Epidemiology

Transcript Epidemiology

Fall, 2009 Community Health Lillian Wald 1912

Epidemiology

The Broad Street Pump Reference: Nies, M. & McEwen, M. (2007). Community / public health nursing: Promoting the health of populations, 4 th Ed. Saunders-Elsevier: St. Louis, MO J. Carley MSN, MA, CNE Fall, 2009

Communicable Disease

John Snow Pub Broad Street, London

An Outline of Sorts…….

        Introduction to Epidemiology Historical Perspective of Nursing Epidemiology Worldwide Implications Local Implications Group 2-hour Mini-Project: Each group research & prepare 10-15 minute presentation related to epidemiology (broad subject!) See Next Slide Each group prepare two test (assessment questions related to epidemiology) Evaluations required

About “Statistics….”

 Demigog / Demigoguery  “Infant Mortality rate”

 From wiki—ways to demigog…

Terminology:

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Epidemiology Levels of Prevention Primary Prevention Secondary Prevention Tertiary Prevention Epidemic Endemic Pandemic Distribution Determinants Incidence rate Risk Prevalence Prevalence proportion Attack rate Case Fatality Rate Mortality rate Morbidity

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Attributable Risk Proportionate Mortality Rate Adjusted mortality & morbidity rates Yield Attack Rate Case-Specific Mortality Rate

1918

World War I is rapidly drawing to its bloody conclusion.

Millions have died in the carnage, including an entire generation of French, English, and Germans. Peace is at hand, the guns have been silenced, yet many more will die.

Many more will die.

1918

Song sung by children in U.S., 1918

I had a little bird, Its name was Enza. I opened the window, And in-flu-enza

ENDEMIC…………………………………………….…….EPIDEMIC

PANDEMIC

WWI Combat Deaths Russell, Kansas Fall, 1917 Trenton, N.J.

June, 1917

Fall, 1917

Trenton, N.J.

France Fall, 1917 Asia Summer 1918 Nationwide, Spring 1918 Europe, 1918 Africa, 1918 ***Number of Mortalities to date attributed to Influenza Outbreak: (Each Figure equals one million deaths)

“Phase Shift”

Mortalities

8 6 4 2 20 18 16 14 12 10

Millions ?

“Spanish Flu” WHO DIES FROM INFLUENZA ?

Deaths World Wide = 20, 000, 000 – 40, 000, 000 Typically, The very young and the very old.

Spanish flu mortalities selected out the healthiest portion of the population, Those between 20 & 40 years old.

Additionally, as with most infectious Disease Outbreaks: HEALTH CARE WORKERS, i.e., NURSES, DIED @ DISPROPORTIONATE RATES.

CONTEXT: AIDS Deaths World Wide = ~19, 000, 000 Year 1 2 3 4 5 6 7 8 9 10 11 12 14 15 16 17 18 19 20

http://www.pandemicflu.gov/storybook /

Pandemic Influenza: The Phie Family

All eight family members were admitted to the emergency hospital in Loveland Colorado, and between October 30 and November 9, 1918: Jessie, age 40 (died Oct. 30); Florence, age 19 (died Nov. 1); Charlie, age 45 (died Nov. 2); Bobbie, age 8 (died Nov. 4); Harry, age 10 (died Nov. 5); Willie, age 4 (died Nov. 5). Tommy, age 16 (died Nov. 7); Davie, age 6 (died Nov. 9).

All eight died from the flu. They were all buried in Eaton, Colorado where they had lived previously.

The Phie Family

http://www.fluwikie.com/index.php

?n=Main.Multimedia

http://www.cdc.gov/nchs/fastats/lcod.htm

10 Leading Causes of Death, U.S. (2004)*

          Heart disease (654,092) Cancer (550,270) Stroke (150,147) Chronic lower respiratory diseases Accidents (108,694) Diabetes (72,815) Alzheimer's disease ( 65,829) Influenza/Pneumonia (61,472)

(

123,884) Nephritis, nephrotic syndrome, and nephrosis (42,762) Septicemia (33,464) *Retrieved from: Center for Disease Control & Prevention’s National Center for Health Statistics FastStats at: http://www.cdc.gov/nchs/fastats/lcod.htm

http://www.cdc.gov/mmwr/PDF/wk/mm5553.pdf

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Collaborative Learning / Research in Epidemiology & Communicable Disease For the assigned ‘reportable’ communicable disease describe the disease, e.g., pathophysiology. Describe and ‘plug-in’ the components of the disease as related to the epidemiological triangle (agent, host, environment, vector).

Is the disease vaccine preventable? Using MMWR provided, discuss the total monthly and yearly total reported cases for 2006.

Discuss how the disease is diagnosed.

Discuss treatment for the disease.

Discuss morbidity & mortality for disease for year 2006.

Discuss incidence of the disease by: Geographical region Age group Sex / gender Race Discuss reported cases of the assigned disease process for Clark County, NV this year (to date). Discuss primary, secondary, and tertiary prevention as it relates to assigned disease process.

5 Minute report by each group starting with group 11—10—9—8—7—6—5—4—3—2--1

Research Topic ------ Cite Sources

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Gp 1: Legionella Gp 2: Botulism (food borne & infant) Gp 3: Coccidiomycosis Gp 4: Gonorrhea Gp 5: Syphilis Gp 6: Chlamydia Gp 7: Typhus Gp 8: Shigellosis Gp 9: Tuberculosis Gp 10: Pertusis Gp 11: Psittacosis

Epidemiology

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Introduction

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Definitions

Epidemiology

Epidemic

– an incidence of disease that is more than usual in a specific population – see example of West Nile Virus on CDC site

Epidemiology

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Introduction

the father of Epidemiology, mapped the incidence and locality of cholera in relationship to the location of the water source, first use of a comparison group, above the city, or downstream from the city.

1870’s – Robert Koch –

discovered the causative bacteria anthrax, T.B., and cholera

1952s -– Dr. Jonas Salk’s

Vaccine Salk Production of Polio Snow Pasteur Koch

The Broad Street Pump

Miasma Theory

Intervention Which Stopped the Cholera Outbreak:

Epidemiology

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History of Epidemiology

World War I

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Agents –

infectious diseases; bacterium, fungi, viruses or parasites. May also be toxic chemicals or physical agents which create illness or injury.

Host

–a host is the person or subject that is susceptible to an agent

Vector

– a carrier or source that transmits the agent to or from the host.

Example : the vector for the West Nile virus is the mosquito, the agent is the virus, and the host can be human, horse, or bird. The environment requires standing water

The New Mothers Project

Epidemiology

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Epidemiology Levels of Prevention

Think outside of the Box – International!

Example:

AID’s in Africa: Primary Prevention:

condoms.

counseling young females and school children on STD prevention and use of

Secondary Prevention

: Screening pregnant females for HIV.

Tertiary Prevention –

Providing AZT and instructions to pregnant mothers with HIV so that they do not transmit the disease

Prevalence:

 the actual measurement of existing disease at a  particular time in a specific group

Levels of Prevention

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Primary Prevention Incidence

: the rate of health problems that are developing in new cases We use primary prevention methods before the person gets the disease.    Primary prevention aims to prevent the disease from occurring. So primary prevention reduces both the incidence and prevalence of a disease.

Encouraging people to protect themselves from the sun's ultraviolet rays is an example of primary prevention of skin cancer.

Epidemiology



Primary, Secondary, Tertiary

Epidemiology Levels of Prevention

 Give an example of Primary Prevention for this Influenza?

 Give an example of Secondary Prevention for this Influenza?

 What are some of the Tertiary Prevention interventions that could be used to prevent influenza?

Epidemiology

Current Epidemics in the United States

  HIV STD’s / STI’s       Smoking Heart Disease Hepatitis B & C Lyme’s Disease West Nile Virus Obesity

Epidemiology

Current Epidemics of the World:

 AIDS – number one – 38,000,000 people were infected as of 2005    Avian Flu West Nile virus Tobacco use    SARS Starvation TB

Epidemiology

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Current Epidemics in Clark County –

CCHD from the http://www.southernnevadahealthdistrict.org/epidemiology/disease_statistics.htm

Chlamydia/Gonorrhea HIV/AID’s Syphilis Smoking & Lung Disease West Nile Encephalitis Rotavirus

