Outbreak Management: The SARS Outbreak in Epiville Essay

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Outbreak Management: The SARS Outbreak in Epiville

D. Background of the Epiville SARS Simulation outbreak

The case definition is a list of specific criteria used to decide whether or not one has the disease under investigation. The case definition of the Epiville SARS outbreak is a visitor to, or resident of the Amoy Apartment Complex or a worker at Star Hospital, who has onset of respiratory flu-like symptoms (high fever, cough, difficulty in breathing) from 10th August 2003 to 23rd August, 2003, without other apparent cause. The Epiville General Hospital suspects that the strange disease is the severe acute respiratory syndrome (SARS) although they are yet to conduct diagnostic tests to confirm the same. A clinical case is defined as an acute respiratory illness lasting ? 2 weeks and with onset from 10th August 2003 without other apparent cause for a person living in the Amoy Apartment Complex. A suspected case is a clinical case epidemiologically linked to a clinical case through a common household residency. All other clinical cases are considered probable.

The choice of case definition influences the scope of an outbreak investigation. For instance, if the case definition is too broad, the epidemiologist will include in their investigation all other illnesses that meet the stated clinical criteria (CDC, 2012). On the other hand, if the case definition is too strict, the investigation will only include people confirmed to have the disease (CDC, 2012). In the Epiville outbreak, for instance, the case definition includes both residents of, and visitors to the Amoy Apartments complex - implying that the epidemiologist will have to focus their outbreak investigation on both residents and visitors. On the other hand, if the case definition only considered residents, the investigation would not bother with non-residents and would only focus on the population living within the Complex.

Factors to Consider when Developing a Case Definition

The epidemiologist considers several factors when formulating a case definition. These are:

i) Person – demographic characteristics of the affected population including their age, sex, occupation, and race

ii) The geographical coverage of the suspected outbreak (place) such as the healthcare facility, street, town, or apartment complex

iii) The time representing the onset of illness in days, weeks, months, or years. Delineating the time period helps to exclude similar illnesses that are not related to the outbreak under investigation

iv) The clinical features associated with the illness under investigation, such as symptoms

v) Whether or not confirmatory laboratory tests have been carried out – this helps in grouping cases as either confirmed, probable, or suspected

vi) The aim of the outbreak investigation for which the case definition is developed – for instance, if the aim of the investigation is to know if anyone in a particular area has symptoms of a communicable disease so that they can begin planning on what actions to take, the case definition may be broad to identify all possible cases (CDC, 2012). However, if the aim of the investigation is to determine the causes of an outbreak, a strict case definition may be adopted to ensure that only people confirmed to have the disease are included (CDC, 2012).

Epiville SARS Simulation Outbreak in terms of PPT


Descriptive Variables

The Epiville Outbreak


Age group, sex, occupation, race, and exclusion criteria of the affected population

The outbreak disproportionately affects older individuals aged over 50


Geographical location


The outbreak is localized within Amoy Apartment Complex and Star Hospital


Onset of illness

between 10th August 2003 and 23rd August 2003

The Epiville SARS outbreak is localized within the Amoy Apartments complex and Star Hospital, with an onset from 10th August to 23rd August 2003, and disproportionately affects older individuals above the age of 50

Steps in the Epiville SARS Outbreak Investigation

i) Define the epidemic by defining the clinical cases, the population at-risk of illness, and calculating attack rates

ii) Examining the distribution of cases by person, place, and time – the epidemiologist does this by reviewing charts of patients, creating lists of names of patients who have died from the disease to identify the patients’ profile, including their residence and age group.

iii) Look for combinations/interactions of relevant variables

iv) Developing hypotheses about the cause of the illness based on existing knowledge of the disease and relationships to diseases whose etiology is known

v) Testing the hypotheses through conduction of an appropriately-designed study and collection of additional data if necessary

vi) Recommend control and management measures such as quarantine, isolation, and public sensitization on prevention and control

E. Summarize the techniques used in the Epiville SARS Simulation outbreak investigation

Surveillance Methods used to Ascertain Cases

Surveillance is the continuous collection and analysis of data on cases that is not necessarily followed by subsequent action. Surveillance methods used to ascertain cases include:

i) Review of case records including centralized disease registries and hospital discharge notes

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…could be measured by the number of children one passes every day (Giessecke, 2017). In the case of the Epiville SARS outbreak, it could be the number of people one passes as they go about their duties within the complex.

Measures that should be implemented to control the SARS simulation outbreak

The probability that a contact will get infected (measured by the parameter k) is relatively high in Amoy as the complex houses 600 residents, implying a significant degree of individual social interaction. As such, the most plausible measures need to focus on reducing movement among infected persons and hence, ensuring minimal contact with uninfected persons. Quarantine and isolation are the most plausible measures as they minimize movement and limit contact between persons (Giessecke, 2017).

Rationale for recommending a specific surveillance type

Surveillance could take one of two types: active and passive surveillance. It is based on the idea that a physician may only have physical access to a few cases in an outbreak and may require access to the collected notifications on a national or regional level to understand the whole picture of the outbreak (Giessecke, 2017). Passive surveillance is regular reporting by different institutions that does not involve the active search for cases, but notifying a central location of the number of suspected and confirmed cases as well as tests conducted. However, active surveillance is more beneficial during an outbreak as it is proactive and does not just involve reporting what an institution has done, but also contacting other healthcare providers and laboratories to request information about a disease. It helps to portray a clearer picture of the outbreak as it provides better avenues for identifying the prevalence of suspected and confirmed cases within the greater population.

In conclusion, the processes of outbreak investigation and management were carried out effectively. First, the broad case definition that includes both residents and non-residents of Amoy Complex increases the scope of the investigation, reducing the likelihood that a positive case in the population would fail to be identified. Techniques employed in the outbreak management process include continuous surveillance and the development of effective working hypotheses to guide the investigation. In the end, quarantine and isolation were used to minimize movement in the most risky areas and, hence, reduce the risk of direct person-to-person transmission. The low case mortality rate could be an indicator that the disease is not very deadly. However, it could also be an indicator of the effective outbreak investigation and management. A crucial point of learning from the analysis…

Sources Used in Documents:


CDC (2012). Lesson 1: Introduction to Public Health, Center for Diseases control and Prevention. Retrieved from https://www.cdc.gov/csels/dsepd/ss1978/lesson1/section5.html

Giesecke, J. (2017). Modern Infectious Disease Epidemiology (3rd ed.). Boca Raton, FL: CRC Press.

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