Descriptive Epidemiology Continued It is now the middle of October. You have recorded the demographi

Descriptive Epidemiology Continued It is now the middle of October. You have recorded the demographic data of the patients who meet the case definition. Demographics are information about a specific group of people, like their age, gender, where they live, or other characteristics. Age Group (years Gender: Male Gender: Female TOTAL 0-9 2 (17%)* 2 (8%) 4 (11%) 10-19 2 (17%) 3 (12%) 5 (13%) 20-39 3 (25%) 9 (35%) 12 (32%) 40-59 2 (17%) 8 (31%) 10 (26%) 60+ 3 (25%) 4 (15%) 7 (18%) TOTAL 12 (101%) 26 (101%) 38 (100%) *percentages refer to column tables Age and Gender Distribution of Typical E. coli O 157:h7 Cases Age Group (years Gender: Male Gender: Female TOTAL 0-<1 5 (3%) 5 (3%) 10 (3%) 1-9 77 (48%) 77 (43%) 154 (45%) 10-19 36 (22%) 18 (10%) 54 (16%) 20-29 10 (6%) 20 (11%) 30 (9%) 30-39 6 (4%) 12 (7%) 18 (5%) 40-49 7 (4%) 5 (3%) 12 (4%) 50-59 7 (4%) 17 (10%) 24 (7%) 60+ 14 (9%) 24 (13%) 38 (11%) TOTAL 162 (100%) 178 (100%) 340 (100%) At This Point AN Epidemiologist would: (Please respond to the Question below) Question 1A: Compare the age and gender data presented in Tables 1 and 2 by creating a histogram for each table. Age should be your X axis. Be sure to identify gender differences by shading a section of each age group. Question 1B: In this outbreak, what age group has the most cases? Question 1C: In this outbreak, what gender has the most cases? Question 1D: What do these age and gender differences suggest about the source of this infection? Hypothesis Generation The 38 cases of E. coli O157:H7 infection meeting the investigation case definition were reported from 10 neighborhoods in the southern regions of the Maule Region. Onset of illness occurred from the middle of September to the middle of October, peaking on September 22. (Figure 3) Date of illness onset for persons with E. coli infection matching the case definition, Maule Region, September 12- October 20. (N= 38) The word "onset" means the beginning or start of something, like the beginning of symptoms. Next you try to further develop hypotheses. You have arranged to conduct hypothesis-generating interviews with seven patients. The purpose of these interviews is to explore all potential sources of infection with a limited number of patients. These hypotheses can then be specifically tested in subsequent epidemiologic (and other) studies. You will interview patients who live in four different neighborhoods and range in age from 5-69 years. Three of the patients are female. Before conducting these interviews, your team meets to identify what questions to ask. At This Point AN Epidemiologist would ask Themselves: (Please respond to the Question below) Question 2A: Considering the typical incubation period of E. coli 0157:H7, how far back from the onset of symptoms should you ask the cases about their behaviors? Explain your decision. Question 2B: Aside from the clinical details of their illness and demographic information, what other topics should your interview cover? Be sure to consider all possible modes of transmission of. E. coli 0157.H7. Question 2C: Using these questions and what you learned in your reading about hypothesis generating interviews, conduct two mock-interviews. In order to complete these mock INTERVIEWS, you will need to get the help of two people. They will need to participate for about 20 minutes. Step 1: Share the "Patient 1" handout with your first volunteer. Step 2: Ask them to read the document (5 minutes). Step 3: Conduct your interview as if you really were a field epidemiologist. (15 minutes) Step 4: Repeat steps 1-3 with your second volunteer and the "Patient 2" handout. Write one paragraph discussing two things that went well in your interviews. In a second paragraph, discuss two things you would change if you could do a third interview. Patient 1 Background Information Name: Maria Garcia Age: 25 years Sex: Female Address: City: 35 County: 12 Phone number: (248) 555-0991 (home) (248) 555-1423 (work) works as office manager for local legal firm, lives in apartment by herself ILLNESS Onset of symptoms: 9/22/97 Symptoms: bloody diarrhea, abdominal cramps, vomiting, (no fever) Duration of symptoms: 5 days Initially treated with Pepto-Bismol and Imodium AD Visited Dr. Locke on 9/25/97 Treatment received: ciprofloxacin PAST MEDICAL HISTORY No antibiotics in two weeks before illness. No antacids in two weeks before illness No chronic illness EXPOSURES IN 7 DAYS BEFORE ILLNESS: No travel outside Maule Region No swimming or wading in recreation areas Did not drink water from a private well No contact with animals FOOD HISTORY FOR 7 DAYS BEFORE BECOMING ILL: High risk foods: Hamburgers: NEG Ground