Download 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…….
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Introduction to Epidemiology
Historical Perspective of Nursing Epidemiology
Worldwide Implications
Local Implications
Group 2-hour Mini-Project:
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Each group research & prepare 10-15 minute presentation related to
epidemiology (broad subject!) See Next Slide
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Each group prepare two test (assessment questions related to
epidemiology)
Evaluations required
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About “Statistics….”
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Demigog /
Demigoguery
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“Infant Mortality rate”
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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
Russell, Kansas
Fall, 1917
WWI
Combat Deaths
Asia
Summer 1918
Trenton, N.J.
June, 1917
Fall, 1917
Trenton, N.J.
France
Fall, 1917
Nationwide,
Spring 1918
Europe,
1918
Africa,
1918
***Number of Mortalities to date attributed to Influenza Outbreak:
(Each Figure equals one million deaths)
“Phase Shift”
?
“Spanish Flu”
Deaths
World Wide =
20, 000, 000 –
40, 000, 000
Mortalities
20
18
16
14
12
10
8
6
4
2
WHO DIES FROM INFLUENZA ?
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,
CONTEXT:
i.e., NURSES, DIED @
AIDS Deaths
DISPROPORTIONATE RATES.
World Wide =
~19, 000, 000
Millions
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)*
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Heart disease (654,092)
Cancer
(550,270)
Stroke
(150,147)
Chronic lower respiratory diseases (123,884)
Accidents
(108,694)
Diabetes
(72,815)
Alzheimer's disease ( 65,829)
Influenza/Pneumonia (61,472)
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
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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
Definitions
Epidemiology – “The study of the
distribution and determinants of health-related
states or events in specific populations, and
the application of this study to control of
health problems”. (Last, 2001, pp. 62)
http://www.waldenu.edu/c/Schools/Schools_6955.htm
Epidemiology
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Introduction
Definitions
Distributions – the patterns of health events in
specific populations http://www.cdc.gov/mmwr/
Determinants – factors or variables that affect
patterns and health events
Example: analysis of how and why a population has
different health trends, financial factors, diet,
sanitation, recent catastrophes, etc….
Epidemiology
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Introduction
Definitions
Incidence rate – the rate of health problems
that are developing in new cases
Risk – the probability that the health event
will occur within a specific time, i.e. the risk
of breast cancer over a lifetime in the United
States
Epidemiology
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Introduction
Definitions
Prevalence – the actual measurement of
existing disease at a particular time in a
specific group
Prevalence Proportion – the proportion of
the group which has the existing disease at a
particular time
Epidemiology
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Introduction
Definitions
Attack rate – The proportion of people who
are exposed to the disease and get the illness.
Mortality Rate – a rate that indicates the
proportion of a population who has died from
any cause in a certain period of time, i.e. one
year.
Epidemiology
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Introduction
Definitions
Morbidity = RATE of which an illness or
health event occurs in a specific population,
usually expressed as a proportion; determined
by dividing the affected population by the
total number of population in that group.
Epidemiology
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Introduction
Definitions
Epidemic – an
incidence of disease
that is more than usual
in a specific
population – see
example of West Nile
Virus on CDC site
Epidemiology
Introduction
 Definitions
Pandemic – a worldwide
incidence of disease that
is more than usual
in world populations
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Epidemiology
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Introduction
Definitions
Pandemic – WHO Organization has six stages of
alert for pandemics and a global preparedness plan.
The stages range from Level I, which is the lowest
risk of human cases to Level VI – Efficient and sustained “human – to –
human transmission.
Epidemiology
History of Epidemiology
 Moses – wrote the laws for Exodus
 4th Century B.C.E. = Hippocrates, defined
symptoms of disease, prevalence, and cure rates
( descriptive epidemiology – the who, where, and when)
 1400’s – Turkish women inoculated children with a
needle and pieces of dried smallpox scabs to
vaccinate them against future plagues.
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Epidemiology
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History of Epidemiology
1853 -William Snow – 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 Production of Polio
Vaccine
Salk
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 – the Public Health Nurse Corp
was formed by the Red Cross in answer to the
1919 worldwide influenza pandemic.
World War II – as nurses were called
overseas in the Navy and Army Nurse Corps,
Public Health nursing became the back up for
the rural Americans with a local public health
department for any population >50,000.
Epidemiology
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History of Epidemiology
1960’ CDC was formed as a government
institution separately from the military
biological warfare labs.
1983 – cause of AID’s was discovered
Epidemiology
Epidemiological
Concepts in Nursing
 Epidemiologic Triangle
Changes in any one
triangle component will
either increase or decrease
your risk of disease
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Epidemiology
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Epidemiological Concepts in Nursing
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
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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: counseling young females and
school children on STD prevention and use of
condoms.
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:
Levels of Prevention
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actual measurement of existing disease at a
particular time in a specific group
Incidence:
the rate of health problems that
are developing in new cases
Primary Prevention
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
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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 – from the
CCHD
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http://www.southernnevadahealthdistrict.org/epidemiology/disease_statistics.htm
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Chlamydia/Gonorrhea
HIV/AID’s
Syphilis
Smoking & Lung Disease
West Nile Encephalitis
Rotavirus
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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:
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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
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http://www.mclph.umn.edu/watersedge/play.html
Some Good Sites…………….
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WHOSIS
(World Health Organization Statistical Information System)
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The Office of Minority Health
Brazos-Nurse.Org Community Health Page
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“Cold Cases: Itinerant Nursing in South West Alaska”
http://www.medscape.com/viewarticle/488041
American Anthrax Outbreak of 2001
Medical Mystery
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American Anthrax Outbreak of 2001
http://www.ph.ucla.edu/epi/bioter/detect/antdetect_intro.html
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SUPERCOURSE: Anthrax
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http://www.pitt.edu/~super1/lecture/lec1221/index.htm
Cool Sites:
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http://wonder.cdc.gov/WelcomeT.html
http://www.cdc.gov/nchs/fastats/default.htm
http://www.cdc.gov/epiinfo/
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http://www.southernnevadahealthdistrict.org/epidemiology/epidemiology.htm
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http://www.bt.cdc.gov/surveillance/syndromedef/index.asp
DOWNLOADS
(Free)
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EpiInfo
http://www.cdc.gov/epiinfo/
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Studying Populations
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http://www.dundee.ac.uk/~cdvflore/SPUpdates.htm
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APPENDIX
121 Cities Mortality Reporting System
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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).
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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.
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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).
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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).
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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.
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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
E.N. CENTRAL
EASTERN
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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
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
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PACIFIC
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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
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MOUNTAIN
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Albuquerque, NM
Boise, ID
Colorado Springs, CO
Denver, CO
Las Vegas, NV
Ogden, UT
Phoenix, AZ
Pueblo, CO
Salt Lake City, UT
Tucson, AZ
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
Evidence-Based Public Health
http://phpartners.org/tutorial/04-ebph/index.html
finis