Epidemiology Team Research Articles

Epidemiology and public health in primary care: looking back and forward - 30 years after Alma Ata.

Epidemiology is the basic science of public health, and an epidemiologist has been described as someone with a brilliant mind but dirty hands! The dirty hands come from the essential ability to count, collate and analyse raw data in order to give meaning to it. This ability to synthesise research evidence and transform health service activity data into simple and clear information for health service managers is what makes epidemiology an essential link between research and health policy. One of the key aims of the London Journal of Primary Care is to facilitate the transfer of good research evidence and best practice into London primary care, as well as helping to build up the evidence base to support clinical practice from a variety of sources including local audits and experiential learning. As the Epidemiology Editor, I look forward to reviewing articles that are grounded in both qualitative and quantitative research methodology, but will also encourage articles with simpler methodologies where the focus is on improving clinical quality and systems. London is a unique city – not only in the financial, arts and multi-cultural realms, but in its contribution to the history and development of epidemiology and public health in the United Kingdom and rest of the world. It is not surprising therefore that London is home to some ‘national treasures’ ranging from great medical and social science institutions, research centres, health observatories, prisons, air and sea ports to unique and prestigious government departments. These have one thing in common – they are a rich source of routine data which could be used to improve the health of Londoners in various ways ranging from infectious disease surveillance, to monitoring trends in patterns and distribution of morbidity, mortality and health inequalities across the capital. The epidemiology team will seek to build collaborations between the journal and these London institutions so that the journal becomes an important vehicle for disseminating information relevant to the health of Londoners. We will also welcome articles from other metropolitan cities across the world with similar demographic profiles to that of London. This year marks the 30th anniversary of the WHO declaration of the Alma Ata principles which emphasised the central role of primary health care (PHC) in any given health system. Many of the issues specifically addressed in that declaration such as the need for appropriate social and cultural systems to support health care, involving individuals and communities in health care decisions, the need for affordable health care, health inequalities, the link between poverty and health and the menace from vaccine preventable childhood illnesses are still very much important health issues in London today. The next issue of the London Journal of Primary Care will focus on the Alma Ata declaration and I would like to invite articles that demonstrate relevant lessons learnt across primary care from different perspectives. That includes articles that look forward using these lessons, derived from the familiar research methods to case studies and relevant experiences over the past 30 years in settings relevant to a metropolitan city.

Feed contaminated with classical swine fever vaccine virus (lom strain) can induce antibodies to the virus in pigs

In November 2004, antibodies to classical swine fever virus (csfv) were detected in finishing pigs during the annual serological surveillance in Jeju Province, Korea. In addition, csf vaccine viruses (lom...

Detecting Human-to-Human Transmission of Avian Influenza A (H5N1)

To the Editor: This letter is in response to a recently published article about statistical modeling to assess human-to-human transmission of avian influenza A (H5N1) viruses in 2 case clusters (1). Sporadic cases and clusters of human infection with highly pathogenic avian influenza A (H5N1) viruses have occurred after direct contact with diseased or dead poultry (2,3). Limited, nonsustained human-to-human transmission of avian influenza (H5N1) viruses is believed to have occurred in some clusters (4). Every human infection with a novel influenza A virus should be investigated, and suspected clusters should be investigated immediately to assess exposures and transmission patterns. Yang et al. applied a statistical model to evaluate publicly available data from 2 case clusters of human infection with avian influenza A (H5N1) viruses (1). These clusters were investigated in detail during 2006 by field epidemiologic investigation teams. Yang et al. suggest that statistical methods can prove or confirm human-to-human transmission, but this suggestion is misleading. Modeling approaches can suggest transmission modalities to account for case patterns, but determination of human-to-human transmission requires detailed field epidemiologic investigations in which human, animal, and environmental exposures as well as clinical and laboratory data are assessed and interpreted. Indication that a novel influenza A virus has acquired the ability to spread among humans could be reflected by a change in the epidemiology of clusters, such as increases in 1) size and frequency of clusters, 2) cases among nonrelated persons, and 3) clinically mild cases. This ability could also be reflected in accompanying changes in viruses isolated from case-patients. When facing emerging infectious disease threats such as those posed by highly pathogenic avian influenza A (H5N1) viruses, surveillance should rapidly detect human cases and case clusters and facilitate accurate identification of the agent. Field epidemiologic investigations, initiation of evidence-based clinical management of case-patients, and epidemiologic disease-control methods (including appropriate infection control measures) should be implemented immediately. Statistical modeling can provide useful and supportive insights but should not be viewed as an alternative to a detailed field epidemiologic investigation combined with laboratory data. Timely and comprehensive field investigations remain most critical to guiding decisions about containment efforts for pandemic influenza and other emerging infectious diseases (5).

