EPIVILLE SARS COMMUNITY OUTBREAK, Exercises of Nursing

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OUTLINE

• BACKGROUND OF THE EPIVILLE SARS

OUTBREAK

• CASE DEFINITION AND KEY FACTORS
• SUMMARY OF TECHNIQUES OF

INVESTIGATION

• DESCRIPTION OF THE CASE CONTROL

STUDY DESIGN ANALYSIS

• MANAGING THE EPIVILLE SARS

OUTBREAK

• PRESENTATION SUMMARY

o (^) The Amoy Apartment Complex, is the determined as primary outbreak source outbreak center

Case Definition and Key factors

Clinical Criteria

• (^) Symptoms

➢ (^) Fever above 100.4, cough, shortness of breath, and difficulty breathing

• (^) Exposure

➢ (^) Has been in contact with another SARS identified patient

Case Distrubution

➢ (^) All residents, living in the Amoy Apartment Complex, in the timeframes from August 3rd-August 24th

KEY FACTORS WHEN DEVELOPING A CASE

DEFINITION

• (^) A case definition needs to be created before data collection begins
• (^) Criteria is used to determine if a patient does or does not have the disease
• (^) Based on specific symptoms identified during the evaluation of each case
• (^) Cases must match according to person, place, and time (PPT)
• (^) This criteria helps to determine if candidates will be included within thecase

study

Epiville SARS Outbreak in terms of person, place, and

time (PPT)

PERSON

❑ (^) The people being

impacted in Epiville were in different age groups

❑ (^) Ranging from 3

years to 60 years and more

PLACE ❑ (^) The common place of transmission was within the Amoy Apartment Complex ❑ (^) One patient exposedat above location, exposed staff at Star Hospital

TIME ❑ (^) Exposure noted, 300 tenants attended the Annual Luau at the Amoy Apartment Complex ❑ (^) Time curve

❑ (^) Evaluation of a time frame

Techniques Used for Investigation

• (^) Passive surveillance is ongoing and requires facilitiesto report designated illness and diseases
• (^) Active surveillance requires

more interviews, calls, and in

person screening techniques

Determining if cases meet the case definition for

suspect cases or probable cases

SUSPECT CASES

Identified by symptoms defined in the

case definition

• (^) Fever above 100.4F
• (^) Cough, shortness of breath, or respiratory issues
• (^) Exposure to anyone at the Amoy Apartment Complex

Epiville had 70 suspected case

ModeofTransmission

Amoy Apartment Complex

• (^) Direct person to person
• (^) Primary residence for the majority of cases
• (^) Luau, was one community event that most patients had either attended or been exposed to someone who attended

Star Hospital

• (^) Direct person to person
• (^) One patient, 70 year old man, fromthe

Amoy Apartment Complex Luau

• (^) Then a nurse and doctor became

sick

• (^) 20 additional staff members had

direct contact and became ill

Process for Creating aWorking Hypothesis

• (^) Investigating the cases located at the hospital
• (^) Determining mode of transmission
• (^) How and where did the epidemic originate from
• (^) Utilizing existing knowledge of the suspected disease
• (^) Comparison to other unknown causes
• (^) Creating a case definition
• (^) Developing lists and a spot map to determine case locations of outbreak
• (^) Creating outbreak management

Identifying the disease ✓ (^) Testing methods ✓ (^) Investigating links between each case ✓ (^) Comparison of symptoms ✓ (^) Screening

Process to determine themode of transmission ✓ (^) Determine if the mode is indirect or direct ✓ (^) Using similarities between symptoms and PPT ✓ (^) Direct contact is determined by the trend of exposure and the amount of primary and secondary cases

70/53,000= 0.0013207547169811 then multiply by 1,000= 1.320754716981132, which rounds out to

1.32 per 1,000 in three-week timeframe

• (^) The selected type of study is a case-control

study

• (^) Benefits include less time required to

perform and less expenses

• (^) It allows for monitoring of treatment and

prevention

• (^) Used frequently in the medical field, effective

with studying of disease processes

Study Design Analysis

EPIDEMIC CURVE FOR EPIVILLE

SARS OUTBREAK

THE INCUBATION PERIOD AND THEIMPORTANCE

• (^) The exposure date was on August 1st^ at the Luau
• (^) Incubation period can range from 2-20 days
• (^) Cases from the Amoy Apartment have incubation periods from 2-12 days
• (^) The Star Hospital patient became symptomatic and hospitalized on August 3rd, 2 days after Luau
• (^) The Star hospital staff began showing symptomsat day 7
• (^) It is important to be able to see both the primary attack incubation in comparison to the secondary attack incubation