Step 2: Establish existence of an outbreak • Contacts • 1st case- 2 contacts • 2nd case- 3 contacts • 3rd case- Sexual contacts • 3 current boyfriends & fmr.boyfriend - Household contacts • Son • Mother & Father • A Gentleman and Lady & 2 Kids • Sister & Boyfriend & 2 Kids • 1 Contact
4/30/03 Mother 2/21 Child 2/21 StepFather S+ 1/15 Girlfriend Sister T + 2/13 Mother Girlfriend Sister Boyfriend M + 3/25 Hepatitis A Outbreak Fmr.Boyfriend Boyfriend M - J+ 3/21 F - Boyfriend Sister’s Boyfriend Boyfriend Sister Contact IG Given Child IgM + C Child GS JW J Household contact Child
Step 3: Verify Diagnosis • 8 individuals with HAV-IgM + • All 8 showed signs and symptoms (i.e. jaundice)
Step 4: Define & Identify Cases • Clinical case definition: • Discrete onset of symptoms and • Jaundice or elevated serum aminotransferase levels • Laboratory criteria • Immunoglobulin M (IgM) antibody to hepatitis A (anti-HAV) positive
Step 4: Define & Identify Cases • Confirmed Case: A case that meetsthe clinical case definition and is laboratory confirmed or for hepatitis A, a case that meets the clinical case definition and occurs in a person who has an epidemiological link with a person who has laboratory-confirmed hepatitis A (i.e. household or sexual contact with an infected person during the 15-50 days before onset of symptoms) • 8 Cases of acute hepatitis A
Step 6: Develop Hypotheses • M was the index case • Did not seek medical care or treatment • S wanted to hide his sexual preference and did not expose M • Positive individuals did not reveal contacts to LHD thus number of cases increased
Step 9: Implement Control/Preventive Measures • Letter was sent to students of school • Prevention messages • Always wash your hands after using the bathroom. • Always wash your hands after cleaning the toilet. • Always wash your hands after changing diapers. • Always wash your hands after handling soiled towels or linens. • Always wash your hands before fixing food or eating. • If exposed to hepatitis A, ask your doctor about immune globulin.