Assignment 1: Epidemiology And Risk Management
LASA 1
Epidemiology and Risk Management
PH6012 A01
August 28, 2013
The role of an epidemiologist is to study the relationship between conditions that arise within a given population. Their job is to collect and analyze data that will determine how the disease occurred and how they can prevent the spread and reoccurrence of the disease in question. In regards to the diarrhea outbreak in Taylor Township and Simon Township, the epidemiologist would have to determine what occurred, why did the illness occur, where did it originate from, who did the illness affect, and how can they stop the disease. The information given tells us that hospital-east and hospital-west celebrated their 50th year anniversary of incorporation. …show more content…
A special dinner was served to 1000 staff members. Proceeding the dinner, 35 people died and 115 called in sick complaining of diarrhea. Information given tells us that water was served with dinner and that no other drink was consumed.
The townships share one landfill. Hospital-east receives their water supply from Metropolis while Hospital-west receives their water supply from the Centervale’s filtrated water system. The town’s main aquifer which supplies water to the town by way of water wells is located beneath the town’s landfill. It is known that the landfill is contaminated with polychlorinated biphenyls (PCBs) and lead that exceeds the allowed amount approved by the Environmental Protection Agency (EPA). This landfill is toxic and is possibly the cause of many illnesses and deaths among the attendees. Investigators can search for similar occurrences to determine what steps to take in order to gain control over the outbreak.
On August 31, 1854, Dr. Snow investigated a series of deaths which occurred by ingestion. He determined that the distribution of contaminated water was the cause. One hundred twenty-seven deaths occurred during the time of investigation and less than five weeks later five hundred people died from this outbreak. He believed that a high number of deaths occurred near a water pump and persuaded local authorities to remove the water handle which played a significant role in the outbreak. A decrease in the number of deaths changed once the handle was removed and tested for infectious bacterium. Cholera was found in the water. Symptoms of Cholera (Vibrio cholera) are diarrhea, nausea and vomiting, and dehydration Dr. Snow used the city’s map to locate the source. Today epidemiologist mimic after Dr. Snow’s method of research and investigation to determine source and ways to treat and prevent the spread of diseases.
Another historical event that took place occurred in Woburn, Massachusetts from the period of 1969 thru 1979.
This epidemic affected children in the worst way. A case study was conducted on children that suffered from childhood leukemia. During this period, many cases arose which alarmed investigators. The Massachusetts Department of Public Health (MDPH) began an investigation concerning reports of childhood leukemia, liver cancer, renal caner, and bladder cancer. Emphasis was placed on water sources in that area. Investigators found that water from the water well G and H could have been the source of the outbreak. “Residents of Woburn and neighboring towns have complained about their water and unpleasant atmospheric odors for at least 100 years” (Parker, Rosen 1981). Recent complaints were heard from residents who only source of water came from water wells in that region. The arguments were based on the conclusion that chemical factories in that region contaminated the town’s water well for more than ten years. Parents believed “industrial solvents” in Woburn killed their …show more content…
children.
The case was tried in a court of law by 69 families and at the end of the proceedings; the court did not render a verdict which caused the families to settle out of court. Several studies went underway leading to inconclusive results. According to the author of this publication, “a case study of childhood leukemia in Woburn, Massachusetts: the relationship between leukemia incidence and exposure to public water, finally established that the relative risk of developing childhood leukemia was greater for those children whose mothers were likely to have consumed water from wells G and H (which had been contaminated by industrial solvents) during pregnancy than for those who did not.” (Ropeik, 2013).
The cholera epidemic of 1854 and the cancer cluster epidemic of 1969 both show a population of people who were affected by water contamination. The main water source for both towns relied heavily upon water from the pump in London and water wells G and H in Woburn. Taylor Township and Simon Township were both exposed to the water from the well in their town. An epidemiologist would more than likely study both cases to gather information of similarities and to also look for clues that could aide in preventive measures. He/she would study the geographic location, possible factories that may be responsible for releasing toxins into the water, landfills, and other possible causes. Researching both incidents could help the investigator look at other factors associated with the outbreak if any. The epidemiologist would review maps of surrounding areas to locate the source and to find out where it began and where it ended. The epidemiologist would review air and water quality and if air pollution has any bearing on the epidemic in question. He/she might also review these cases to find out if the outbreak was an isolated event. The investigator might look at the population size in general to narrow down the possibility of the outbreak continuing after taking necessary precautions to prevent future occurrences.
