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Sheet2 IDCase statusAgeSexHospitalizedDiarrheaCrampsHeadacheVomitingNauseaFeverBlood in stoolSore throatDiarrhea onset dateDiarrhea onset timeStool sampleLab resultCase definition...

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Sheet2
    ID    Case status    Age    Sex    Hospitalized    Dia
hea    Cramps    Headache    Vomiting    Nausea    Fever    Blood in stool    Sore throat    Dia
hea onset date    Dia
hea onset time    Stool sample    Lab result    Case definition
    1    Case    34    M    Y    Y    Y    Y    N    N    Y    N    N    2-May    7:00 PM    Y    POSITIVE    CONFIRMED
    2    Control    9    M
    3    Case    40    F    N    Y    Y    Y    N    N    Y    N    N    3-May    2:00 PM            PROBABLE
    4    Control    63    F
    5    Case    83    M    Y    Y    Y    Y    N    Y    Y    N    N    3-May    12:15 AM    Y    POSITIVE    CONFIRMED
    6    Control    35    M
    7    Case    73    F    N    Y    Y    Y    N    Y    N    N    N    3-May    3:00 PM            PROBABLE
    8    Case    34    M    N    Y    Y    N    Y    Y    N    N    N    3-May    9:00 PM            PROBABLE
    9    Control    7    F
    10    Case    34    M    N    N    N    Y    N    Y    Y    U    Y                    POSSIBLE
    11    Control    11    M
    12    Control    82    M
    13    Case    41    M    N    Y    Y    Y    Y    Y    U    U    U    3-May    2:30 PM            PROBABLE
    14    Case    6    F    N    Y    U    U    N    Y    Y    U    U    4-May    6:00 PM            PROBABLE
    15    Case    5    M    Y    Y    U    U    Y    Y    Y    N    Y    3-May    2:00 AM    Y    POSITIVE    CONFIRMED
    16    Case    36    F    Y    Y    Y    Y    N    Y    Y    N    N    3-May    5:00 PM    Y    POSITIVE    CONFIRMED
    17    Control    69    M
    18    Case    52    F    N    Y    Y    Y    N    Y    Y    N    N    3-May    4:00 PM            PROBABLE
    19    Case    59    M    N    Y    Y    N    Y    Y    Y    U    U    3-May    1:00 PM            PROBABLE
    20    Control    81    F
    21    Control    60    M
    22    Control    57    F
    23    Case    17    F    N    Y    Y    Y    N    Y    Y    N    Y    4-May    6:00 AM            PROBABLE
    24    Case    15    F    Y    Y    Y    Y    Y    Y    Y    N    Y    3-May    2:00 PM    Y    POSITIVE    CONFIRMED
    25    Control    34    F
    26    Case    45    F    N    Y    Y    Y    U    Y    Y    Y    N    3-May    5:30 PM            PROBABLE
    27    Case    49    F    N    Y    N    Y    N    Y    Y    U    Y    4-May    4:00 AM            PROBABLE
    28    Control    35    M
    29    Case    79    M    Y    Y    Y    Y    Y    Y    Y    N    U    3-May    10:00 AM    Y    POSITIVE    CONFIRMED
    30    Case    81    F    Y    Y    Y    Y    N    Y    Y    Y    N    3-May    5:00 PM    Y    POSITIVE    CONFIRMED
    31    Case    33    M    N    Y    Y    Y    N    Y    Y    N    N    4-May    3:00 AM            PROBABLE
    32    Control    6    F
    33    Case    31    M    N    Y    Y    Y    Y    U    Y    U    U    3-May    2:00 PM            PROBABLE
    34    Case    29    F    N    Y    N    Y    U    Y    Y    N    N    3-May    8:00 PM            PROBABLE
    35    Control    8    F
    36    Case    55    M    Y    Y    N    Y    Y    Y    Y    Y    N    3-May    4:00 PM    Y    POSITIVE    CONFIRMED
    37    Case    55    F    N    Y    Y    Y    Y    Y    Y    U    Y    3-May    7:30 PM            PROBABLE
    38    Case    63    M    Y    Y    Y    Y    N    N    Y    N    Y    3-May    1:00 PM    Y    POSITIVE    CONFIRMED
    39    Control    57    F
    40    Case    48    F    N    Y    Y    Y    N    Y    Y    N    N    4-May    3:00 AM            PROBABLE
    41    Case    24    M    Y    Y    N    Y    Y    Y    Y    Y    N    3-May    7:00 AM    Y    POSITIVE    CONFIRMED
    42    Case    62    F    N    Y    Y    Y    Y    Y    Y    Y    N    4-May    1:30 AM            PROBABLE
    43    Control    51    F
    44    Case    56    F    N    Y    Y    Y    N    N    N    N    N    3-May    2:00 PM            PROBABLE
    45    Case    58    M    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    5:00 PM    Y    POSITIVE    CONFIRMED
    46    Control    17    M
