Disease Outbreak Investigation

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Disease Outbreak Investigation

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2. 2

3. 3 ?????????? ??? ...

4. 4 ???????????????????????????????? ????????? ?????????????? ?????????? ??????????????????????? * RM Page, et al. “Basic epidemiological methods and biostatistics, 1995 p.32

5. 5

6. 6 ???????????? vs. ??????????? : ???????????????? ???????? Infectious/ ?????? communicable ??????/????????? ????????/?????????

7. 7 Causal Chain Leading to Disease Distal socioeconomic causes

8. 8 ???????? (Outbreak or Epidemic) ????? ???????? ?????????? ?????????????? ??? Epidemic curve

9. 9 “??????????? ???..” ??????? ?????????? 5 ?? ???????? *** ???? ????????? + ???????????????????? 5 ?????????? ???? ???????????? 2-3 ??????????? 2-3 ????? ???????????? ???? 2 ????????? ??????????????????????? ?????????????????????????????????? ???? 1 ??? ?????????????????? ???? ????????????????????

10. 10 ????? Epidemic = Outbreak (outbreak -> ????????????????????????????????, Epidemic -> ???????????????????????????????????) Cluster = ???????????????????????????????????? (????????????????????????) Pandemic = ??????????????????????????????? ????????????????????? Endemic = ????????????

11. 11

12. 12 ???????? 5 ??????????? : ????????? ?., ???????????????? 3-8 ??? (??????? Median = 5) ?????????????????????????????????????????????? ????????????????????????????? ?. 3 ?. 5 ?. 8 ?. 3-8 (??????? “ Preventable Death ” )

13. 13 Pandemic : ???????? “AIDS in the world, 1992” ?????????????????????????????????????????? 1981 ????????????? 12.9 ?????? : ??? 7.1 ????, ???? 4.7 ???? ??????? 1.1 ???? 1 ?? 5 ???????????????????? ???????????? ?? 2000 ?????? 40 ????????????????

14. 14

15. 15

16. 16 ?????????? ???????????????????

17. 17

18. 18 ?????????????????? ?????????????????? : ??????????????????????????????????????????????? ???????????? ??????? ?????????? ??????????? ??. ???? ???????????????????????? ??? ? ?????????? ???????????? : ????????????, ????, ????????????

19. 19

20. 20 ???????????? ?????????????????????????????

21. 21 ?????????????????????????? ?????????????????????? ???????????????????????????????????? ????????????????????????????????????????? ????????????????????????????????? ??????????????????? ?????????????????????????? ???????? ??????????

22. 22

23. 23 ?????????????????? “??????????????”

24. 24 ???????????? ??? ????????????

25. 25 ???????????????????????(????????)

26. 26 ?????????????? (outbreak patterns) ????????????????????????? (Common source outbreak) Point (?????????????????? ??????????????) Intermittent (?????????????????? ???????????????) Continuous (?????????????????? ??????????????) ????????????????????????????? Propagated source outbreak (Person-to-person)

27. 27 ????????????????????????? Common Source Outbreak

28. 28 Epidemic Curve ????????????????????????????

29. 29 ??????????????????????????????????

30. 30

31. 31

32. 32 1. ?????????????????????????? Rapid Response Team 2. ???????????????????????? ??????????? 3. ?????????????????????????????????????? 4. ????????????????????????? -??????????????? ???? ??????? ????? 5. ???????????????????????? 6. ???????????????????????????? – ?????????????? 7. ??????????????????? ????????? 8. ??????????????????? 9. ????????????????? 10. Follow-up the control implementations

33. 33 1. ?????????????????????????? Rapid Response Team ????????? : ???????, ???????, ????????????????????????????????? ??? ????????? – ??????????? ??????? ? ?????????????

34. 34 2. ???????????????????????? ??????????? ???????????? “ ????????????? ” ??????? ???????????????????????? ? ?????????????????? y ? ???????????????? ? ????????????????????????????????????????? ???????????????????, ??????????, ??????????????????