Prise en charge de 90 patients suspects de syndrome respiratoire aigu sévère. Expérience d'une collaboration épidémioclinique en situation d'alerte sanitaire liée à une infection émergente

ObjectiveThe characteristics of patients with a suspected SARS hospitalized in a Paris hospital were studied to analyze the hypothetic differences between epidemiologic and clinical teams in the management of an epidemic emerging disease, and to gather experience for the management of the next outbreak. Study designAll 90 patients hospitalized between March 16 and April 30, 2003, were included. Epidemiological and clinical data were shared with the French National Institute for Health. Cases were classified according to both the official definition (“possible”, “probable”, “excluded”) and a local one, adapted from the official definition but including an additional level of suspicion (“equivocal”), intermediate between “possible” and “excluded”. ResultsThe initial assessment was different in 39% of the cases (n=35), according to epidemiological (n=24) or clinical (n=11) elements. The final assessment diverged in 54% of the cases (n=47). All patients were officially considered as "excluded" for epidemiologists, while 47 remained as "possible" or "equivocal" cases of SARS according to the clinicians. ConclusionThe risk assessment was different in almost 40% of the cases, with no impact on epidemic diffusion or hospital-borne exposure as no probable case of SARS was diagnosed among these patients or their households. The confrontation of these different but complementary points of view will thus enrich the interdisciplinary management of eventual future outbreaks.

Risk for Epidemics after Natural Disasters

To the Editor: Myths that disaster-affected populations are at high risk for outbreaks and that dead bodies contribute to this risk are common (1). Conversely, some experts deny high, short-term risk after disasters (2). We agree with Watson et al. (3) that the risk for communicable diseases transmission after natural disasters is low but real and that it is not directly related to the disasters and dead bodies, but primarily associated with the characteristics of the displaced population within the local disease ecology. This belief supports the need for rapid but accurate assessment of health status, risk, and needs, the results of which greatly influence the nature of relief activities (4). Key functions of relief teams are communicable diseases surveillance, early warning, and rapid response to epidemic-prone situations or outbreaks. As an example, on October 26, 2005, after an earthquake in Pakistan, the World Health Organization asked the French military epidemiologic assessment team (1 epidemiologist and 1 veterinarian) to perform a sanitary assessment after cases of acute bloody diarrhea were reported in the camp of Tariqabad (estimated population ≈2,000), near Muzaffarabad. The assessment highlighted a lack of safe water and sanitation facilities, low routine immunization coverage, and disruption of healthcare services. To prevent further diarrhea, we recommended improving the overall water and sanitation conditions. A medical team from a French nongovernment organization was also provided to help the 1 physician at the camp. Concurrently, we recommended a vaccination campaign as preventive strategy against diseases likely to occur in such conditions: tetanus, diphtheria, and measles. These measures were quickly implemented to reduce the overall risk, and no further unusual increases in disease incidence were noted during the following weeks. As in another outbreak documented in a camp in the Muzaffarabad area (5), rapid detection, response, and implementation of control measures are critical for minimizing the illness and death associated with outbreaks in these high-risk populations.

Distinguishing between natural and unnatural outbreaks of animal diseases

An intentional outbreak of disease among livestock, or agricultural crops, will share a number of characteristics with those aimed at humans - unexpected pattern of disease in season or place, possible explosive incidence, unusual pathogen either in itself or of its genetic structure, difficult diagnosis - but there will also be notable differences: human cases, if they occur, will be coincidental and the major impacts will be delayed and of severe economic consequence. An investigative and analytical protocol is proposed for identifying such an event. Unless the nature of the event is self-declaring, such investigations necessitate a very thorough and careful investigation by a dedicated and experienced epidemiologic team. Atthe same time a country should take steps in advance of such an event to be prepared and to save time later, such as determining possible targets, identifying early warning indicators, establishing molecular biologic expertise and reference collections of possible pathogens, and preparing a tactical and forensic response.

Candidemia is Costly--Plain and Simple

As physicians, we are notoriously ignorant when it comes to money matters, both in personal and professional matters. As advocates for our patients, our decisions regarding interventions or therapies are more often based on issues of availability, safety, and efficacy than on cost. It is only in our roles as members of the hospital epidemiology team or pharmacy and therapeutics committee that issues of costs play a pivotal role in decision making, especially regarding the use of therapeutics or technical devices that may prevent health care-related infections, such as bloodstream infections. The clear and ob-

Molecular typing strategies

Nosocomial infections among infants in neonatal intensive care units are an increasing cause of morbidity and mortality. Efforts to rapidly detect, contain and ultimately prevent cross-transmission of these pathogens require constant vigilance by members of the epidemiology team. A vital component of an epidemiological evaluation is the ability to assess the interrelatedness of clinical isolates. This review focuses on the basic principles, strengths and weaknesses of some of the most commonly used molecular-based procedures, which determine clonal identity of outbreak strains in neonatal settings. Published evidence for the cogent selection of the method best suited for studying a particular organism and technological advances that await the new science of Molecular Epidemiology are also presented. The appropriate use of molecular typing technologies should enable reliable tracking of epidemic clones and thereby enhance the effectiveness of infection control strategies.

