1. Epi Tools Everyone Can Use
Emily Mosites, MPH
Alice Green, DVM
Katie Garman, MPH

2. Objectives Review concepts from regional outbreak training
Line list
Resources for outbreaks
Demonstrate use of statistical software to develop
Epi-curve
Symptom profile
2x2 tables (OR, RR)
Data management/ analysis tips

3. Regional Outbreak Training Objectives
Provide Regional Health Departments with tools to investigate clusters and outbreaks
Today: foodborne diseases
Concepts are generalizable
Promote collaboration and understanding between epidemiologists/CEDS staff, environmentalists, and laboratorians
“Epi-Ready” model

4. Foodborne illness investigations
The “Stool”
Foodborne illness investigations
Lab
Epidemiology
Environmental

5. Foodborne illness investigations
Epi Tools
Foodborne illness investigations
Lab
Epidemiology
Environmental

6. Tools
Many tools you can use
Today’s focus
Excel
SAS
EpiInfo

7. Compile a Line list: Excel

8. Data Entry Tips Blank does not equal “No” Single-word variable name
Use 1= yes & 0= no OR 1=yes & 3=no
Proper alignment to calculate RR

9. Analysis in Excel

10. Why Excel? If you don’t want to start having dreams in SAS code
If you have never heard of EpiInfo
If you find yourself doing analysis in the middle of the woods with only Microsoft ® Office™
USE EXCEL!!!

11. Overview Summarizing Data with PivotTables
RR, OR, and Chi Squares Test Page
Incubation period and EpiCurve
We will send you an excel workbook with these formulas and explanations!

12. Why use SAS in an outbreak investigation?
It’s powerful
Fisher’s exact
Easy to screen large numbers of variables
It’s subsidized by CDC
It’s fun!!
Embrace your dorkiness

22. Fisher’s Exact Test

24. Meal Date (exposure)

25. Illness Onset Date

26. End Illness Date

27. Why use Epi-Info (Version 3.5.1)
Easy
Point and click
Rapid questionnaire development
Simple commands
Accessible
available anywhere at anytime at
FREE

29. Click on analyze data

30. Click on Read (Import)

31. Select the correct data format
Find your file

32. Make sure all of your records have been imported

33. Start looking at your data

34. Type “=1” to select those who were sick
Select your variable

35. List Select your variable Sick = 1 is selected
To unselect click on cancel select

36. Create symptom profile using frequency command

37. Frequencies
Stratify by sick
Select your variables

38. Symptom Profile

39. Develop an epi curve using the graph command

40. Select Bar
Graph
Choose onset date

42. Calculating relative risk or odds ratio using the tables command

43. Remember… In order to calculate RR well 1 ill BBQ 15 20 No BBQ 5 1 ill
1= yes
3= no
well 1
ill
BBQ 15 20
No BBQ 5 1
ill 3
well
BBQ 20 15
No BBQ 5
RR= 15/(15+20) = 0.53
20/(20+5)
RR= 20/(20+15) = 2.85
5/(5+20)

44. Add exposure variable
Add outcome variable

45. BBQ Chicken

46. Sweet Tea

47. Resources for Outbreaks

48. Modifiable gastrointestinal outbreak questionnaires
Modifiable gastrointestinal outbreak questionnaires
Sample databases

49. Thank you!
Connie Robinson and staff
Rand Carpenter
John Dunn

50. Questions 615-741-7247 Emily: Emily.Mosites@tn.gov
Alice:
Katie: