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Field Epidemiology


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Essential Field Epidemiology: Outbreak Investigations

Essential Field Epidemiology is an intensive course that covers the essential knowledge, skills, and abilities necessary to conduct an epidemiologic field (outbreak) investigation. To get an overview, download our Quick Reference Guide. We cover the following:

Contents

  1. 1 Textbooks
  2. 2 Course Readings
    1. 2.1 Epidemiologic Concepts for the Prevention & Control of Infectious Diseases
    2. 2.2 Epidemiologic Approach: Steps to Public Health Action
    3. 2.3 Conducting an Outbreak Investigation in 7 Steps (or less)
    4. 2.4 Step 1: Case Investigation
    5. 2.5 Step 2: Cause Investigation
    6. 2.6 Step 3: Control Measures
    7. 2.7 Step 4: Conducting an Analytic Study
    8. 2.8 Step 5: Conclusions: Making Inferences
  3. 3 Exercises
    1. 3.1 Discussion-based
    2. 3.2 Computer-based
    3. 3.3 Operations-based
  4. 4 Miscellaneous materials

Textbooks

  • Aragon TJ, Reingold A. Essential Field Epidemiology. Selected Chapters.
  • Centers for Disease Control and Prevention. Principles of Epidemiology in Public Health Practice: An Introduction to Applied Epidemiology and Biostatistics. Third Edition (2006). Self-Study Course SS1000. (Download PDF)

Course Readings

Epidemiologic Concepts for the Prevention & Control of Infectious Diseases

  • Aragon TJ, Reingold A. Chapter 1: Epidemiologic Concepts for the Prevention and Control of Infectious Diseases. In. Essential Field Epidemiology.
  • Pirofski L, Casadevall A. The meaning of microbial exposure, infection, colonisation, and disease in clinical practice. Lancet Infect Dis. 2002;2:628-635 (PMID: 12383613)
  • Goldmann DA. Transmission of viral respiratory infections in the home. Pediatr Infect Dis J. 2000 Oct;19(10 Suppl):S97-102. Review. (PMID: 11052396)
  • Musher DM. How contagious are common respiratory tract infections? N Engl J Med. 2003 Mar 27;348(13):1256-66. Review. (PMID: 12660390)
  • Musher DM, Musher BL. Contagious acute gastrointestinal infections. N Engl J Med. 2004 Dec 2;351(23):2417-27. Review. (PMID: 15575058)
  • Roy CJ, Milton DK. Airborne transmission of communicable infection--the elusive pathway. N Engl J Med. 2004 Apr 22;350(17):1710-2. (PMID: 15102996)
  • Brankston, G.; Gitterman, L.; Hirji, Z.; Lemieux, C. & Gardam, M. Transmission of influenza A in human beings. Lancet Infect Dis. 2007:7;257-265 (PMID: 17376383)
  • Mangili A, Gendreau MA. Transmission of infectious diseases during commercial air travel. Lancet. 2005 Mar 12-18;365(9463):989-96. Review. (PMID: 15767002)
  • Hayes EB, Komar N, Nasci RS, Montgomery SP, O'Leary DR, Campbell GL. Epidemiology and transmission dynamics of West Nile virus disease. Emerg Infect Dis. 2005 Aug;11(8):1167-73. (PMID: 16102302)
  • Rangel JM, Sparling PH, Crowe C, Griffin PM, Swerdlow DL. Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002. Emerg Infect Dis. 2005 Apr;11(4):603-9. (PMID: 15829201)

Epidemiologic Approach: Steps to Public Health Action

  • Aragon TJ, Reingold A. Chapter 2: The Epidemiologic Approach: Steps to Public Health Action. In. Essential Field Epidemiology. (Chapter)
  • Guris D, Harpaz R, Redd SB, Smith NJ, Papania MJ. Measles surveillance in the United States: an overview. J Infect Dis. 2004 May 1;189 Suppl 1:S177-84. Review. (PMID: 15106108)
  • Reingold A. If syndromic surveillance is the answer, what is the question? Biosecur Bioterror. 2003;1(2):77-81. (PMID: 15040185)
  • Henning KJ. What is syndromic surveillance? MMWR Morb Mortal Wkly Rep. 2004 Sep 24;53 Suppl:5-11. (PMID: 15714620)

Conducting an Outbreak Investigation in 7 Steps (or less)

  • Aragon TJ, Enanoria WT, Reingold A. Conducting an outbreak investigation in 7 steps (or less). (Quick Ref Guide)
  • NCCPHP. Overview of Outbreak Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Anatomy and Physiology of an Outbreak FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Embarking on an Outbreak FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • Reingold AL. Outbreak investigations--A perspective. Emerg Infect Dis 1998;4(1):21-7. (PMID: 9452395)
  • Goodman RA, Buehler JW, Koplan JP. The epidemiologic field investigation: science and judgment in public health practice. Am J Epidemiol. 1990 Jul;132(1):9-16. (PMID: 2356818)
  • Palmer SR. Epidemiology in search of infectious diseases: methods in outbreak investigation. J Epidemiol Community Health. 1989 Dec;43(4):311-4. Review. (PMID: 2693574)
  • Palmer SR. Outbreak investigation: the need for 'quick and clean' epidemiology. Int J Epidemiol. 1995;24 Suppl 1:S34-8. (PMID: 7558549)
  • Sistrom MG, Hale PJ. Outbreak investigations: Community participation and role of community and public health nurses. Public Health Nurs. 2006;23:256-263. (PMID: 16684204)