Diarrhea can occur due to many things and is not limited to food and water intake. Bacteria causes diarrhea and is a part of our life whether we like it or not. Diarrhea can stem from taking various medications and/ or experiencing stress. Viral infections can lead to diarrhea as well. Among the attendees, for some, medication could have been the culprit behind the diarrhea outbreaks. Stress is not a possibility and can be ruled out. It is also possible for some individuals suffering from a viral infection to show similar symptoms and maybe the food and water triggered the body to expel the food in liquid form. Looking at what occurred, when it occurred, and why it occurred, can help in determining how it occurred.
During my research on the topic, conducting an outbreak investigation is very important.
An outbreak investigation can identify risk factors that are associated with the infection. The outbreak investigation can not only identify risk but prevent risks associated with the infection. An outbreak investigation also includes a preliminary phase, an analytic phase, and a control and follow-up phase. All of which is important in controlling the outbreak as well as preventing reoccurrences. An epidemiologist first step would be to control the outbreak to prevent further exposure and interrupt transmission of the disease. There are 10 steps used in an outbreak investigation and they are according to
EXCITE:
1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Define and identify cases
5. Describe and orient the data in terms of time, place, and person
6. Develop hypotheses
7. Evaluate hypotheses
8. Refine hypotheses and carry out additional studies
9. Implement control and prevention measures
10. Communicate findings
Although control is at the bottom of the list, investigators are encouraged to implement control and prevention measures early on.
In Taylor Township Hospital-East celebrated their 50th anniversary of being incorporated. The guest list included 500 employees. In Simon Township Hospital-West celebrated their 50th anniversary of being incorporated. The guest list also included 500 staff members. Both hospitals served a meal along with water for their chosen drink. Taylor Township and Simon Township sits on the east and west side of town. Taylor Township main water source is from the water well that lies underneath a land fill. A small percentage of Simon Township residents use the same well water. The remaining residents as well as the hospital use water from another source. Three days after the celebration, an outbreak of diarrhea occurred in Taylor Township. The outbreak killed 30 staff members and five family members of the staff that attended the affair. The five deaths are due to eating the food prepared at Hospital-East. In addition to the 35 deaths, 115 staff members called in complaining of stomach problems. There were no casualties or illnesses reported from Hospital-West. data: contingency table
A B
1 115 35 150
2 350 0 350
465 35 500
expected: contingency table
A B
1 140. 10.5
2 326. 24.5
chi-square = 87.8 degrees of freedom = 1 probability = 0.000
The table shows that this was an independent event. The probability of people getting sick is 23%. People who are exposed to death are 7%. The probability of being directly affected with the illness or dying from the disease is 30%. The probability of not being affected at all is 70%.
References
Gerald S. Parker, P.E, Sharon L. Rosen, Ph.D. (January 1981). Woburn Cancer Incidence and Environmental Hazards 1969 – 1978. Retrieved from http://webcache.googleusercontent.com/search?q=cache:CJAu1jFdGRYJ:www.mass.gov/eohhs/docs/dph/environmental/investigations/woburn/woburn-cancer-hazard.pdf+&cd=1&hl=en&ct=clnk&gl=us
David Ropeik. (March 2013). Toms River, Woburn, and the sad lack of clean answers about 'Cancer Clusters ' Retrieved from http://bigthink.com/risk-reason-and-reality/toms-river-woburn-and-the-sad-lack-of-clean-answers-about-cancer-clusters
Excite. (November 2004). Steps of an Outbreak Investigation. Centers for Disease Control. Retrieved from http://www.cdc.gov/excite/classroom/outbreak/steps.htm
Epidemiology and Risk Management
PH6012 A01
August 28, 2013
The role of an epidemiologist is to study the relationship between conditions that arise within a given population. Their job is to collect and analyze data that will determine how the disease occurred and how they can prevent the spread and reoccurrence of the disease in question. In regards to the diarrhea outbreak in Taylor Township and Simon Township, the epidemiologist would have to determine what occurred, why did the illness occur, where did it originate from, who did the illness affect, and how can they stop the disease. The information given tells us that hospital-east and hospital-west celebrated their 50th year anniversary of incorporation. …show more content…
A special dinner was served to 1000 staff members. Proceeding the dinner, 35 people died and 115 called in sick complaining of diarrhea. Information given tells us that water was served with dinner and that no other drink was consumed.