Basics of Surveillance: An Overview

Surveillance of nosocomial infections is the foundation of an infection control program. This article describes components of a surveillance system, methods for surveillance, methods for case-finding, and data sources. We encourage the epidemiology team to use this background information as they design surveillance systems that meet the goals of their individual institution's infection control program.

Basics of surveillance--an overview.

Surveillance of nosocomial infections is the foundation of an infection control program. This article describes components of a surveillance system, methods for surveillance, methods for case-finding, and data sources. We encourage the epidemiology team to use this background information as they design surveillance systems that meet the goals of their individual institution's infection control program.

Dengue Fever in US Military Personnel in Haiti

To describe clinical manifestations and public health implications of an outbreak of dengue fever (DF) during Operation Uphold Democracy, Haiti, 1994. Consecutive sample. Military combat support hospital, Port-au-Prince, Haiti. A total of 101 US military personnel with acute febrile illnesses. A disease surveillance team collected clinical and epidemiologic data from US military clinics throughout Haiti. Febrile patients admitted to the combat support hospital were evaluated with standardized clinical and laboratory procedures. The surveillance team followed patients daily. Arbovirus isolation and specific antibody determination and symptoms and physical findings. Febrile illnesses accounted for 103 (25%) of the 406 combat support hospital admissions during the first 6 weeks of deployment. All patients with febrile illness recovered. A total of 30 patients had DF; no patient had evidence of infection with malaria. Dengue virus serotypes 1, 2, and 4 were isolated from 22 patients, and 8 patients developed IgM antibody to dengue virus. Patients with DF could not be distinguished from other febrile patients on clinical grounds alone. No arboviruses other than dengue were identified. Active surveillance, with clinical and laboratory evaluation directed by an epidemiologic team, led to the timely recognition of an outbreak of febrile illness among US troops in Haiti. Viral isolation and serological studies were essential in confirming DF. During the surveillance period, DF accounted for at least 30% of the febrile illnesses among hospitalized US troops. Dengue fever is a significant threat to military personnel and civilian travelers in Haiti and has the potential for introduction to and transmission in the United States.

Present aspects of immunodiagnosis of schistosomiasis.

Facilitated and improved by advances in molecular biology, techniques for the immunodiagnosis of schistosomiasis, including assays based on the detection of antigens circulating in the serum and/or excreted in the urine, have now reached the stage of multi-centre trials. There is a need to complement parasitological techniques as some national programmes are becoming increasingly successful in establishing control of the disease and the classical approach frequently fails to reveal low-intensity infection. Epidemiological survey teams in some areas have tentatively started to use serology and their experience indicates that antibody detection suffices in eradicated or controlled areas with low expected prevalence but that detection of circulating antigens is needed for assessment of the incidence of infection or reinfection in areas recently brought under control. Before reagents and procedures can be recommended for routine use of national control programmes, the assays must be standardized with sera from clinically well-characterized patients in geographically defined regions, hence emphasizing the need for a reference serum bank. Implementation of serological testing, carried out by national public health laboratories using standardized testing systems, would permit valid comparisons between different areas providing support for decisions regarding national health policies.

The United States Army Special Forces—Walter Reed Army Institute of Research Field Epidemiological Survey Team (Airborne), 1965–1968

In 1965, an innovative concept in field medicine was launched in the form of a team of highly-trained, multi-disciplined AM-EDD specialists who were assigned to the Walter Reed Army Institute of Research and attached to the 5th Special Forces Group (Abn) while in Vietnam. Officially designated the U.S. Army Special Forces--Walter Reed Army Institute of Research Field Epidemiologic Survey Team (Airborne) (WRAIR-FEST), these personnel took their investigative skills into some of the more remote areas of Vietnam to study disease transmission in militarily hostile circumstances. From 1966-1968, numerous important studies of arthropod-borne diseases, including malaria, scrub typhus, and plague, and of gastrointestinal disorders, medically important arthropods, and cutaneous diseases were successfully conducted.