    47    Case    49    M    N    Y    Y    Y    N    Y    Y    N    N    4-May    12:01 AM            PROBABLE
    48    Control    17    F
    49    Case    32    F    N    Y    Y    Y    N    Y    U    U    N    3-May    6:30 AM            PROBABLE
    50    Case    37    F    N    Y    Y    Y    Y    Y    Y    N    Y    3-May    7:00 AM            PROBABLE
    51    Case    30    M    N    Y    Y    Y    N    N    Y    Y    N    3-May    11:59 PM            PROBABLE
    52    Control    58    M
    53    Control    40    M
    54    Case    23    M    N    Y    Y    Y    Y    Y    N    U    N    3-May    12:30 PM            PROBABLE
    55    Control    53    F
    56    Case    60    M    Y    Y    Y    Y    Y    Y    Y    N    Y    3-May    1:00 PM    Y    POSITIVE    CONFIRMED
    57    Case    56    F    N    Y    Y    Y    Y    Y    Y    U    N    3-May    8:00 PM            PROBABLE
    58    Control    6    M
    59    Case    60    F    N    Y    Y    Y    N    Y    U    N    N    3-May    11:30 PM            PROBABLE
    60    Control    9    F
    61    Case    61    M    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    3:00 PM    Y    POSITIVE    CONFIRMED
    62    Case    60    F    N    Y    Y    Y    Y    Y    Y    U    N    3-May    11:00 PM            PROBABLE
    63    Control    56    M
    64    Case    69    M    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    11:00 AM    Y    POSITIVE    CONFIRMED
    65    Control    51    F
    66    Case    29    F    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    5:30 PM    Y    POSITIVE    CONFIRMED
    67    Case    27    M    N    Y    Y    Y    N    Y    Y    N    N    3-May    8:00 PM            PROBABLE
    68    Control    27    M
    69    Case    39    F    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    6:00 PM    Y    POSITIVE    CONFIRMED
    70    Case    35    M    Y    Y    Y    Y    Y    Y    Y    Y    Y    3-May    6:00 PM    Y    POSITIVE    CONFIRMED
    71    Case    15    M    N    Y    Y    Y    Y    Y    Y    N    Y    3-May    9:00 PM            PROBABLE
    72    Control    29    F
    73    Case    19    M    N    Y    Y    Y    Y    Y    Y    N    N    3-May    12:00 PM            PROBABLE
    74    Case    18    F    N    N    N    Y    Y    Y    Y    U    N                    POSSIBLE
    75    Control    11    F
    76    Case    59    M    N    Y    Y    Y    N    Y    Y    N    N    3-May    2:00 PM            PROBABLE
    77    Case    58    F    N    Y    Y    Y    N    U    Y    N    Y    3-May    3:00 PM            PROBABLE
    78    Case    46    F    N    Y    Y    Y    Y    Y    U    N    N    3-May    10:00 PM            PROBABLE
    79    Control    14    M
    80    Control    37    M
    81    Case    47    M    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    12:00 PM    Y    POSITIVE    CONFIRMED
    82    Case    86    F    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    2:00 PM    Y    POSITIVE    CONFIRMED
    83    Control    40    F
    84    Case    36    F    N    Y    Y    Y    N    Y    Y    N    N    3-May    8:00 PM            PROBABLE
    85    Control    63    F
    86    Control    42    M
    87    Case    64    F    N    Y    Y    Y    N    Y    N    N    N    3-May    6:00 PM            PROBABLE
    88    Case    64    F    Y    Y    Y    Y    Y    Y    Y    Y    N    3-May    10:00 PM    Y    POSITIVE    CONFIRMED
    89    Control    49    M
    90    Case    55    M    N    N    N    Y    N    N    Y    U    N                    POSSIBLE
    91    Case    44    F    Y    Y    Y    Y    N    Y    Y    N    U    3-May    7:00 PM    Y    POSITIVE    CONFIRMED
    92    Case    10    M    Y    Y    Y    Y    Y    Y    Y    N    N    3-May    12:30 PM    Y    POSITIVE    CONFIRMED
    93    Control    42    M
    94    Control    15    F
    95    Case    5    M    Y    Y    Y    Y    N    Y    Y    Y    U    3-May    7:00 PM    Y    POSITIVE    CONFIRMED
    96    Case    12    F    N    Y    Y    Y    N    Y    Y    U    N    3-May    8:00 PM            PROBABLE
    97    Control    11    F
    98    Case    45    M    N    Y    Y    N    Y    Y    N    N    Y    3-May    1:00 PM            PROBABLE
    99    Case    46    F    N    Y    Y    Y    N    Y    Y    U    N    3-May    5:00 PM            PROBABLE
    100    Control    5    M
    101    Control    81    F

