13 Jan Week 7: Outbreak Investigation
On February 7, 2018, a nurse employed at the Flinn Corporation noticed an increase in the number of employees who were sick. She was concerned that there may be a Salmonella outbreak at the company. She has interviewed each of the employees at the corporation. She has taken samples and sent them out for testing but has not received the results. She asks you, the local epidemiologist, to investigate to see if an outbreak exists and if so what the source of the outbreak is. You follow the Center for Disease Control and Prevention's steps in outbreak investigation (https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section1.html) and report your findings to her. Please note that we will not address all outbreak investigation steps in this assignment.
Use the attached Excel worksheet to produce graphs and statistics to answer the questions below. Submit your report as a Word doc (PDF file format is not allowed for this final assignment) and include figures and tables you generate. The report should be easy to follow and interpret and should be written as an academic paper in proper APA formatting.
1. Look at the Excel Spreadsheet attached. There are 3 worksheets (see tabs on bottom of page – "Nurse's Interview", "Epi Curve", "Retrospective Cohort Study"). The first sheet "Nurse's Interview" has a line list of employees who work at Flinn Corporation. This sheet represents the data the nurse has collected from those employees in an interview. Do you think that an outbreak exists? Why would you recommend to further investigate? Discuss your reasoning. (Step 2: Establish outbreak)
2. Research salmonellosis using academic sources. Are the symptoms that the ill employees exhibit consistent with salmonellosis? Provide a brief summary (1-2 paragraphs) of the disease and discuss the chain of infection for this disease. Use in-text citations in proper APA format and include all sources in your reference section. (Step 3: Verify diagnosis)
3. Identify the percentage of ill employees with each symptom. For example, 1 out of 12 ill employees had blood in stool (Bs) = 8.3%. (Step 4: Working case definition)
4. Conduct descriptive epidemiology (Step 6). Describe the characteristics of the ill employees to determine trends and risk factors.
a. Person – Calculate the percentage of ill employees that are male/female. Determine the mean age of the ill employees.
b. Place – What percentage of ill employees ate at the cafeteria? What percentage of well employees ate at the cafeteria?
c. Time – Using the data collected in the Nurse's Interview, fill in the column "# of cases" in the "Epi Curve" worksheet. Use 0 if there are no cases. As you fill in the data, the graph will automatically generate. Choose an appropriate title for the graph. Copy and paste graph into your report. What type of epidemic curve is it ? (Hint: read https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section2.html#step6)
5. Based on the information you have gathered, you have developed an hypothesis that there is a food being served at the cafeteria that is causing the employees to become ill. You need to further test this hypothesis by conducting a retrospective cohort study (Step 8). Use the worksheet "Retrospective Cohort Study" to calculate attack rates and risk ratios. The first food item Baked Chicken is done for you. You can also consult https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section2.html#step8 for help. Report the Risk ratio for each food item. Based on risk ratios, which is food is most likely to be the source of the illness? Explain.
6. Based on your findings, what would you recommend for prevention and control measures? Apply food safety principles from academic sources to discuss further prevention of Salmonella outbreaks in the cafeteria. (Step 11) Use in-text citations and include sources in reference section.
7. Include a properly formatted reference section in APA format that includes at least 3 academic sources (popular sources should not be used).
Paper layout Instructions
"Title of Your Paper"
Introduction. (You must have this heading)
Your paper needs to start with an introductory section and this is where you introduce the paper to the reader. It will be 1-2 paragraphs. (You must have 1-2 paragraphs that introduce the paper)
The Next Headings Will be Based Upon the Steps in an Epi Investigation
Your paper will continue from here and there will be written content under each heading. Follow the assignment directions for the specific content in each step. The headings are:
Step 2: Establish the Salmonella Outbreak. (You must have this heading
and then the related paragraphs)
Step 3: Verify Diagnosis. (You must have this heading
and then the related paragraphs)
Step 4: Working Case Definition. (You must have this heading and then the related paragraphs)
Step 6: Conduct Descriptive Epidemiology. (You must have this heading and then the related paragraphs)
Step 8: Conducting a Retrospective Cohort Study. (You must have this heading and then the related paragraphs) This Epi final paper does not have steps 9 or 10 in it.
Step 11: Apply Food Safety Principles to Further Prevent Salmonella Outbreaks in the Cafeteria (You must have this heading and then the related paragraphs)
Conclusion (You must have this heading)
Your paper needs a concluding section and this is where you summarize the paper to the reader. It is NOT the same as the introductory paragraphs. The conclusion will have 1-2
|Gender||Name||Age||Ate at cafeteria?||ill?||Onset||Symptoms|
|F||Kate||32||Yes||Yes||1-Feb||Ac, F,C,D, H||Abdominal cramps||Ac|
|F||Vanessa||24||No||No||n/a||n/a||Blood in the stool||Bs|
|F||Catherine||36||Yes||Yes||3-Feb||Ac, F, C, D, Bs|
|M||Sean||31||Yes||Yes||4-Feb||F, C, D, H|
|M||Peter||33||Yes||Yes||4-Feb||Ac, D, N|
|F||Colleen||48||Yes||Yes||1-Feb||Ac, D, N|
|Onset Date||# of cases||Use Data from Step 2 Spreadsheet to complete "# of cases" column (you will notice the y-axis change range as you input data)|
Click here to insert your title
# of cases 43129 43130 43131 43132 43133 43134 43135 43136 43137 43138
Retrospective Cohort Study
|Foods in cafeteria||Ate Food||Did Not Eat Food|
|Ill||Well||Attack Rate||Ill||Well||Attack Rate||Risk Ratio|
|Vanilla ice cream||5||6||7||2|
|Chocolate ice cream||3||2||9||6|
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