
C, and G, small enough for the sequencing machine that reads it. DNA bar-coding is when
scientists add small pieces of DNA bar-codes to identify which piece of sheard DNA
belongs to which bacteria; similar to the grocery store. DNA analysis is when bar-coded
DNA is compiled and put into a sequencer, which identifies the bases that make up bacterial
sequences. The bar code is used to keep track of which DNA belongs to which piece of
bacteria. Lastly, data analysis is when scientists use analysis tools, comparing sequences
they can compare and contrast. The amount they can contrast tells how close the relationship
is between pieces of bacteria, seeing how likely it is that both result in the same outbreak.

D) c), Date of when clinical symptoms first appear; the reasoning behind this being
correct is the date symptoms were onset on the human. It also has to abide by regulations
stated in the Social Security Act, where clients need to meet certain factors first like
symptoms. Other answers had a relation in cures and nonsense, unable to fit under the onset
date of the disease. In the line listing, the disease examined was dengue fever, where five
adult participants showed strong symptoms; three of which were positive in lab testing.
 33

Question: Strategies for Disease Control (3 C)

A) Josh is an epidemiologist who researches disease control in vehicle illnesses. He recently
picked up a new case related to food-borne illnesses. He got samples from clinical
monitoring of infected patients, where he confirmed it was an infectious disease. He used
FATTOM to also confirm the present growth of infected food-borne pathogens. After clearly
working out a case study, a vaccine was developed for the patients with the illness.

1. What does the acronym F.A.T.T.O.M. represent for the growth of food-borne
pathogens?
a. Food, acidity, temperature, time, oxygen, medicine
b. Formation, accumulation, temperature, tepid, organic, moisture
c. Formation, accumulation, tepid, time, organic, medicine
d. Food, acidity, time, temperature, oxygen, moisture

2. Josh helped develop a vaccine to cure the patients infected with the food-borne
illness. Which of the following immunities did Josh use as a cure?
a. Active Immunity
b. Herd Immunity
c. Passive Immunity
3. How may knowing about FATTOM help prevent and control food-borne diseases in
surveillance? Explain the reasoning behind Josh’s strategies.

B) Zachary investigates a food-borne illness with information provided by surveillance data.

The food contained multiple rich ingredients, especially with a lot of protein. The FDA pH
level of the food is in the range of 5.4 to 6.4. The considered danger zone has been removed
for 1 hour by cooling, not meeting the absolute minimum of 2 hours. The food has been left
in an area with room temperature of 1.5 + or 1.5 - 98 Fahrenheit. Kept in an area with
oxygen present, aerobic pathogens were most dominant in the food. The food’s AW is
dynamic, having AWs of around 0.95.

1. What percent amount of oxygen amount is needed for aerobic pathogens to grow?
a. 10%
b. 15%
c. 20%
d. 15%

2. Explain all the data Zachary provided about the food-borne illness from surveillance
data.
 34

Answer: Strategies for Disease Control (2 C)

A) 1. d. Food, acidity, time, temperature, oxygen, moisture; all altogether the acronym
F.A.T.T.O.M is created. Two ways to say it FAT TOM or FATOM, but besides the way to
say it, six different words come together to represent itself. FATTOM are the six most
favorable conditions in which food-borne pathogens can grow and thrive, where FATTOM is
also used as a main prevention strategy. This very much helps the study and research about
food in epidemiological surveillance methods.

2. b. Herd Immunity; is defined as a public health approach to immunization by

vaccines, therefore breaking infectious chains. The other two immunity methods are by
the help of antibodies and primary immune responses. Herd immunity is an amazing
discovery in the public health department, because of the significant amount of background
help given to clinical research.

3. Knowing about FATTOM helped Josh’s research in surveillance by making a case

study and also collecting clinical data from monitoring. Josh is an epidemiologist, who
helps cure people, FATTOM is one of the biggest methods used in vehicle illness groups to
prevent food-borne illnesses. Making a case study can give him different hypotheses and
methods, having diverse ideas about what to use in the vaccine.

B) 1. c. 20%; this amount of oxygen is needed for aerobic pathogens to start growing.
Twenty percent of the air should be contained with oxygen, which is the second most
dominant, far from nitrogen. Keeping food out can easily pick up aerobic pathogens in a few
hours if not careful.