The townships share one landfill. Hospital-east receives their water supply from Metropolis while Hospital-west receives their water supply from the Centervale’s filtrated water system. The town’s main aquifer which supplies water to the town by way of water wells is located beneath the town’s landfill. It is known that the landfill is contaminated with polychlorinated biphenyls (PCBs) and lead that exceeds the allowed amount approved by the Environmental Protection Agency (EPA). This landfill is toxic and is possibly the cause of many illnesses and deaths among the attendees. Investigators can search for similar occurrences to determine what steps to take in order to gain control over the outbreak.
On August 31, 1854, Dr. Snow investigated a series of deaths which occurred by ingestion. He determined that the distribution of contaminated water was the cause. One hundred twenty-seven deaths occurred during the time of investigation and less than five weeks later five hundred people died from this outbreak. He believed that a high number of deaths occurred near a water pump and persuaded local authorities to remove the water handle which played a significant role in the outbreak. A decrease in the number of deaths changed once the handle was removed and tested for infectious bacterium. Cholera was found in the water. Symptoms of Cholera (Vibrio cholera) are diarrhea, nausea and vomiting, and dehydration Dr. Snow used the city’s map to locate the source. Today epidemiologist mimic after Dr. Snow’s method of research and investigation to determine source and ways to treat and prevent the spread of diseases.
Another historical event that took place occurred in Woburn, Massachusetts from the period of 1969 thru 1979.
This epidemic affected children in the worst way. A case study was conducted on children that suffered from childhood leukemia. During this period, many cases arose which alarmed investigators. The Massachusetts Department of Public Health (MDPH) began an investigation concerning reports of childhood leukemia, liver cancer, renal caner, and bladder cancer. Emphasis was placed on water sources in that area. Investigators found that water from the water well G and H could have been the source of the outbreak. “Residents of Woburn and neighboring towns have complained about their water and unpleasant atmospheric odors for at least 100 years” (Parker, Rosen 1981). Recent complaints were heard from residents who only source of water came from water wells in that region. The arguments were based on the conclusion that chemical factories in that region contaminated the town’s water well for more than ten years. Parents believed “industrial solvents” in Woburn killed their …show more content…
children.
The case was tried in a court of law by 69 families and at the end of the proceedings; the court did not render a verdict which caused the families to settle out of court. Several studies went underway leading to inconclusive results. According to the author of this publication, “a case study of childhood leukemia in Woburn, Massachusetts: the relationship between leukemia incidence and exposure to public water, finally established that the relative risk of developing childhood leukemia was greater for those children whose mothers were likely to have consumed water from wells G and H (which had been contaminated by industrial solvents) during pregnancy than for those who did not.” (Ropeik, 2013).
The cholera epidemic of 1854 and the cancer cluster epidemic of 1969 both show a population of people who were affected by water contamination. The main water source for both towns relied heavily upon water from the pump in London and water wells G and H in Woburn. Taylor Township and Simon Township were both exposed to the water from the well in their town. An epidemiologist would more than likely study both cases to gather information of similarities and to also look for clues that could aide in preventive measures. He/she would study the geographic location, possible factories that may be responsible for releasing toxins into the water, landfills, and other possible causes. Researching both incidents could help the investigator look at other factors associated with the outbreak if any. The epidemiologist would review maps of surrounding areas to locate the source and to find out where it began and where it ended. The epidemiologist would review air and water quality and if air pollution has any bearing on the epidemic in question. He/she might also review these cases to find out if the outbreak was an isolated event. The investigator might look at the population size in general to narrow down the possibility of the outbreak continuing after taking necessary precautions to prevent future occurrences.