Exercise # 1 - Measures of Risk
Infectious Disease Epidemiology
OUTBREAK INVESTIGATION
Scenario:
For this workshop on out
eak investigation you are an epidemiologist working for the Foodborne and Dia
heal Diseases Branch, the
anch of CDC that investigates out
eaks that occur on cruise ships. Your
anch chief informs you that there has been an out
eak of dia
hea with high fever on a ship that has recently returned from the Bahamas. Using the actual data collected during this real out
eak of food-borne illness aboard a cruise ship, you will investigate the out
eak and make recommendations for controlling this out
eak and preventing similar out
eaks in the future.
Background Information:
The cruise ship "Fantasy" came into Cape Canaveral, FL, early in the morning on May 4, 1995, several hours ahead of schedule, because of an out
eak of fe
ile dia
hea on board. The symptoms—a rapid onset of fever, vomiting, and dia
hea, in some cases bloody—were typical of Shigella sonnei infection. Shigella can be transmitted in contaminated food or water or by direct fecal-oral transmission. Paramedical personnel had been summoned, and patients, many with IVs already in place as they were taken off the ship, had been taken to the emergency departments of 5 local hospitals. The cruise ship captain notified the Vessel Sanitation Program, a CDC program for cruise ships, of the out
eak, and a standard questionnaire was distributed to passengers who had not yet disembarked. There are so many cruise ship out
eaks that a standard questionnaire has been developed. It asks about illness onset, symptoms, food consumption, and use of the ship's water and ice. If the ship's water system is implicated, then different measures need to be taken than for a standard food-borne out
eak, and the ship may not be able to set out to sea again. In this case, the ship’s water and ice were not associated with illness.
The “Fantasy” had departed from Cape Canaveral on April 30 for a 4-day cruise to the Bahamas, docking in Freeport on May 1 and in Nassau on May 2, and spending May 3 at sea. On May 2, 393 passengers went on an optional tour to Blue Lagoon Island, which included a lunch on the beach provided by an on-shore caterer. The captain reported that all of the sick passengers had gone on the Blue Lagoon tour. The incubation period of Shigella infection is 12-96 hours. The initial questionnaire was returned by only 8 ill passengers, although 64 patients had already been sent to the hospital. The 8 newly identified ill passengers were
ought to the hospital for evaluation.
For more on:
Shigellosis: https:
www.cdc.gov/shigella/index.html
Cruise ship travel recommendations: https:
wwwnc.cdc.gov/travel/page/cruise-ship
CDC’s Vessel Sanitation Program: http:
www.cdc.gov/nceh/vsp/default.htm
 
As soon as you a
ive at work on May 4, your
anch chief asks you to go to Florida and investigate. Before heading to the airport, you assemble laboratory supplies. You also reach several passengers in Cape Canaveral hospitals by telephone and try, from their accounts of the buffet, to make a list of the food items that had been offered for lunch on the Blue Lagoon tour. On the airplane, you develop a simple questionnaire including illness information and food exposures based on the menu items served at the Blue Lagoon lunch. You strongly suspect a foodborne out
eak, so you plan to do a study to determine which, if any, of these menu items were associated with illness. You a
ive in Cape Canaveral later that day with two assistant investigators.
You and your team visit the 5 local hospitals to administer the questionnaire to ill cruise ship passengers. Of the 72 passengers sent to Cape Canaveral hospitals for evaluation of the fe
ile dia
heal disease, 23 were admitted for medical treatment. Following standard procedure, hospital staff attempted to collect stool samples from the 23 hospitalized patients to test for Shigella infection and other common infectious agents that cause fe
ile dia
heal disease. You are able to track down 63 patients and 62 agree to complete your questionnaire (including all 23 of the hospitalized patients). You were unable to collect stool samples from patients who were not hospitalized.
You know that you will also need to interview some non-ill passengers to compare to these ill passengers. Some members of your group back at CDC feel that you should sample the controls randomly from a list of all the passengers who went on the Blue Lagoon tour, but others feel that this would be impractical, since the passengers have all disembarked and most have returned home. As it turns out, the cruise ship does not have a list of Blue Lagoon passengers available. Instead, you decide to interview well friends and family members who accompanied the patients to the hospital. Although you know that this has some limitations for sampling controls, you decide that under the circumstances, this is the best that you can do.
Data Collection: Your team interviews all of the passengers that you can find. Each person is interviewed using the questionnaire that you developed earlier that day, on which the investigator records whether the person was sick, what their symptoms were, and whether they ate each of the foods served at the Blue Lagoon tour.
Table 3. Onset of Dia
hea Among 59 Ill Passengers Reporting Dia
hea – Date and Time
    Date
    Time
    
