Part 1. Disease Outbreaks and Epidemic Curves A student in

Part 1. Disease Outbreaks and Epidemic Curves A student in a kindergarten classroom in Marin County was diagnosed with mumps on March 1, 2010. Over the next few weeks, there were several new cases of mumps reported in the same community. The Marin County public health department recorded the number of new cases of mumps per day. The data for March are shown below. Date # of new cases 3/1/10 1 3/3/10 2 3/4/10 5 3/6/10 2 3/10/10 1 3/12/10 2 3/15/10 3 3/18/10 5 3/19/10 6 3/22/10 3 3/23/10 2 3/26/10 2 1. According to the CDC, the average incubation period for mumps is 16 to 18 days. In no more than 1 sentence, explain what this means. 2. Using Excel or a similar program, generate an epidemic curve for these data following the directions from the CDC and paste it below. (See the video recording and practice worksheet from Module 4’s synchronous session, and resources provided in Module 4 for more information on making epi curves). In no more than 1 sentence, define epidemic. In no more than 1 sentence, define single-exposure, common-vehicle outbreak (also known as a point-source outbreak). 3. Would these events be considered a single-exposure, common-vehicle outbreak? Explain your reasoning. 4. What evidence can you use from the epidemic curve you generated above to assess whether or not these events would be considered a single-exposure, common-vehicle outbreak? 5. Mumps has an R0 of about 11. What percentage of the community would need to be vaccinated against mumps to achieve herd immunity? Calculation Final answer Part 2. Screening It is recommended that women aged 21 to 65 years receive a pap smear every three years to screen for cervical cancer. A study examined the accuracy of the pap smear test by comparing its results to the results from a biopsy carried out among a small group of 100 people at high risk for cervical cancer. Among this group, 43 people received a positive pap smear screen. The prevalence of cervical cancer in this sample was found to be 60% (from the biopsy results) and the specificity of this test was found to be 75%. Fill in the table below with the results from this study: Biopsy results Has cervical cancer Does not have cervical cancer Total Pap smear results Positive Negative Total 100 1. Calculate and interpret the sensitivity of the pap smear test. Calculation: Final answer interpret your answer 2. Calculate and interpret the positive predictive value of the pap smear test. Calculation: Final answer interpret your answer. 3. Calculate and interpret the negative predictive value of the pap smear test. Calculation: Final answer interpret your answer Women aged 30 years and older can choose to receive an HPV DNA test at the same time as the pap smear to screen for cervical cancer (95% of cervical cancers are due to HPV). Assume that all people in the previous example also elected to receive an HPV DNA screening test, which has a sensitivity of 77%. 50 people screened negative on the HPV DNA test. Fill in the table below with the results from this study. (HINT: Since this is the same sample, there will be the same number of people with and without cervical cancer as in the table above). Biopsy results Has cervical cancer Does not have cervical cancer Total HPV DNA results Positive Negative Total 100 1. Calculate and interpret the specificity of the HPV DNA test. Calculation: Final answer interpret your answer. 2. Among people with cervical cancer, calculate the number of people who screened positive on both the pap smear and HPV DNA tests. Calculation: Final answer 3. Among people with cervical cancer, calculate the number of people who screened positive on only the pap smear test. Calculation: Final answer 4. Among people with cervical cancer, calculate the number of people who screened positive on only the HPV DNA test. Calculation: Final answer 5. Using the numbers you calculated above, calculate the net sensitivity from using both screening tests. Calculation: Final answer 6. Was the net sensitivity using both screening tests higher or lower than each test on its own? Underline the correct answer below. 7. The net sensitivity using both tests was higher than the individual sensitivities of the pap smear and HPV DNA test. 8. The net sensitivity using both tests was lower than the individual sensitivities of the pap smear and HPV DNA test. 9. Among people without cervical cancer, calculate the number of people who screened negative on both the pap smear and HPV DNA tests. Calculation: Final answer 10. Among people without cervical cancer, calculate the number of people who screened negative on only the pap smear test. Calculation: Final answer 11. Among people without cervical cancer, calculate the number of people who screened negative on only the HPV DNA test. Calculation: Final answer 12. Using the numbers you calculated above, calculate and interpret the net specificity from using both screening tests. Calculation: Final answer 13. Was the net specificity using both screening tests higher or lower than each test on its own? Underline the correct answer below. 14. The net specificity using both tests was higher than the individual specificities of the pap smear and HPV DNA test. 15. The net specificity using both tests was lower than the individual specificities of the pap smear and HPV DNA test. 16. If the researchers instead conducted this study among individuals who were not at high risk for cervical cancer, how would you expect the positive predictive value of each of the screening tests to change (if at all)? Underline the correct answer below. (HINT: Think about how the prevalence of breast cancer would compare in a high risk vs. a low risk sample). The PPV of both tests would increase The PPV of both tests would decrease The PPV of both tests would stay the same

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