Case study: Outbreak investigation Objectives 1. Discuss

Case study: Outbreak investigation Objectives 1. Discuss the route of transmission and prevention methods forcommon waterborne illnesses.2. Describe the epidemiological triad for infectious diseases.3. Provide examples of reportable diseases.4. Describe key assessment data collected in outbreakinvestigations.5. Discuss the role of the public health nurse in communityoutbreaks of infectious diseases. Case study A nurse at a summer camp for adolescents observed anexcessive number of people at the camp seeking help for diarrhea and/or vomiting during a week in late June. Normally, two or three campers per week would report to the health office with these symptoms; however, 23 campers and staff sought help in a two-day span. The nurse reported the increased incidence to the camp manager and the local health department, and the camp was closed. 1. What education should the nurse provide tocampers and staff as they go home? Answer: After consulting with the state health department, the local health department obtained the results of 23 stool samples from symptomatic campers/staff and tested for bacterial and viral pathogens. Fifteen of the 23 stool samples (65 percent) tested positive for Escherichia coli (E. coli). The incubation period for E. coli, the agent responsible for the gastroenteritis in the camp, is three to four days. After further investigation, it is suspectedthat the well water was contaminated; a sample of the water wasanalyzed. Representatives from various state agencies investigated the outbreak. In mid-July, the department of health notified the campthat the water sample from the camp tested positive for fecalcontamination.1 1 Adapted from Centers for DiseaseControl and Prevention [CDC],2007a. 1 CA S E S T U D Y : O U T B R E A K I N VE S T I G A T I O N 2. Is this infectious disease a communicable disease? Explainyour answer following the graph below. Answer: 3. Are all the campers and staff at the camp susceptible hosts?Explain your answer. Answer: Active case finding and surveillance began after the departmentof health identified the E. coli positive well water sample on July 19. A case of gastroenteritis is defined as an illness lasting for more than 24 hours that includes three or more episodes ofdiarrhea, vomiting, or both. The attack had to occur in a camper or staff member after arriving or leaving the camp during the period from June 1 through July 19. The health department obtained lists of camp attendees and staff from camp managers, and conducted a retrospective cohortstudy by administering a telephone questionnaire to 210 out of277 (76 percent) of individuals. The study identified 141 cases (67 percent). 102 people reported diarrhea (72 percent), 92 reported vomiting (65 percent), and 89 reported stomach cramps (63 percent). 4. What is the definition of incidence rate? (How would this be calculated? Answer: 5. Is the agent in this summer camp outbreak, E. coli,a reportable disease in your state? Where did you find this information? Cite the source. Answer: 6. Did the occurrence of E. coli at the camp meet the definitionof an outbreak? Why or why not? Answer: Two wells provided the camp with water. The septic tank, whichheld the camp’s sewage, was full and had not been maintained properly. It was believed that the large number of camp attendees overburdened the septic system and created a heavydemand for well water. This allowed the septic system effluent to contaminate the water that replenished the wells. It was determined that the camp’s water system should be regulated as a public water system. The camp installed a newseptic system following a professional site evaluation. In thefuture, the camp’s water system will be subject to periodic EPA testing guidelines and subsequent evaluations. 7. Class Discussion: What roles might a public healthnurse assume following report of a communicable disease outbreak? Answer:

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