2. From the data Zachary provided, we can see that he used FATTOM with the
information given to him. For the food part, it was said to contain a high amount of
protein, which is most susceptible to food-borne pathogens. The pH level from the FDA is
mentioned to be in the range of 5.4 to 6.4, which fits under the 4.6 to 7.5 range of acidity
food-borne pathogens need to thrive. Also, the food was cooled for only one hour, which did
not reach some state's absolute minimum of two hours. The recommendation is around four
hours or higher, either by heating up or cooling it down. The temperature came around to be
1.5 + or 1.5 - the average room temperature of 98 degrees Fahrenheit. This also fits in the
minimum temperature and maximum temperature needed for food-borne pathogens. Aerobic
pathogens in the food have also been reported, knowing that it has been left out too long in
an area with average or higher oxygen levels. The last essential group left is water, which is
shown to have a dynamic AW of around 0.95. The food-borne pathogens thrive best in water
environments of AW 0.95 to 1.00. Zachary concludes that it is an intermediate case of
food-borne illness.
 35

Question: Analysis of Epidemiological Data (3 A)

Aaron is studying an epidemic of vaping in a 3-year time frame to collect information about the risks
of lung cancer. He issued a case study, gathering 10,000 individuals, where he then calculated and
collected the data on vaping history, amount of times vaping per hour and day, and how long of a rip
is taken each time when vaping. After the 3 years, around 600 participants were clinically diagnosed
with lung cancer. The standard deviation was calculated to be about 8 entire years. The average age
of lung cancer in the experiment was around 55 years, which contained 400 of the participants
diagnosed with lung cancer. Aaron then calculated the odds ratio, giving him the number of 4.6,
which meant people who vaped had 4.6 times the chance of developing lung cancer than those who
did not vape. Also, those who were exposed to active vaping had a higher chance than unexposed
people. The p-value was issued to be much less than 0.01, associating that it was significant data and
value in epidemiology. People who vaped much more were put at a higher risk than those who vaped
much less.

1. The words “odds ratio” are used, not including the risk ratio. What type of case study
is performed in the passage?
a. Quasi Experiment
b. Cohort
c. Case-Controlled
d. Cross-Sectional

2. How may the standard deviation have associations with Aaron’s findings? What
about the average age of diagnosis?

3. In the case study, Aaron calculated the p-value to be less than 0.001, which was
supposedly significant. What is the reasoning behind this?
a. Unlikely occurring by chance
b. Uncomparable null data
c. Likely occurring by chance
d. Comparable null data

4. The percentage of people who developed lung cancer around the age of 55 out of the
number of individuals who participated in the case study is 25%. True or False?
a. True
b. False
 36

5. What is the main objective of this vaping study for Aaron and the association found
between the amount vaped and the risk of lung cancer?

Answer: Analysis of Epidemiological Data (3 A)

1. c. Case-Controlled; the word odds ratio is a statistical measure that only applies to
case-control epidemiological studies. It is a valid estimate of the risk ratio, without
specifying if the disease is rare or not. Much better for calculating exposure variables than
among control variables.

2. The standard deviation may be associated with Aarons's findings by information about
when study participants were diagnosed with lung cancer. The average age also helps
to do the job of the standard deviation, where both sources of information can help
build an understanding of risk factors related to age. The average age is 55 in the vaping
and lung disease association concept, explaining that those who smoke when they are old
have a weaker respiratory system than those who are younger adults. Concluding the effects,
the statistics of both findings help Aaron’s investigation.

3. a. Unlikely occurring by chance; the more significant the p-value is, the less likely it
occurs in a real scenario. This often gets confused with likely occurring by chance because
of the major word “significant”, which gives the wrong idea of p-value data. Null data,
unlikely or likely, are used to compare and find the significance of the t-value; another
epidemiological statistic. The statistical cut-off is usually 0.05, which means anything above
that number applies to the study likely occurring in a real-world scenario.

4. True; when doing the calculations of (those diagnosed - those diagnosed at a specific
age)/participants = amount, where if multiplied by hundred you get a percentage number,
arriving at the answer. (600-400)/10000 = 200/10000 = 0.25. Now multiply by 100 for
percentage: 0.25 x 100 = 25, therefore resulting in a calculation answer of 25%.

5. The main objective was to investigate the association between vaping and lung cancer
among the 10,000 people who participated in this case-controlled study. Many different
constants for descriptive epidemiology were in use, where very important data existed.
Analyzing the epidemiological data, it is shown that those who have weaker immune
systems and are older are more likely to get lung cancer when vaping than those who have
stronger immune systems and/or are younger. Those exposed also had a higher risk than
unexposed, assuming both categories have not been vaping, even though vaping is not
infectious; it is what is released in the surrounding air that harms the exposed.
 37

Question: Strategies for Prevention (3 D)

A) Which of the following is NOT a prevention strategy used by public health professionals
and epidemiologists? Briefly explain all prevention strategies used in the study of
epidemiology.
a) Tertiary Prevention
b) Primordial Prevention
c) Secondary Prevention
d) Quaternary Prevention
e) Conservational Prevention
f) Primary Prevention

B) In City F, all citizens have to get checkups for certain diseases annually, so developments of
diseases are quickly taken care of, removing the chance of that certain disease entering the
body, and being fully funded by the advanced country's health system. The city’s
environment has fully been changed, focusing on having the best prevention methods for
their population. Quincy studies the city’s clinical records in the first 3 years after the
change in City F was initiated.