Epidemiology

Environmental Health from Healthy People 2010 Clark County Priorities

 Cultural programs  Access to health care   Bioterrorism response improvement Reduce second hand smoke exposure      Increase food safety education Drowning in toddlers Reduce Suicide rate Decrease in low birth weight rate Use of seatbelts and child car restraints

Challenges for Public Health Nursing:

 Promote the health of communities  Need for a bimodal focus on prevention, health promotion, and home care  Education to meet the needs of the aggregate  Concern for cost-benefit ratios  Population approach for nursing care

Disease Detective

http://library.thinkquest.org/06aug/01865/index.html

Outbreak at Water’s Edge

 http://www.mclph.umn.edu/watersedge/play.html

Some Good Sites…………….



WHOSIS

( World Health Organization Statistical Information System) 

The Office of Minority Health

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Brazos-Nurse.Org Community Health Page

“Cold Cases: Itinerant Nursing in South West Alaska” http://www.medscape.com/viewarticle/488041

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American Anthrax Outbreak of 2001 Medical Mystery

American Anthrax Outbreak of 2001 http://www.ph.ucla.edu/epi/bioter/detect/antdetect_intro.html

DOWNLOADS (Free)

 EpiInfo 

http://www.cdc.gov/epiinfo/

 Studying Populations  http://www.dundee.ac.uk/~cdvflore/SPUpdates.htm

APPENDIX 121 Cities Mortality Reporting System

   In the late 1800's and early 1900's pneumonia and influenza deaths were reported to state and federal health officials only in times of an epidemic. Health officials would then conduct personal interviews to collect information about the age, sex, severity of illness, and other demographic information regarding cases in the household. The results of these interviews were the only source of mortality information available to researchers for measurement of the impact of an epidemic or prediction of future trends (Collins, et al. 1951).

  In response to the influenza pandemic of 1918-1919, the U.S. Bureau of the Census reported one of the first quantitative measurements of the epidemic impact on mortality. In the March 4, 1919, issue of the "Weekly Health Index," the death rates for 31 large cities for the period of September 18, 1918-March 1, 1919 were compared to the death rates for the same period in 1917-1918, and the difference between them was calculated as the "excess mortality" during the epidemic.

 Selwyn Collins further refined this concept of a quantitative measure or index of the impact of influenza epidemics in the 1930's.  He used his refined method to characterize influenza epidemics for data collected monthly from 35 cities (1910-1919) and weekly from 90 cities (1920-1942), 56 cities (1943-1950), and 62 cities (1951-1956).

 In 1957, fear of the Asian flu prompted the CDC (formerly Communicable Disease Center) to develop a method of early detection of an epidemic using a modification of Collins' procedures. At this time, the system consisted of 108 cities from which Collins had previously been collecting weekly (unpublished) data (Serfling, et al. 1962).

 In 1962, after responsibility for publication of the Morbidity and Mortality Weekly Report (

MMWR

) was transferred to CDC from the National Office of Vital Statistics, CDC continued to collect weekly mortality data reported voluntarily by a number of selected cities in the United States.

   Today, the 121 Cities Mortality Reporting System continues to serve as the most timely source of mortality data in the United States. Despite changes in the methods for reporting and the cities participating, the system has consistently captured one-third of the nation's deaths. Furthermore, evaluations have shown that the 121 Cities Mortality Reporting System detects trends and patterns in pneumonia and influenza deaths similar to those shown by mortality statistics for the entire nation (Baron, et al. 1988). An updated evaluation of the representativeness of the 121 cities and the mortality patterns observed is currently underway. The Influenza Branch, National Center for Infectious Diseases, also relies on this system for timely estimates of the impact of epidemic influenza on mortality each influenza season.