Diarrhea can occur due to many things and is not limited to food and water intake. Bacteria causes diarrhea and is a part of our life whether we like it or not. Diarrhea can stem from taking various medications and/ or experiencing stress. Viral infections can lead to diarrhea as well. Among the attendees, for some, medication could have been the culprit behind the diarrhea outbreaks. Stress is not a possibility and can be ruled out. It is also possible for some individuals suffering from a viral infection to show similar symptoms and maybe the food and water triggered the body to expel the food in liquid form. Looking at what occurred, when it occurred, and why it occurred, can help in determining how it occurred.
During my research on the topic, conducting an outbreak investigation is very important.
An outbreak investigation can identify risk factors that are associated with the infection. The outbreak investigation can not only identify risk but prevent risks associated with the infection. An outbreak investigation also includes a preliminary phase, an analytic phase, and a control and follow-up phase. All of which is important in controlling the outbreak as well as preventing reoccurrences. An epidemiologist first step would be to control the outbreak to prevent further exposure and interrupt transmission of the disease. There are 10 steps used in an outbreak investigation and they are according to
EXCITE:
1. Prepare for field work
2. Establish the existence of an outbreak
3. Verify the diagnosis
4. Define and identify cases
5. Describe and orient the data in terms of time, place, and person
6. Develop hypotheses
7. Evaluate hypotheses
8. Refine hypotheses and carry out additional studies
9. Implement control and prevention measures
10. Communicate findings
Although control is at the bottom of the list, investigators are encouraged to implement control and prevention measures early on.
In Taylor Township Hospital-East celebrated their 50th anniversary of being incorporated. The guest list included 500 employees. In Simon Township Hospital-West celebrated their 50th anniversary of being incorporated. The guest list also included 500 staff members. Both hospitals served a meal along with water for their chosen drink. Taylor Township and Simon Township sits on the east and west side of town. Taylor Township main water source is from the water well that lies underneath a land fill. A small percentage of Simon Township residents use the same well water. The remaining residents as well as the hospital use water from another source. Three days after the celebration, an outbreak of diarrhea occurred in Taylor Township. The outbreak killed 30 staff members and five family members of the staff that attended the affair. The five deaths are due to eating the food prepared at Hospital-East. In addition to the 35 deaths, 115 staff members called in complaining of stomach problems. There were no casualties or illnesses reported from Hospital-West. data: contingency table
A B
1 115 35 150
2 350 0 350
465 35 500
expected: contingency table
A B
1 140. 10.5
2 326. 24.5
chi-square = 87.8 degrees of freedom = 1 probability = 0.000
The table shows that this was an independent event. The probability of people getting sick is 23%. People who are exposed to death are 7%. The probability of being directly affected with the illness or dying from the disease is 30%. The probability of not being affected at all is 70%.
References
Gerald S. Parker, P.E, Sharon L. Rosen, Ph.D. (January 1981). Woburn Cancer Incidence and Environmental Hazards 1969 – 1978. Retrieved from http://webcache.googleusercontent.com/search?q=cache:CJAu1jFdGRYJ:www.mass.gov/eohhs/docs/dph/environmental/investigations/woburn/woburn-cancer-hazard.pdf+&cd=1&hl=en&ct=clnk&gl=us
David Ropeik. (March 2013). Toms River, Woburn, and the sad lack of clean answers about 'Cancer Clusters ' Retrieved from http://bigthink.com/risk-reason-and-reality/toms-river-woburn-and-the-sad-lack-of-clean-answers-about-cancer-clusters
Excite. (November 2004). Steps of an Outbreak Investigation. Centers for Disease Control. Retrieved from http://www.cdc.gov/excite/classroom/outbreak/steps.htm