1. What prevention method is mainly implemented by the city? Explain why.

2. Quincy’s study in the past 3 years shows that the clinical records keep on decreasing every
year. Would this affect the country’s surveillance negatively, neutrally, or positively?

Answer: Strategies for Prevention (3 D)

A) e) Conservational Prevention; this type of prevention is used for archaeological
discoveries, which has no direct relation with medicinal practices and prevention. All
the other prevention methods are currently being used by public health professionals and
epidemiologists, being the five main prevention methods used. First, there is primordial
prevention, which tries to stop the development of a certain disease from spreading before
symptoms first occur. Primary prevention is when early intervention is used to stop initial
exposure, causing the disease to not develop. Secondary prevention is when the disease is
first identified, where screening and treatment are used to eliminate the problems before
they even happen. Tertiary prevention is when the patient starts to show symptoms, where
most of the actions that clinical professionals take are to weaken the disease as much as
possible. Quaternary prevention is a little bit different, using certain medical activities to
 38

avoid unnecessary consequences of the healthcare system, and strongly relying on clinical
help. All these prevention methods are effective strategies in the health care system, whereas
conservational prevention is a strong method used in archaeology,

B) The prevention method mainly implemented by the city is primordial prevention. The
reason why it is not also primary prevention is because having the country’s entire
environment changed; is not part of the primary prevention strategy. Primordial prevention
in the passage shows that all citizens are annually being prevented by certain lingering
diseases the city government does not want present. Also shown in the passage,
environmental changes have taken effect, which focus on improving the country's health
care system to the best of its abilities.

C) The city’s public health surveillance would be negatively affected because of an

important reason. The important reason for this being is the definition of surveillance.
The clinical cases going down does not always mean that the surveillance goes higher,
whereas in this case, it went lower. Surveillance truly means gaining new knowledge from
different types of disease cases in epidemiology. City F is so developed in its public health
sense, that new data is much less common than 3 years ago. In this scenario, this is a good
thing for the residents of City F because they are much less likely to get new diseases,
saving multiple lives.
 39

Question: Experimental Design (2 H)

Illness X is a rare disease that can only occur due to extremely hypertensive activity near the
top of mountains, making it difficult to breathe as well. Hospital Y receives monitoring
information about incoming patients who have this advanced illness. Dr. Mary, adroit in the
clinical health department, goes to a medical library from a hunch. She realized two old
treatment regimens might be effective in treating illness X because of a reported recovery a
hundred years back that was extremely similar to illness X. Dr. Mary and her team were the
only ones determined to save the patients, whereas everyone else was averse in helping.
They first tested out one of the three patients for the first regimen, where in a month the
results portrayed no change in illness X. At the same time they monitored the second patient
who was not given any regimen, where results showed no change as well. The last patient,
however, had an incredibly fast recovery, needing some rehab. Dr. Mary and her team
conclude that the second method in the medical library is proven correct to stop illness, X.

A) 1. According to the passage above, which of the following is the control variable?
a. First patient
b. Second patient
c. Third patient
d. Dr. Mary and her team

2. Which of the following would be an acceptable surveillance method/test in the

illness X case, comparing all three patients? Explain.
a. ANOVA
b. Fisher’s test
c. McNemar’s test
d. Chi-Square

B) In a fairly new City XYZ, a nasty infectious parasite outbreak has occurred, targeting those
who are over the age of 65. The population of the city is currently 8,500,000 people, where
60,000 of the elderly have been infected. In a month, the deaths of those 60,000 totaled
42,000 people, also having 45 births per day at a constant rate every day of the month.

1. How do you calculate the infant mortality rate? Calculate the infant mortality rate
of the passage shown above.
 40

2. If the infant mortality rate stays the same for a year, what is the population in a
year? Use an inference test to help.

Answer: Experimental Design (2 H)

A) 1. b. Second patient; the second patient was the control variable because no regimens
were used, being the control of the experiment. By monitoring the second variable, they
can use surveillance between the control variable and the experimental variables (first and
third patients). Dr. Mary and her team can contrast the results, having sufficient data to send
to public health epidemiologists.

