1. Factors that affect disease dynamics and outbreaks
a recent increase in amount or virulence of the agent,
recent introduction of the agent into settings where it has not been before,
enhanced mode of transmission so that more susceptible individuals are exposed,
an environment that is conducive to interaction between the host and the agent,
a change in the host susceptibility to agents,
factors that increase host exposure or or involve introduction through new portals of entry

2. Disease Levels and Patterns
Levels of disease
·        Epidemic
·        Outbreak
·        Cluster
·        Endemic
·        Pandemic
Patterns of disease occurrence:
common source
point
intermittent
continuous
Propagated
Mixed
Other

3. Susceptibility to the effect (s) of agent(s):
susceptible, immune, infected
Spectrum of response to exposure:
sub-clinical
clinical
·   mild
·   severe
Environment
Surrounding conditions/influences not part of agent or host
Components: physical, climatologic, biologic, social, economic

4. Transmission Modes of Spread Direct contact Indirect contact vehicles
·        Agent
·        Source
·        Transmissibility of the agent
·        Susceptibility of exposed hosts
Modes of Spread
Direct contact
intimate contact
        oral, respiratory, mucus membranes,
blood
 Indirect contact
   vehicles
     vectors

5. Epidemiologic approaches to outbreak investigation:
·        Determines prevalence and incidences of disease in well-defined populations.
·      Makes inferences.
Epidemiologic approach covers:
        Factors related to host
      Exposure
       Susceptibility
       Factors related to agent(s):
       Modes of transmission.
       Factors related to vectors and the Environment.
Epidemiologic studies:
       Non-experimental (observational)
       Cohort
       Case-control
       Cross-sectional
       Ecological
       Experimental
      Clinical trials
      Field trials
       Community intervention trials

6. Morbidity and mortality rates:
Attack rate Prevalence  Time   Temporal relation between
exposure and occurrence   
How to graph time data    Number of cases over time
    Rates over time  

9. Special Features ii. Epidemic curve iii. Point sources epidemics
  i.      Examining your graph
ii.    Epidemic curve
iii.    Point sources epidemics
iv.   Person to person
  v.   Intermittent or continuing common source
 vi.   Information on place
vii.   How to examine place
viii.  Person
ix.   Attribute categories
  x.   Examination of person data
 xi.   Interpretation of person data

10. Reasons and standards for epidemiologic investigations:
Operational aspects of epidemiologic investigations
i.   Legal considerations in a Field investigation
ii.  Investigation in food catering facilities
iii. Investigation in child care facilities
iv. Epidemiologic investigation in international
settings
v.  Laboratory support for the epidemiologic
investigation in the field
vi. Dealing with the public and the media

11. Response and responsibilities:
2. The
                       i.  To control and prevent further disease
                     ii.      To provide agreed upon or statutorily mandate services
                     iii.      To derive more information about interaction between the human
host, the foodborne agent, and the environment
                     iv.      To strengthen surveillance at eh local level through assessment of
its quality and by direct and personal contact or to determine the
need to establish a new surveillance system
                      v.      To provide training opportunities in epidemiology
                     vi.      What resources, including personnel, will be available locally?
                     vii.     What resources will be provided by the visiting team?
                     viii.    Who will direct the day-to-day investigation?
                     ix.      Who will provide the overall supervision and ultimately be
responsible for the investigation?
                      x.      How will the data be shared and who will be responsible for their
analysis?
                     xi.      Will a report of the findings be written?

12. Ten steps of field investigation:
·       
                                                               i.      Determine the existence of the epidemic
                      ii.      Confirm the diagnosis
                     iii.      Define a case and count cases
                     iv.      Orient the data in term of time, place, and person
                      v.      Determine who is at risk of becoming ill
                     vi.      Develop a hypothesis explaining the specific
exposure that caused disease and test this
hypothesis by appropriate statistical methods
                     vii.     Compare the hypothesis with the established
facts
                     viii.    Plan a more systemic study
                     ix.      Prepare a written report
x Execute control and preventive measures

13. Management Log decisions Accuracy Communication
Kiss (keep it simple, Stupid)
Ongoing writing
Filing
Friendship
Departure
9. Reports