“121 cities” surveillance system

EASTERN

 Boston, MA Bridgeport, CT Cambridge, MA Fall River, MA Hartford, CT Lowell, MA Lynn, MA New Bedford, MA New Haven, CT Providence, RI Somerville, MA Springfield, MA Waterbury, CT Worcester, MA

MID ATLANTIC

Albany, NY Allentown, PA Buffalo, NY Camden, NJ Elizabeth, NJ Erie, PA Jersey City, NJ New York City, NY Newark, NJ Paterson, NJ Philadelphia, PA Pittsburgh, PA Reading, PA Rochester, NY Schenectady, NY Scranton, PA Syracuse, NY Trenton, NJ Utica, NY Yonkers, NY

E.N. CENTRAL

Akron, OH Canton, OH Chicago, IL Cincinnati, OH Cleveland, OH Columbus, OH Dayton, OH Detroit, MI Evansville, IN Fort Wayne, IN Gary, IN Grand Rapids, MI Indianapolis, IN Lansing, MI Milwaukee, WI Peoria, IL Rockford, IL South Bend, IN Toledo, OH Youngstown, OH

W.N. CENTRAL

Des Moines, IA Duluth, MN Kansas City, KS Kansas City, MO Lincoln, NE Minneapolis, MN Omaha, NE St. Louis, MO St. Paul, MN Wichita, KS

S. ATLANTIC

Atlanta, GA Baltimore, MD Charlotte, NC Jacksonville, FL Miami, FL Norfolk, VA Richmond, VA Savannah, GA St. Petersburg, FL Tampa, FL Washington, DC Wilmington, DE

E.S. CENTRAL

Birmingham, AL Chattanooga, TN Knoxville, TN Lexington, KY Memphis, TN Mobile, AL Montgomery, AL Nashville, TN

W.S. CENTRAL

Austin, TX Baton Rouge, LA Corpus Christi, TX Dallas, TX El Paso, TX Ft. Worth, TX Houston, TX Little Rock, AR New Orleans, LA San Antonio, TX Shreveport, LA Tulsa, OK    

PACIFIC

Berkeley, CA Fresno, CA Glendale, CA Honolulu, HI Long Beach, CA Los Angeles, CA Pasadena, CA Portland, OR Sacramento, CA San Diego, CA San Francisco, CA San Jose, CA Santa Cruz, CA Seattle, WA Spokane, WA Tacoma, WA

MOUNTAIN

Albuquerque, NM Boise, ID Colorado Springs, CO Denver, CO Las Vegas, NV Ogden, UT Phoenix, AZ Pueblo, CO Salt Lake City, UT Tucson, AZ

Evidence-Based Public Health

http://phpartners.org/tutorial/04-ebph/index.html

Epidemiology

Transcript Epidemiology

Epidemiology

John Snow Pub Broad Street, London

An Outline of Sorts…….

About “Statistics….”

Terminology:

Song sung by children in U.S., 1918

I had a little bird, Its name was Enza. I opened the window, And in-flu-enza

PANDEMIC

“Phase Shift”

Pandemic Influenza: The Phie Family

http://www.fluwikie.com/index.php

?n=Main.Multimedia

10 Leading Causes of Death, U.S. (2004)*

http://www.cdc.gov/mmwr/PDF/wk/mm5553.pdf

Research Topic ------ Cite Sources

Epidemiology

Introduction

Definitions

Epidemiology

Epidemiology

Introduction

Definitions

–

Epidemiology

Introduction

Definitions

Epidemiology

Introduction

Definitions

Epidemiology

Introduction

Definitions

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Epidemiology

Introduction Definitions

Epidemiology

Introduction

Definitions

Epidemiology

Epidemiology

Epidemiology

The Broad Street Pump

Intervention Which Stopped the Cholera Outbreak:

Epidemiology

History of Epidemiology

Epidemiology

History of Epidemiology

Epidemiology

Epidemiology

Epidemiology

Levels of Prevention

Epidemiology

Epidemiology Levels of Prevention

Epidemiology

Epidemiology

Epidemiology

Epidemiology

Challenges for Public Health Nursing:

Disease Detective

Outbreak at Water’s Edge

WHOSIS

The Office of Minority Health

Brazos-Nurse.Org Community Health Page

American Anthrax Outbreak of 2001 Medical Mystery

SUPERCOURSE: Anthrax

Cool Sites:

http://wonder.cdc.gov/WelcomeT.html

http://www.cdc.gov/nchs/fastats/default.htm

http://www.cdc.gov/epiinfo/

DOWNLOADS (Free)

http://www.cdc.gov/epiinfo/

“121 cities” surveillance system

Evidence-Based Public Health

finis

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