Step 1: Case Investigation

  • Review Step 1: Case Investigation, in Conducting an outbreak investigation in 7 steps (or less). (Chapter | Quick Ref Guide)
  • NCCPHP. Case Finding and Line Listing: A Guide for Investigators. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Epidemic Curves Ahead. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Hypothesis Generation During Outbreaks. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • Green MS, Swartz T, Mayshar E, Lev B, Leventhal A, Slater PE, Shemer J. When is an epidemic an epidemic? Isr Med Assoc J. 2002 Jan;4(1):3-6. Review. (PMID: 11802306)
  • Jernigan DB et al. Investigation of bioterrorism-related anthrax, United States, 2001: Epidemiologic findings. Emerg Infect Dis, 2002;8:1019-1028. (PMID: 12396909)
  • CDC. Shigella sonnei outbreak among men who have sex with men--San Francisco, California, 2000-2001. MMWR Morb Mortal Wkly Rep, 2001, 50, 922-926. (PMID: 10079063)
  • CDC. Nosocomial group A streptococcal infections associated with asymptomatic health-care workers--Maryland and California, 1997. MMWR Morb Mortal Wkly Rep, 1999, 48, 163-166 (PMID: 11699845)

Step 2: Cause Investigation

  • Review Step 2: Cause Investigation and Types of Investigative Questions, in in Conducting an outbreak investigation in 7 steps (or less). (Chapter | Quick Ref Guide)
  • NCCPHP. Hypothesis-Generating Interviews. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Environmental Health Investigations: Conducting Traceback Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Conducting Environmental Health Assessments. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Collecting Specimens in Outbreak Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Laboratory Diagnosis: An Overview. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Laboratory Diagnosis: Molecular Techniques. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • Winthrop KL, Abrams M, Yakrus M, Schwartz I, Ely J, Gillies D, Vugia DJ. An outbreak of mycobacterial furunculosis associated with footbaths at a nail salon. N Engl J Med. 2002 May 2;346(18):1366-71. (PMID: 11986410)
  • Reed KD, Melski JW, Graham MB, et al. The detection of monkeypox in humans in the Western Hemisphere. N Engl J Med. 2004 Jan 22;350(4):342-50. (PMID: 14736926)
  • CDC. Diagnosis and Management of Foodborne Illnesses: A Primer for Physicians and Other Health Care Professionals. MMWR 2004;53(RR-4). (PMID: 15123984)
  • NCCPHP. Introduction to Forensic Epidemiology. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Forensic Epidemiology Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)

Step 3: Control Measures

  • Review Step 3: Control Measures in Conducting an outbreak investigation in 7 steps (or less). (Chapter | Quick Ref Guide)
  • Aragon TJ. Designing Infectious Disease Control Measures. (Quick Ref Guide)
  • Svoboda T, Henry B, Shulman L, et al. Public health measures to control the spread of the severe acute respiratory syndrome during the outbreak in Toronto. N Engl J Med. 2004 Jun 3;350(23):2352-61. (PMID: 15175437)
  • Weinstein RA. Planning for epidemics--the lessons of SARS. N Engl J Med. 2004 Jun 3;350(23):2332-4. No abstract available. (PMID: 15175434)
  • Frieden TR, Das-Douglas M, Kellerman SE, Henning KJ. Applying public health principles to the HIV epidemic. N Engl J Med. 2005 Dec 1;353(22):2397-402. No abstract available. (PMID: 16319391)
  • Stern AM, Markel H. International efforts to control infectious diseases, 1851 to the present. JAMA. 2004 Sep 22;292(12):1474-9. (PMID: 15383519)
  • Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis. 2003 Oct 15;37(8):1094-101. Epub 2003 Sep 19. (PMID: 14523774)
  • Balicer RD, Huerta M, Levy Y, Davidovitch N, Grotto I. Influenza outbreak control in confined settings. Emerg Infect Dis. 2005 Apr;11(4):579-83. (PMID: 15829197)