Laboratory Investigation of a Poisoning Epidemic in Sierra Leone

In June 1986, an epidemic of poisoning occurred in Sierra Leone, West Africa; it involved 49 persons--with 14 deaths. Our laboratory's approach and investigation of this incident is described. Using positive chemical ionization mass spectrometry and nuclear magnetic resonance spectroscopy, the toxicant was identified as parathion, a highly toxic organophosphorus pesticide. Analysis of various items supported the epidemiologic hypothesis that bread was made from contaminated flour and that the flour became contaminated with parathion during a truck shipment. Modern analytical instruments played a major role in this laboratory investigation and effected the identification of the unknown toxicant within hours of receiving the initial bread sample. Close cooperation and clear communication between the epidemiologic and laboratory teams were important in this investigation.

A call for pharmacoepidemiologists

Journal Article A call for pharmacoepidemiologists Get access Robert C. Nelson, Ph.D. Robert C. Nelson, Ph.D. candidate, Pharmacoepidemiologist and Epidemiology Team Leader Office of Epidemiology and Biostatistics Center for Drugs and Biologies Food and Drug Administration Rockville, MD 20857 Search for other works by this author on: Oxford Academic Google Scholar American Journal of Hospital Pharmacy, Volume 42, Issue 10, 1 October 1985, Page 2145, https://doi.org/10.1093/ajhp/42.10.2145a Published: 01 October 1985

DATA NEEDS FOR RESEARCH IN ROAD TRAUMA

This paper laments the existence of widespread "instant" expertise on road trauma; postulates the need for multidisciplinary epidemiological research teams to produce a more scientific approach to this problem, based on authoritative information and analysis; and suggests that any such teams will require accessible, comprehensive, compatible data. The paper describes some problems of existing data collections associated with the source of the data, the lack of compatibility and comprehensiveness, and the absence of data on exposure and on severity of injury. It is suggested that, in the context of these deficiencies, extensive development of new data is unrealistic. Instead, the paper concludes by recommending gradual expansion of currently available data on a national basis, under the control of the Australian Bureau of Statistics. It is suggested that Section 51 of the Constitution provides the necessary head of power for this development.

THE NEED FOR EPIDEMIOLOGICAL RESEARCH IN ROAD TRAUMA

This paper discusses the application of epidemiological methods to the public health problem of road trauma. The complex nature of the system is stressed, and some consequent difficulties in the formulation of appropriate hypotheses are outlined. Examples are given. To solve these problems, the paper proposes the formation of multidisciplinary full-time epidemiological research teams.

A model for combining human behavior and disease ecology to assess disease hazard in a community: Rural Ethiopia as a model

Abstract A method is presented for assessing communicable diseases hazardous to a given population. The method combines knowledge of disease agents present, life cycles and modes of transmission of these agents, and normative cultural behavior of the human population at risk. A study of a rural village in highland Ethiopia is used as an example. In contrast to studies using hospital records or those which use an epidemiologic team. this approach emphasizes the people at risk instead of the diseases. It is proposed that this methodology can be used on any scale, from one individual to a whole society. Resulting policy suggestions can be implemented as preventive measures against disease hazards. Diseases are considered as hazard systems rather than as individual and isolated medical problems. Researchers, including local people outside the traditional medical disciplines. can be used for the gathering and initial assessment of hazard-related data.

A model for combining human behavior and disease ecology to assess disease hazard in a community: Rural Ethiopia as a model

A method is presented for assessing communicable diseases hazardous to a given population. The method combines knowledge of disease agents present, life cycles and modes of transmission of these agents, and normative cultural behavior of the human population at risk. A study of a rural village in highland Ethiopia is used as an example. In contrast to studies using hospital records or those which use an epidemiologic team. this approach emphasizes the people at risk instead of the diseases. It is proposed that this methodology can be used on any scale, from one individual to a whole society. Resulting policy suggestions can be implemented as preventive measures against disease hazards. Diseases are considered as hazard systems rather than as individual and isolated medical problems. Researchers, including local people outside the traditional medical disciplines. can be used for the gathering and initial assessment of hazard-related data.

Epidemiological field experiments to prevent heroin spread

Field research into heroin abuse in Chicago suggests that heroin addiction follows epidemic rather than endemic patterns. During the appearance of a large (macro) or small (micro) epidemic in any given community, spread is primarily from user to user. As the epidemic spreads, it becomes necessary for users to associate with other users to maintain their drug supplies. Because of this association, case-finding is relatively easy. A special epidemiological field team has been developed consisting both of methadone-maintained ex-heroin users from the community and professional researchers. The field team was found to be able to detect rapidly a large percentage of involved persons in a given epidemic; one helpful technique was concentrating on the so-called heroin copping areas within the community. It was found possible to intervene successfully in epidemics by involving a large percentage of identified active heroin users in treatment; to do so, treatment facilities must be attractive and conveniently located. The major contention of these investigations is that the spread of heroin can be investigated and aborted by the utilization of standard epidemiologic principles ordinarily applied to contagious infectious diseases.