    Date
    Time
    2-May
    7:00 PM
    
    3-May
    6:00 PM
    3-May
    12:15 AM
    
    3-May
    6:00 PM
    3-May
    2:00 AM
    
    3-May
    6:00 PM
    3-May
    6:30 AM
    
    3-May
    7:00 PM
    3-May
    7:00 AM
    
    3-May
    7:00 PM
    3-May
    7:00 AM
    
    3-May
    7:30 PM
    3-May
    10:00 AM
    
    3-May
    8:00 PM
    3-May
    11:00 AM
    
    3-May
    8:00 PM
    3-May
    12:00 PM
    
    3-May
    8:00 PM
    3-May
    12:00 PM
    
    3-May
    8:00 PM
    3-May
    12:30 PM
    
    3-May
    8:00 PM
    3-May
    12:30 PM
    
    3-May
    9:00 PM
    3-May
    1:00 PM
    
    3-May
    9:00 PM
    3-May
    1:00 PM
    
    3-May
    10:00 PM
    3-May
    1:00 PM
    
    3-May
    10:00 PM
    3-May
    1:00 PM
    
    3-May
    11:00 PM
    3-May
    2:00 PM
    
    3-May
    11:30 PM
    3-May
    2:00 PM
    
    3-May
    11:59 PM
    3-May
    2:00 PM
    
    4-May
    12:01 AM
    3-May
    2:00 PM
    
    4-May
    1:30 AM
    3-May
    2:00 PM
    
    4-May
    3:00 AM
    3-May
    2:00 PM
    
    4-May
    3:00 AM
    3-May
    2:30 PM
    
    4-May
    4:00 AM
    3-May
    3:00 PM
    
    4-May
    6:00 AM
    3-May
    3:00 PM
    
    4-May
    6:00 PM
    3-May
    3:00 PM
    
    
    
    3-May
    4:00 PM
    
    
    
    3-May
    4:00 PM
    
    
    
    3-May
    5:00 PM
    
    
    
    3-May
    5:00 PM
    
    
    
    3-May
    5:00 PM
    
    
    
    3-May
    5:00 PM
    
    
    
    3-May
    5:30 PM
    
    
    
    3-May
    5:30 PM
    
    
    
1. Construct an epidemic curve for onset of dia
hea (a histogram with time of onset on the x-axis and number of cases on the y-axis). Use whatever unit of time makes most sense for the data. The incubation period for Shigella infection is usually about 12-96 hours, although it can be longer. you should create a publication-worthy figure using Excel
2. Based on your epidemic curve, do you think this was a point source or a propagated out
eak? When (day/time) do you think the exposure occu
ed? Think both about the incubation period of Shigella infection and the specific details of the timing of this out
eak.
Part 2
Based on the additional Excel document provided labeled Fantasy Ship answer the following questions.
1. Considering person, place, and time, how would you characterize this out
eak by person (i.e., demographics)?
2. Describe the cases by person. Combine confirmed and probable cases.
Using data from the food questionnaires, you construct Table 3, which presents the data on reported food exposures among ill and well persons. Calculate the appropriate measure of association and 95% confidence interval* between each food item and illness. Exclude those with missing data from your calculation.
Table 4. Exposure Assessment for Ill and Well Passengers – Results of Food Questionnaires
    Food Exposure
    Sick
    Not sick
    Total
    Measure of Association (95% CI)
    Ate Ribs?
Yes
No
Don’t Know
    
51
10
1
    
32
7
0
    
83
17
1
    
    Ate Pasta Salad?
Yes
No
Don’t Know
    
54
6
2
    
4
34
1
    
58
40
3
    
8
3. Consider the 95% confidence intervals for the measures of association in the above tables. Are the confidence intervals na
ow or wide? Why? Does knowing the confidence intervals affect your conclusions about the source of the out
eak?
4. You conclude that the pasta salad is the likely source of the out
eak. How would you further investigate the source of the out
eak?
5. What control measures would you implement immediately?
6. After completing this phase of the investigation, what recommendations would you make for next steps? Consider both any further investigations that you might think are necessary for this out
eak and any follow-up and recommendations that you would make to prevent future similar out
eaks.
Risk (or Prevalence) Ratios and Differences
    