beef: NEG Raw or unpasteurized milk: NEG 6/15 (Sunday) Breakfast: bread, strawberry jelly, coffee with cream, banana Lunch: spaghetti, salad with lettuce, Coke Dinner: bread, dulce de leche (thick caramel sauce that is spread on bread) 6/16 (Monday) Breakfast: bread, strawberry jelly, coffee with cream, banana Lunch: soup (noodles, chicken broth, rice) Dinner: bread, dulce de leche, milk 6/17 (Tuesday) Breakfast: eggs, toast, butter, milk, Lunch: left-over baked chicken, pita bread, sprouts (alfalfa), cucumbers, diet Coke Dinner: bread, dulce de leche, milk 6/18 (Wednesday) Breakfast: bread, strawberry jelly, coffee with cream Lunch: empanadas (filled with hamburger, onions, eggs, and raisins), honeydew melon, Coke Dinner: sandwich (ham, cheese, mayonnaise), Coke 6/19 (Thursday) Breakfast: milk/banana drink Lunch: broiled fish, rice, salad (lettuce, spinach, carrots), vinaigrette dressing Dinner: bread, dulce de leche, milk 6/20 (Friday) Breakfast: eggs, toast, butter, milk Lunch: chicken salad sandwich, tomato, sprouts (alfalfa), pickle spear, diet Coke (5th Street Diner) Dinner: bread, dulce de leche, milk Party: variety of cheese and crackers, white wine 6/21 (Saturday) Breakfast: coffee with cream Lunch: bagel, cream cheese, potato chips, oreos, ding dongs, chocolate bar, potato chips, diet Coke Dinner: (Did not have dinner.) NAMES AND LOCATIONS OF RESTAURANTS OR CAFETERIA'S WHERE ATE IN THE 7 DAYS BEFORE ILLNESS: 5th Street Diner City: 35 USUAL STORES OR MARKETS: (does own shopping) Store: 1 (City: 35) Store: 2 (City: 35) Store: 3 (City: 35) STORES OR MARKETS FOR PRODUCE: Store: 1 (City: 35) Store: 2 (City: 35) OTHER SPECIAL EVENTS: party at friends on 6/20 OTHER ILL PERSONS: no family members or acquaintances ill Patient 2 Background Information PATIENT #2: Carlos Alvarez Age: 69 years Sex: Male Address: City: 5 County: 5 Phone number: (616) 555-1547 (home) lives with wife and elderly mother-in-law, retired tire salesman, wife prepares all the food ILLNESS Onset of symptoms: 6/25/97 Symptoms: bloody diarrhea, abdominal cramps, (no vomiting or fever) Duration of symptoms: 7 days No antidiarrheal medications Visited Dr. Smith on 6/29/97 (concerned about perforated diverticulum), hospitalized for 4 days Treatment received: antibiotics, intravenous fluids, transfusion PAST MEDICAL HISTORY No antibiotics in two weeks before illness No antacids in two weeks before illness Diverticulitis, gastric ulcer disease, smokes EXPOSURES IN 7 DAYS BEFORE ILLNESS: No travel outside Maule Region No swimming or wading in recreation areas Drinks water from private well (source of water for home) No contact with animals (wife has 7 cats which do not come into house) FOOD HISTORY FOR 7 DAYS BEFORE BECOMING ILL: High risk foods: Hamburgers: NEG Ground beef: NEG Raw or unpasteurized milk: NEG 6/18 (Wednesday) Breakfast: toast, coffee (Sanka), preserves Lunch: pork ribs, empanadas with hamburger and egg, empanadas with cheese and apple filling, Coke Dinner: avocado on toast, red wine 6/19 (Thursday) Breakfast: fried eggs, bacon, toast, coffee (Sanka), preserves Lunch: ham sandwich with Swiss cheese and mustard, corn chips, oatmeal cookies, coffee (Sanka) Dinner: fried chicken, mashed potatoes, lettuce and tomato salad, corn-on-the cob, canned peaches, rolls, butter, ice cream 6/20 (Friday) Breakfast: fried eggs, bacon, toast, coffee (Sanka), preserves Lunch: tuna salad sandwich with mayonnaise, sprouts (alfalfa), tomato, oatmeal cookies, coffee (Sanka) Dinner: avocado on toast, red wine 6/21 (Saturday) Breakfast: fried eggs, bacon, toast, hash brown potatoes, coffee (Sanka) Lunch: round steak, parsley potatoes, zucchini, bread, butter, ice cream Dinner: bread, dulce de leche 6/22 (Sunday) Breakfast: crepes with dulce de leche and milk Lunch: Beans and noodles Dinner: Avocado on toast, red wine 6/23 (Monday) Breakfast: fried eggs, bacon, toast, coffee (Sanka), preserves Lunch: roast beef sandwich with mayonnaise and sprouts (alfalfa), corn chips, peanut butter cookies, coffee (Sanka) Dinner: cheese, crackers , red wine 6/24 (Tuesday) Breakfast: fried eggs, bacon, toast, coffee (Sanka), preserves Lunch: chicken and rice, green beans, fruit salad, ice cream Dinner: ham and cheese sandwich with mayonnaise, red wine NAMES AND LOCATIONS OF RESTAURANTS OR CAFETERIA'S WHERE ATE IN THE 7 DAYS BEFORE ILLNESS: did not eat out USUAL STORES OR MARKETS: (wife does all of the shopping) Store: 5 (City: 49) Store: 24 (City: 49) Store: 2 (City: 49) STORES OR MARKETS FOR PRODUCE: Store: 5 (City: 49) OTHER SPECIAL EVENTS: square dancing at senior citizens center (no food served) OTHER ILL PERSONS: wife and mother-in-law not feeling well, loose stools and abdominal cramps

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