2. ANOVA would be the best method used in this scenario because it statistically finds
the variance of tests for two or more variables. In this case, three variables are used where
using the ANOVA statistical method to find variability would be extremely beneficial for
monitoring. Fischer’s test is great to use for only two variables, which cannot be applied in
this study because more than two variables are present. McNemar’s test and Chi-Square are
both similar to each other, both not applicable in this scenario

B) 1. To calculate the infant mortality rate, find the ratio of deaths to births
(deaths:births). First, multiply 45 by 30 to find the number of births in a month which is
13,500. Now, 42,000:13,500 = 28:9. In the month, 28 people died when 9 people were born.
The amount of deaths when 10 people were born was 31.112. In conclusion, the infant
mortality rate is 331.112 %.

2. Using an inference test, the following calculations can be made to solve the infant
mortality rate in a year. 45 x 365 = 16425. There are 16425 births in the year. 42000 x 12 =
504000. There are 504000 elderly deaths in the year (yikes)! When calculated, we get the
same infant mortality rate throughout the year. After deaths, the population is 7,996,000.
When we add the births, we get 8,012,425. If the infant mortality rate stays the same
throughout the year, City XYZ’s population will decrease to 8,012,425 people
 41

Question: 5-Step Process for Surveillance and Surveillance

Systems (1 F)
A) Which of the following does NOT belong? Explain why the other 5 have in common.
a) Identify, define, and measure the health diagnoses
b) Monitor and evaluate the effectiveness and efficiency of surveillance, improving it
for the future
c) Analyze and clarify data
d) Find the Chi-Square of the data table for the p-value
e) Collect and arrange data about the problem and the major factors that influence
f) Show the analyzed data to public health professionals, thereby controlling the
situation

B) What are the four types of surveillance that have an acronym of P.A.S.S.? What is the
purpose of surveillance in public health?

C) Law enforcement finally captured the infamous Criminal Micky Rat, notorious for committing many
crimes in the past. While questioning him, Micky Rat decided to release his newest and final
weapon: a vile from McMagoo River (which hadn’t been cleaned for 10 years) that contained a
severely infectious disease. Putting the P.U. jail in lockdown was far too late, as the infectious
disease spread rapidly; making it hard to breathe. Across the city, Micky Capybara, captain of the
best epidemiology surveillance team in the country heard about what happened inside the P.U. jail.
Micky Capybara and his team decided to use the five-step surveillance process to send valuable data
to the government health agency. Dynamic symptoms first showed up in those with a weak immune
system.

How might Micky Capybara and his team use the five-step surveillance process to make the
valuable data? Explain each step, concluding the response with an analogy.

Answer: 5-Step Process for Surveillance and Surveillance

Systems (1 F)
A) d) Find the Chi-Square of the data table for p-value; the Chi-Square and p-value both
do not fit in the 5 processes for surveillance and systems, which the others have in
common. The first step would be to identify, define, and measure the health diagnoses.
Then, collect and arrange the data about the problem and the major factors that influence it.
Analyze the newfound data clarifying and organizing it. After that, show the analyzed data
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to public health professionals, controlling the situation. Lastly, monitor and evaluate the
effectiveness of efficiency of surveillance; better for the future.

B) The four types of surveillance are Passive, Active, Syndromic, and Sentinel, having an
ironic acronym (P.A.S.S.). Passive surveillance means diseases are reported by healthcare
providers, having quality defects. Active surveillance means health agencies contact other
health professionals about specific reports, ensuring more complete data. Syndromic
surveillance is monitored as a proxy for types of illnesses, being unique and
time-consuming. Sentinal surveillance is when professionals represent their area health
reports to agencies, implementing intervention earlier.

C) Micky Capybara and his team first get going to identify the infectious disease, deciding
to check out McMagoo River, where the waters crawled with viruses. The infectious disease
turned out to be a virus commonly known to have symptoms for those with weak immune
systems. The team carefully took a sample, having their first step complete. Trying to gather
the information, hospitals gave information about how there are first dynamic symptoms for
those with weak immune systems all around the city. A source of information would be the
McMagoo River, which is extremely dirty and filled with rotten items. Mr. Capybara and his
crew interviewed those in the hospitals by video chat, saying that they suffered from
shortness of breath the moment they got infected. Finished their second step, they arranged
their data, finding the Risk Ratio, R0 percentage, Odds Ratio, Attack Rate, and Chi-Square.
Organizing all the data provided by local healthcare in the city, and having a great
monitoring system. After the third step, Micky Capybara and his crew store online
documents of everything collected, having EHRs report and analyze current patients. They
ensure the privacy of the data is secure and then send it to higher authorities like the
government. Moving forward to step five, the governmental health agencies spread the
information and tell the important actions to take. The situation continues to be monitored,
adjusting public health concerns over time. Making an analogy, Micky Capybara and his
crew saved the city and stopped the spread of the virus. The government used the
organized and analyzed data to implement the correct actions at the correct time.