Common Gastrointestinal Illnesses in Vermont – Epidemiology Example

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"Common Gastrointestinal Illnesses in Vermont" is a perfect example of medical research on epidemiology.   Epidemiology is the science that studies the frequency, distribution, causes, and determinants of disease in the human population. Norovirus is a group of viruses that cause gastroenteritis in people. Symptoms include nausea, vomiting, diarrhea, and stomach cramping. Illness often begins suddenly and the infected person may feel sick. Symptoms usually begin 24-48 hours after exposure to the virus although in some cases they can appear as early as 12 hours. In investigating an outbreak speed is critical, but getting the right answer is essential, too.

In order to satisfy both requirements, the epidemiologist’ s approach in carrying a systematic investigation is employed.                   Epidemiological steps to be taken in the case study of a mother reporting a possible outbreak due to the signs shown by her young child aged 5 years and two neighborhood children. In this case study, a questionnaire is solicited to assist in investigating the hypotheses about the source and transmission of the suspected outbreak. In order to determine the seriousness of the problem the mother of the child is to be asked questions aimed at: Getting a clear and detailed description of the illness. The people who are ill, their characteristics, and relationships with each other. Date and time the affected people became ill. Location of the affected people and possible means of contacting them. Getting the risk factor’ s modes of transmission and clues of the possible cause of illness. The collection of information is very much detailed and accurate in recordings of symptoms, dates, and time.

If the illness is consistent with potential foodborne illness, then options of possible cause should be open as illnesses caused by food are normally acquired through other means.

A wide collection of the food history of the last 72 hours is essential too.                   The second series of questions are aimed at determining the etiological agents that are consistent with the illness among the three children. Etiologies of gastrointestinal illness are broadly categorized into two: Infectious and Intoxications. Infectious are consequences of the growth of microorganisms in the body and are characterized by the incubation period that is measured in days. On the other hand, intoxications are caused by ingestions of food already contaminated by toxins that exist naturally in animals, plants, and fungi.

Illness from a toxin manifests faster than those of infections because the time for growth and invasions of the intestinal lining is not required. The incubation period for intoxication is often measured in minutes or hours. This information is critical in shortening the list of etiologic agents suspected during the outbreak investigation. Other additional information that may be obtained includes the incubation period, symptoms duration, suspect exposures, and laboratory testing of stool, blood, and vomitus.           The third series of questions are aimed at determining the next step to be taken in regard to the collected information and determining if any additional information is required.

The following steps are taken: Notification of the situation to the local /district department because they might have heard of the illness or suspicious exposures in the community and keeping the communication open. Collection of further information through contact of other party attendees, collecting stool specimen from ill persons for laboratory testing, contacting the seeming club manager, characterize the ill person in order to get a clue on the source of the outbreak, investigating the swim club, and collecting samples of leftover food and drinks from the birthday party and testing them.                   The swim club manager’ s corporation is gained by making the intentions of the call very clear and pointing out how helpful the information he/she would provide would be helpful in the identification of the possible cause and even possible prevention measures.

Additional powers from the authority of the health department could be used in order to get detailed information from the pool club manager.

Recordings of a clear statistical data based on the contacted 21 case-patients interviewed in summery. Signs and symptoms are closely observed in order to ascertain the suspicion about the causative agent. Based on the patterns shown by the demographic results this could be a perfect lead to the causative agent which forms the basis of the hypotheses of the pool being the possible lead. Thereafter an environmental assessment on the private swimming pool follows.                   Based on the information collected from the swimming pool: Design features, operations, policies, turnover rate, chemical analysis of the water, and how its treated and maintenance procedure could lead to the possible sources of pathogens.

Possible leads involve determining the turnover rate and comparing it to the desired rate as per the size, type, and volume of the pool. Detailed chemical analysis of the pool water and chlorine’ s concentration, contact time, pH, and other substances in water could point out the source of pathogens. Determining the tests that are routinely on pool done on pool water to ascertain the level of safety of pool water to the bathers.

Interpretation of all these results and giving recommendations is critical for ensuring the recommended health standards of the pool water are maintained for the welfare of all bathers.                   An epidemiologic study is necessary in order to test the hypothesis to prove its certainty of the suspicious source of outbreak and identification of risk factors for the infection. At this point information obtained is to determine activities that put one at risk of exposure to the pathogens.

This should account for the date and time that a person was in the pool and the amount of contact to the pool water. Following the tabulation of the cohort study, relative risk is calculated in order to determine the likelihood of a person exposed to a factor to experience illness.                   It’ s very evident that the cohort study confines the suspicion of the outbreak. That the outbreak resulted from a facial incident in the pool which coincided with the failure of the chlorinator. Recommendations made were as follows: Having trained personal and having policies and procedures in place when a problem is recognized, developing clear lines of communications within the pool facility, educating young pool users on pool hygiene.

As for the young bathers, they should be advised not to swim if they have diarrhea, not swallowing pool water, showering thoroughly before entering a pool, using diaper changing facilities in the bathroom, washing hands with soap and warm water after going to the toilet, reporting of facial incidences to the pool stuff and also follow pool staff instructions.

All the information on the case study should be shared with the pool staff members in order to ensure to cordially join efforts and ensure that another outbreak in the future is prevented.                                                                         Incorporation of results from the epidemiological association, environmental association, environmental, and laboratory investigations form a basis for informing and testing hypotheses. Careful development of epidemiologic inferences coupled with persuasive clinical and laboratory evidence normally will indicate the source and mode of the disease. Epidemiology plays an important role in monitoring, investigating, and evaluating disease surveillance systems and health data.

It provides the necessary information to monitor trends in health and disease and understanding variations in disease frequency geographically. This enables identification of trends in health and means of planning resources for the population.  

References

Committee on Communicable Diseases Affecting Man, Food Subcommittee. Procedures to Investigate Foodborne Illness. Fourth Edition, Des Moines, Iowa: International Association of Milk, Food and Environmental Sanitarians, Inc., 1988.

FDA, Division of Human Resource Development, State Training Branch. Principles and Concepts For Investigating Foodborne Illness. U.S. Government Printing Office, 1994.

will indicate the source and mode of the disease.

Case study link. http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CCoQFjAA&url=http%3A%2F%2Fwww.cdc.gov%2Fepicasestudies%2Fdownloads%2FnoroVT_inst.pdf&ei=yxtwU8CQJ8SsO4GZgdgC&usg=AFQjCNESJu13l5W9jjC-D7xwuhm0Z0TIYg&sig2=ZqFedFURHh8QEieu2G462g&bvm=bv.66330100,d.ZWU

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