35. 35

36. 36

37. 37

38. 38

39. 39 3. ????????????????? ???????????????????????? ???????????????????? ???????????????????????????????? ????????????????????????????????????????? ???????????????? ???????????????/????????? ?????????????????????? ???? ?????????? ????????? ??????????????????? ??????? ?????????????????? ????????????? (Sensitivity) ??? ?????????? (specificity)

40. 40 ???????????? : ????????

41. 41 ?????? Sensitivity vs. ?????????? specificity

42. 42 ??????????????????? Sensitive case definition

43. 43 ??????????????????????? Specific case definition

44. 44 ???????????????????????? Multiple case definition ???????????? (Possible) ???????????????????????????????? ... ???????????????? (Probable) ?????????? 5 ???????? ???????????????????????? ?????????????????????????????????? ????????????? (Confirmed) ?????????????? ???????? Vibrio cholerae ???

45. 45

46. 46

47. 47 4. ?????????????????????????

48. 48

49. 49

50. 50

51. 51

52. 52

53. 53 ?????????????????? ??. (/ ??????? 100,000 ??) ????????????????? ?????? Cyprus, 5 July - 5 November 1996

54. 54

55. 55

56. 56

57. 57 ?????????????

58. 58 ??????????? Cohort

59. 59 ??????????? Cohort

60. 60 ??????????? Case – control

61. 61 ??????????? Case – control

62. 62 ?????????????????????????? ????????????????????

63. 63

64. 64 ???????? ????????????????????????

65. 65 ???????????????? ??????????????????????????? ???????????? ???????????????????????? ????????????? ??????????????????????????????

66. 66 ??????????? ????????????????? ?????????????????? ??????????????????????? ??????????????????

67. 67

68. 68 ??????????? 1956 ??????????????????????????????????? 1956 ?????????????? ??????? -??????????????? ??? ?????????? ?????????? ???????????????????????????? 1965 ???????????????????????????????? 1968 ??????? ??????????? -?????????????????????????????????? -????????????? methylmercury ????????????????

69. 69

70. 70 ??????????? the main signs and symptoms sensory disturbance in the distal portions of four extremities cerebellar ataxia bilateral concentric contraction of the visual field disturbed ocular movement caused by central nervous system (CNS) impairment of hearing caused by CNS equilibrium disturbance caused by CNS , Also, fetal Minamata Disease cerebral infantile paralysis

71. 71 Houseboat-Associated Carbon Monoxide Poisonings on Lake Powell --- Arizona and Utah, 2000 During August 2000 At Lake Powell in the Glen Canyon National Recreation Area on the Arizona-Utah border Two brothers died of carbon monoxide (CO) poisoning as they swam near the stern of a houseboat As a result of these deaths, an investigation was initiated The study identified nine boat-related fatal CO poisonings since 1994 and approximately 100 nonfatal poisonings since 1990

72. 72

73. 73 Carbon Monoxide Poisonings Resulting from Open Air Exposures to Operating Motorboats --- Lake Havasu City, Arizona, 2003 During February 1997--August 2002, two fatal and six nonfatal cases of carbon monoxide (CO) poisoning occurred in vacationers who were wading in or boating near the Bridgewater Channel of Lake Havasu The vacationers were near operating motorboats CDC and the Havasu Regional Medical Center Emergency Department (HRMCED) conducted an initial investigation during Labor Day weekend 2002 (August 31--September 1)

74. 74

75. 75 Carbon Monoxide Poisonings Resulting from Open Air Exposures to Operating Motorboats --- Lake Havasu City, Arizona, 2003

76. 76 The assessment determined that the majority of public health emergencies resulted from electric power outages, which affected access to food, water, and medical care. Data and recommendations were provided immediately to local and state emergency responders, who used the information to direct Hurricane Isabel recovery efforts and also to improve the assessment, which was next deployed in August 2004 with Hurricane Charley.

77. 77

78. 78 ???? 1 ??????????? … ?????????????????: common source, and propagated source ????????????????? ??????????????????????????????????????????????????

79. 79 ???? 2 ???????????????? : Verify Dx & OB ->Active case finding -> Descriptive study -> Hypothesis -> Analytic Study ?????????????????????? as soon as possible (ASAP)

80. 80

81. 81 Gold Standard

82. 82

83. 83

84. 84

85. 85

86. 86

87. 87

88. 88

89. 89

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