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MICROBIOLOGY LAB MANUAL Lab Exercise #15 Infections, Infectious Disease, and Epidemiology Objectives 1. Describe the portals of entry and relate these to the routes of transmission for common infections 2. Describe the important components in controlling an epidemic. 3. Analyze the source, transmission, and potential impact of an epidemic when provided pertinent data. 4. Use appropriate types of graphs to display the data and interpret epidemic trends. 5. Critically evaluate and suggest methods to prevent or control an epidemic. 6. Describe the unique social conditions that surround the STD epidemic in the U.S. 7. Access and use the MMWR to look up epidemiologic information. Dr Janet Fulks Bakersfield College August 2010 Page In this lab exercise you will study portals of entry, methods of transmission, and control of infectious diseases. In addition, using the internet you will examine the CDC’s method of reporting, tracking and controlling epidemics. There will also be a simulated epidemic in the classroom which you will track and analyze. In part 1 complete the charts below using the text and other outside sources. In part 2 following the lab simulation, create a graph of the data from the simulated epidemic, make a prediction as to the spread without further intervention, and describe methods of intervention that 1 Epidemiology is the study of the spread of disease through a population. An increase in the prevalence of a disease over a given time, within a specific area or affecting a particular population, it is considered an epidemic. Data is collected on the agent, number of cases, the location and history of the disease, ages involved, contributing factors and other pertinent information. Analysis of these details provides data to determine whether a vaccine, chemotherapeutic agent, quarantine, vector control, behavioral changes, or other precautions may control the disease spread. Depending upon the morbidity or mortality of the disease, strict measures may have to be implemented to control it. One example of these measures are the list of required reportable diseases. The table on the next page lists the nationally notifiable diseases which must be reported to the public health department in the United States. MICROBIOLOGY LAB MANUAL would be effective. Background on Infectious Diseases Designated as Notifiable MMWR June 25, 2010/57(54);1-94 The following is excerpted from the MMWR at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5754a1.htm Any infectious diseases designated as nationally notifiable are diseases where regular, frequent, and timely information regarding individual cases is considered necessary for the prevention and control of the disease. There is a history of nationally notifiable infectious diseases in the United States at http://www.cdc.gov/ncphi/disss/nndss/nndsshis.htm. For the listed diseases, public health workers ensure that: For those people exposed to a reportable disease there is appropriate: Treatment Vaccinations Quarantine Education In addition they work to: investigate and halt outbreaks eliminate environmental hazards and close premises where spread has occurred. Surveillance of notifiable conditions: Page The list of nationally notifiable infectious diseases is revised periodically. The list of diseases considered notifiable varies by state and year. Current and historic national public health surveillance case definitions used for classifying and enumerating cases consistently across reporting jurisdictions are available at http://www.cdc.gov/ncphi/disss/nndss/nndsshis..” 2 helps public health authorities to monitor the impact of notifiable conditions measure disease trends assess the effectiveness of control and prevention measures identify populations or geographic areas at high risk allocate resources appropriately formulate prevention strategies and develop public health policies.. Dr Janet Fulks Bakersfield College August 2010 MICROBIOLOGY LAB MANUAL Anthrax Arboviral neuroinvasive and nonneuroinvasive diseases o California serogroup virus disease o Eastern equine encephalitis virus disease o Powassan virus disease o St. Louis encephalitis virus disease o West Nile virus disease o Western equine encephalitis virus disease Babesiosis Botulism o Botulism, foodborne o Botulism, infant o Botulism, other (wound & unspecified) Brucellosis Chancroid Chlamydia trachomatis infection Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Dengue o Dengue Fever o Dengue Hemorrhagic Fever o Dengue Shock Syndrome Diphtheria Ehrlichiosis/Anaplasmosis o Ehrlichia chaffeensis o Ehrlichia ewingii o Anaplasma phagocytophilum o Undetermined Giardiasis Gonorrhea Haemophilus influenzae, invasive disease Hansen disease (leprosy) Dr Janet Fulks Bakersfield College Hantavirus pulmonary syndrome Hemolytic uremic syndrome, post-diarrheal Hepatitis o Hepatitis A, acute o Hepatitis B, acute o Hepatitis B, chronic o Hepatitis B virus, perinatal infection o Hepatitis C, acute o Hepatitis C, past or present HIV infection* o HIV infection, adult/ adolescent (age > = 13 years) o HIV infection, child (age >= 18 months and < 13 years) o HIV infection, pediatric (age < 18 months) Influenza-associated pediatric mortality Legionellosis Listeriosis Lyme disease Malaria Measles Meningococcal disease Mumps Novel influenza A virus infections Pertussis Plague Poliomyelitis, paralytic Poliovirus infection, nonparalytic Psittacosis Q Fever o Acute o Chronic Rabies o Rabies, animal o Rabies, human Rubella August 2010 Page 3 Nationally Notifiable Infectious Conditions United States 2011 MICROBIOLOGY LAB MANUAL Toxic-shock syndrome (other than Streptococcal) Trichinellosis (Trichinosis) Tuberculosis Tularemia Typhoid fever Vancomycin - intermediate Staphylococcus aureus (VISA) Vancomycin - resistant Staphylococcus aureus (VRSA) Varicella (morbidity) Varicella (deaths only) Vibriosis Viral Hemorrhagic Fevers, due to o Ebola virus o Marburg virus o Arenavirus o Crimean-Congo Hemorrhagic Fever virus o Lassa virus o Lujo virus o New world arenaviruses (Gunarito, Machupo, Junin, and Sabia viruses) Yellow fever * AIDS has been reclassified as HIV stage III Page 4 Rubella, congenital syndrome Salmonellosis Severe Acute Respiratory Syndrome-associated Coronavirus (SARS-CoV) disease Shiga toxin-producing Escherichia coli (STEC) Shigellosis Smallpox Spotted Fever Rickettsiosis Streptococcal toxic-shock syndrome Streptococcus pneumoniae, invasive disease Syphilis o Primary o Secondary o Latent o Early latent o Late latent o Latent, unknown duration o Neurosyphilis o Late, non-neurological o Stillbirth o Congenital Tetanus Dr Janet Fulks Bakersfield College August 2010 MICROBIOLOGY LAB MANUAL NAME________________________ Lab Exercise #15 Infections, Infectious Disease, and Epidemiology Using your text fill in the tables below concerning information about portals of entry and modes of transmission of infectious diseases. 1. Portal of Entry Portal of Entry Example of a disease using this portal of entry Methods to prevent the spread of a disease using this portal of entry. Skin Mucous Membranes Placenta Gastrointestinal Route Parenteral Page 5 Route Dr Janet Fulks Bakersfield College August 2010 MICROBIOLOGY LAB MANUAL 2. Modes of Transmission Mode of Transmission How does this type of transmission occur, under what circumstances? Examples of diseases spread via this mode of transmission. Direct contract Indirect contact Airborne Food and waterborne Page 6 Vector Dr Janet Fulks Bakersfield College August 2010 MICROBIOLOGY LAB MANUAL 3. Examining an Epidemic Go to the web and look up a recent epidemic somewhere in the world. Print off information about the epidemic and fillin the chart below. Staple the information from the web to your lab report. Name of the etiologic agent causing the epidemic: Classification: Brief description of this agent: Portal of Entry: Mode of Transmission: Symptoms: Treatment: Means of Epidemiologic Control: Page 7 Is this a reportable disease? Dr Janet Fulks Bakersfield College August 2010 MICROBIOLOGY LAB MANUAL 4. Following a Simulated Epidemic The disease that you are tracking is the most prevalent STD in the United States caused by Chlamydia trachomatis, an obligate intracellular bacteria. Approximately 3 - 4 million Americans suffer from infections every year costing nearly 1 billion dollars. No one appears to develop immunity after contracting the disease. Often infected women show no obvious symptoms, while approximately 75% of men are symptomatic. In men the disease produces urethritis resulting in painful urination and a discharge from the urethra, sometimes being confused with gonorrhea. Two serious complications occur as a result of this disease: 1) Chlamydia may spread to the fallopian tubes resulting in PID (pelvic inflammatory disease). Approximately 500,000 cases of PID due to Chlamydia occur every year. 2) Infants, born to infected mothers, are at high risk for developing eye infections leading to blindness. Other than trauma related injury, Trachoma is the leading cause of blindness in the world. Chlamydia can be treated with tetracycline and erythromycin. There are no vaccines available. MATERIALS: 1 pipette 1 empty tube 1 full tube developing solution latex gloves test tube rack PROCEDURE: 1. Write the number of your tube on the data chart, label the full tube “round #1” and the empty tube “round #2”. This tube represents your body fluids. Only one person is infected. No one will know who the infected class member is. 2. We will proceed by sharing body fluids (about 1ml), one at a time with someone else in the lab. Follow the instructor's directions carefully. You must exchange body fluids: pipette 1 ml of your fluid into the another person’s tube, when directed, and allow them to pipette 1 ml into your tube. 3. After the first round, pipette pour approximately half the volume of your round #1 tube into the tube marked #2 4. Proceed with a second round of sharing body fluids again pipetting 1 ml into another person’s tube. 7. Graph the information. Remember to title the graph and label all the axes properly. Dr Janet Fulks Bakersfield College August 2010 Page 6. Together we will record the class data on the chart. Try to analyze the spread of infection and answer the questions on the next sheet. 8 5. When the class has completed 2 rounds place the tubes in the rack and remove the caps. The instructor will bring around developing fluid to identify those that have the disease. Any indication of a color change is considered positive. MICROBIOLOGY LAB MANUAL CLASS DATA CHART Person Round #2 + / - 1. 1. 2. 2. 3. 3. 4. 4. 5. 5. 6. 6. 7. 7. 8. 8. 9. 9. 10. 10. 11. 11. 12. 12. 13. 13. 14. 14. 15. 15. 16. 16. 17. 17. 18. 18. 19. 19. 20. 20. 21. 21. 22. 22. 23. 23. 24. 24. Dr Janet Fulks Bakersfield College Contact + or - 9 Contact + or - Page Person Round #1 + / - August 2010 MICROBIOLOGY LAB MANUAL The number of your test tube: How many carriers resulted after round #1? (Make a hypothesis concerning any abnormal or unexplained results) How many carriers after round #2? Draw a graph and attach it to this lab of disease over time. Predict where the third round results may have been. Name of the etiologic agent causing the epidemic: Classification: Briefly describe this agent: Portal of Entry: Who was patient Zero? Describe your rationale or draw a flow chart on the back of this page. Mode of Transmission: Symptoms: Treatment: Means of Epidemiologic Control: What specific aspects of the disease make it difficult to control? (Consider cost, practicality, and social constraints.) Page 1801 Panorama Dr. - Bakersfield, CA 93305 - (661)395-4011 Last Updated 9/11/2010 ©Janet Fulks 10 Is this a reportable disease? Dr Janet Fulks Bakersfield College August 2010