Step 4: Conducting an Analytic Study

  • Review Step 4: Conduct analytic study in Conducting an outbreak investigation in 7 steps (or less). (Chapter | Quick Ref Guide)
  • NCCPHP. Selecting a Study Design. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Cohort Studies for Outbreak Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Case-Control Studies for Outbreak Investigations. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Data Analysis Basics: Variables and Distribution. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Data Analysis: Simple Statistical Tests. FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • NCCPHP. Advanced Data Analysis: Methods to Control for Confounding (Matching and Logistic Regression). FOCUS on Field Epidemiology. (Newsletter | Discussion)
  • Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP, Kuo HW, Jiang DD, Chen KT, Lando J, Hsu KH, Chen TJ, Dowell SF. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003 Dec 18;349(25):2416-22. (PMID: 14681507)
  • Dwyer DM, Strickler H, Goodman RA, Armenian HK. Use of case-control studies in outbreak investigations. Epidemiol Rev. 1994;16(1):109-23. Review. (PMID: 7925720)
  • Nguyen DM, Mascola L, Brancoft E. Recurring methicillin-resistant Staphylococcus aureus infections in a football team. Emerg Infect Dis. 2005 Apr;11(4):526-32. (PMID: 15829189)
  • Fonseca MG, Armenian HK. Use of the case-control method in outbreak investigations. Am J Epidemiol. 1991 Apr 1;133(7):748-52. Review. (PMID: 2018029)
  • Gross PA. Collection of data documenting risk factors: safeguards in conducting case-control studies. Am J Med. 1984 May 15;76(5A):28-33. Review. (PMID: 6372476)
  • Davies HT, Crombie IK. Bias in case-control studies. Hosp Med. 2000 Apr;61(4):279-81. Review. (PMID: 10858807)
  • Jacquez GM, Waller LA, Grimson R, Wartenberg D. The analysis of disease clusters, Part I: State of the art. Infect Control Hosp Epidemiol. 1996 May;17(5):319-27. Review. (PMID: 8727621)
  • Jacquez GM, Grimson R, Waller LA, Wartenberg D. The analysis of disease clusters, Part II: Introduction to techniques. Infect Control Hosp Epidemiol. 1996 Jun;17(6):385-97. Review. (PMID: 8805074)

Step 5: Conclusions: Making Inferences

  • Review Step 5: Conclusions: Epidemiologic and causal inference in Conducting an outbreak investigation in 7 steps (or less). (Chapter | Quick Ref Guide)
  • Rothman KJ, Greenland S. Causation and causal inference in epidemiology. Am J Public Health. 2005;95 Suppl 1:S144-50. (PMID: 16030331)
  • Aragon TJ, Novotny S, Enanoria W, Vugia DJ, Khalakdina A, Katz MH. Endemic cryptosporidiosis and exposure to municipal tap water in persons with acquired immunodeficiency syndrome (AIDS): a case-control study. BMC Public Health. 2003 Jan 6;3:2. Epub 2003 Jan 6. (PMID: 12515584)
  • Aragon TJ, Vugia, DJ, Shallow S, Samuel MC, Reingold A, Angulo FJ, Bradford WZ.
    Case-control study of shigellosis in San Francisco: The role of sexual transmission and HIV infection. Clin Infect Dis, 2007;44:327–334. (PMID: 17205436)  See commentary: Daskalakis DC, Blaser MJ. Another perfect storm: Shigella, men who have sex with men, and HIV. Clin Infect Dis, 2007;44:335–337 (PMID: 17205437)
  • Petersen KE, James WO. Agents, vehicles, and causal inference in bacterial foodborne disease outbreaks: 82 reports (1986-1995). J Am Vet Med Assoc. 1998 Jun 15;212(12):1874-81. (PMID: 9638185)
  • Swift L, Hunter PR. What do negative associations between potential risk factors and illness in analytical epidemiological studies of infectious disease really mean? Eur J Epidemiol. 2004;19(3):219-23. (PMID: 15117114)
  • Rothman KJ, Mahon BE. Confounding and effect-measure modification in the evaluation of immunogenic agents. Eur J Epidemiol. 2004;19(3):205-7. (PMID: 15117112)
  • Mutapi F, Roddam A. p values for pathogens: statistical inference from infectious-disease data. Lancet Infect Dis. 2002 Apr;2(4):219-30. Review. (PMID: 11937422)
  • Halloran ME, Struchiner CJ. Causal inference in infectious diseases. Epidemiology. 1995 Mar;6(2):142-51. (PMID: 7742400)
  • Dickerson MC, Johnston J, Delea TE, White A, Andrews E. The causal role for genital ulcer disease as a risk factor for transmission of human immunodeficiency virus. An application of the Bradford Hill criteria. Sex Transm Dis. 1996 Sep-Oct;23(5):429-40. Review. (PMID: 8885077)

Exercises

Discussion-based

  • Aragon TJ. I Left My Heart (and more) in San Francisco. (Student | Instructor)

Computer-based

  • Essential Field Epidemiology Computer Lab: Using R as a calculator and spreadsheet: (Download PDF)
  • Texarkana—Epidemic Measles in a Divided City (with Computer lab): (Download PDF)
  • Paralytic Illness in Ababo (with Computer lab): (Download PDF)
  • Oswego—An Outbreak of Gastrointestinal Illness Following a Church Supper (with Computer lab): (Download PDF)
  • Investigation of bioterrorism-related anthrax, United States, 2001: Epidemiologic findings (with Computer lab): (Download PDF)

Operations-based

Coming soon

Miscellaneous materials

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