    Exposed
    Unexposed
    Cases
    a
    c
    Non-cases
    
    d
    Total People at Risk
    N1
    N0
    
    
    
    
    
    
Odds Ratios
    
    Exposed
    Unexposed
    Cases
    a
    c
    Controls
    
    d
    
    
    
Incidence Rate Ratios and Differences
    
    Exposed
    Unexposed
    Cases
    a
    c
    Non-cases
    
    d
    Total Person-time at risk
    PT1
    PT0
    
    
    
    
    
    

Exercise # 1 - Measures of Risk
Infectious Disease Epidemiology
OUTBREAK INVESTIGATION
Scenario:
For this workshop on out
eak investigation you are an epidemiologist working for the Foodborne and Dia
heal Diseases Branch, the
anch of CDC that investigates out
eaks that occur on cruise ships. Your
anch chief informs you that there has been an out
eak of dia
hea with high fever on a ship that has recently returned from the Bahamas. Using the actual data collected during this real out
eak of food-borne illness aboard a cruise ship, you will investigate the out
eak and make recommendations for controlling this out
eak and preventing similar out
eaks in the future.
Background Information:
The cruise ship "Fantasy" came into Cape Canaveral, FL, early in the morning on May 4, 1995, several hours ahead of schedule, because of an out
eak of fe
ile dia
hea on board. The symptoms—a rapid onset of fever
Answered 1 days AfterMar 19, 2022

Solution

Mohd answered on Mar 21 2022
66 Votes
Exercise # 1 - Measures of Risk
Infectious Disease Epidemiology
OUTBREAK INVESTIGATION
Scenario:
For this workshop on out
eak investigation you are an epidemiologist working for the Foodborne and Dia
heal Diseases Branch, the
anch of CDC that investigates out
eaks that occur on cruise ships. Your
anch chief informs you that there has been an out
eak of dia
hea with high fever on a ship that has recently returned from the Bahamas. Using the actual data collected during this real out
eak of food-borne illness aboard a cruise ship, you will investigate the out
eak and make recommendations for controlling this out
eak and preventing similar out
eaks in the future.
Background Information:
The cruise ship "Fantasy" came into Cape Canaveral, FL, early in the morning on May 4, 1995, several hours ahead of schedule, because of an out
eak of fe
ile dia
hea on board. The symptoms—a rapid onset of fever, vomiting, and dia
hea, in some cases bloody—were typical of Shigella sonnei infection. Shigella can be transmitted in contaminated food or water or by direct fecal-oral transmission. Paramedical personnel had been summoned, and patients, many with IVs already in place as they were taken off the ship, had been taken to the emergency departments of 5 local hospitals. The cruise ship captain notified the Vessel Sanitation Program, a CDC program for cruise ships, of the out
eak, and a standard questionnaire was distributed to passengers who had not yet disembarked. There are so many cruise ship out
eaks that a standard questionnaire has been developed. It asks about illness onset, symptoms, food consumption, and use of the ship's water and ice. If the ship's water system is implicated, then different measures need to be taken than for a standard food-borne out
eak, and the ship may not be able to set out to sea again. In this case, the ship’s water and ice were not associated with illness.
The “Fantasy” had departed from Cape Canaveral on April 30 for a 4-day cruise to the Bahamas, docking in Freeport on May 1 and in Nassau on May 2, and spending May 3 at sea. On May 2, 393 passengers went on an optional tour to Blue Lagoon Island, which included a lunch on the beach provided by an on-shore caterer. The captain reported that all of the sick passengers had gone on the Blue Lagoon tour. The incubation period of Shigella infection is 12-96 hours. The initial questionnaire was returned by only 8 ill passengers, although 64 patients had already been sent to the hospital. The 8 newly identified ill passengers were
ought to the hospital for evaluation.
For more on:
Shigellosis: https:
www.cdc.gov/shigella/index.html
Cruise ship travel recommendations: https:
wwwnc.cdc.gov/travel/page/cruise-ship
CDC’s Vessel Sanitation Program: http:
www.cdc.gov/nceh/vsp/default.htm
 
As soon as you a
ive at work on May 4, your
anch chief asks you to go to Florida and investigate. Before heading to the airport, you assemble laboratory supplies. You also reach several passengers in Cape Canaveral hospitals...
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