Guide For Laboratory Diagnosis in Herd Problem Investigations

Overview of
Laboratory
Diagnosis in
Disease Outbreak
Dr.Kedar Karki
Senior Veterinary Officer
Central Vet. Laboratory
Tripureshwor
Objectives
• Describe epidemiological approach to
understanding disease etiology
• Distinguish between the stages of
the disease process
2
Biological and Chemical
Epidemiology
The study of the distribution and
determinants of diseases resulting
from a biological or chemical attack
3
Sources of Epidemiologic
Clues to a Disease
Outbreak
• Clinician’s office or medical clinic
• Emergency room
• Laboratory
• Veterinary Clinic
• Pharmacy
4
Epidemiologic Approach to
Understanding Disease
Etiology
• Descriptive epidemiology -
identifying associations of disease in
relation to
– Time
– Place
– Persons
5
Epidemiologic Approach to
Understanding Disease
Etiology
• Analytic epidemiology
– Identify associations of disease with
possible etiologic factors (chemical
release, biological agent)
– Further refine and test hypotheses
regarding etiology
6
Problems Investigating the
Causes of Disease
• Specific agent might not be known

• Location of agent release might not be
known
• Signs and symptoms might not
differentiate disease
• More than one agent might be used
• Time of agent release might not be
known
• Latency period might not be known
7
• Latency is not the same for all Animal
Epidemiologic Triad of
Disease
Host
Agent Environment
8
Modes of Transmission
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
– Vector-borne Agent Environment
• Mechanical
• Biologic
9
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
10
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
11
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
12
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
13
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
14
• Direct
– Contact Host
– Droplets
• Indirect
– Airborne
– Vehicle-borne
• Mechanical
• Biologic
15
Factors That May Be
Associated With Disease
Host Types of Agents and Examples Environmental
Characteristics Factors
Age Biologic (bacteria, viruses, Temperature
Sex toxin) Humidity
Race Chemical (nerve, blister) Altitude
Religion Nuclear Wind
Customs Bombs and flammables Crowding
Occupation
Genetic profile
Marital status
Immune status
Vaccination status
16
Factors That May Be
Age Biologic (bacteria, viruses, Temperature
Sex toxin) Humidity
Race Chemical (nerve, blister) Altitude
Religion Nuclear Wind
Customs Bombs and flammables Crowding
Occupation
Genetic profile
Marital status
Immune status
Vaccination status
17
Factors That May Be
Age Biologic (bacteria, viruses, Location of release
Sex toxin) Temperature
Race Chemical (nerve, blister) Humidity
Religion Nuclear Altitude
Customs Bombs and flammables Wind
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
18
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
19
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
20
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
21
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
22
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
23
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
24
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
25
Factors That May Be
Occupation Crowding
Genetic profile
Marital status
Immune status
Vaccination status
26
The Natural History of
Disease
Outcome
Healthy Cure
Control
Disease Symptoms Seek Diagnosis Treatment
Onset Care Disability
Death
27
Disease
Outcome
Healthy Cure
Control
Death
28
Disease
Outcome
Healthy Cure
Control
Death
29
Disease
Outcome
Healthy Cure
Control
Death
30
Disease
Outcome
Healthy Cure
Control
Death
31
Conducting a
Field
Investigation
Conducting a Field
Investigation
• When possible, collect information
that describes:
– When people became ill
– Where they acquired the disease
– Characteristics of the people
33
Conducting a Field
Investigation
• When descriptive information does
not readily indicate risk factors,
analytical methods will be required:
– Determining rates and comparing them
• Comparing ill and well or
• Comparing exposed and unexposed
– Most analysis should be done in the field
34
Steps in Conducting a Field
Investigation of a
Bioterrorist Event
• Determine if there is an increase in
the occurrence of disease
• Confirm the diagnosis of disease
• Determine definition of a case
• Analyze the data in terms of time,
place, and person
• Determine who is at risk for
becoming ill
35
Steps in Conducting a Field
Investigation of a
Bioterrorist Event
• Develop an hypothesis that explains
the specific exposure that caused
disease
• Test hypothesis using statistics
• Compare hypothesis with known
facts
• Execute control and prevention
measures
• Plan a more systematic study 36
Determine If There Is an
Increase in the Occurrence
of Disease
• Initial indication of an increase might be
syndromic only
• Might need to check hospital and clinic
records for increase in symptoms
• Might need to telephone a sample of
physicians
• Might require a rapid community survey
• Might be difficult to distinguish between a
disease outbreak related to bioterrorism
and one from other causes
37
Confirm the Diagnosis of
Disease
• Frequently requires laboratory
techniques
• Can not always wait for confirmation
before starting treatment and
prophylaxis
• Might only require laboratory
confirmation of first few cases before
relying solely on signs and symptoms
38
Determine Definition of a
Case
• Use signs and symptoms or simple,
rapid laboratory techniques
• At this point, more important to
include all possible cases (high
sensitivity)
• Use simple case definition to initiate
immediate treatment
39
Analyze the Data in Terms
of Time, Place, and Person
to Determine Who is at Risk
• When did patients first start

becoming ill
• Where were they when they
became ill
• What were their activities prior to
becoming ill and where were they
performing these activities 40
Explains the Specific
Exposure That Caused
Disease
• The origin of the specific exposure
might not be obvious
• Can be the most challenging aspect
of the investigation
41
Test Hypothesis Using
Statistics
• Statistics provide a set of tools that
help an epidemiologist reduce the
role of chance in hypothesis testing
• Statistics can not substitute for an
epidemiologists’ review of all the
evidence before he decides on an
intervention plan
42
Compare Hypothesis With
Known Facts
• Is the hypothesis in agreement with
laboratory, clinical, and other
epidemiological evidence
• Might need to consult other scientific
disciplines (e.g. Medicine, Biology,
Environmental Science, Laboratory
Science)
43
Execute Control and
Prevention Measures
• Important to get to this step as
quickly as possible, particularly in a
case of a highly lethal agent
• Sometimes must make decisions that
rely on incomplete information
• These decisions must be continually
reviewed as new information is
obtained
44
Plan a More Systematic
Study
• As control measures are initiated,
additional questions will arise that
will require additional studies
• These studies should use the most
applicable epidemiological study
methods available
45
Prepare a Written Report
• A document for action
• A record of performance
• A document for potential medical/legal
issues
• A systematic review of the investigational
methods that might suggest additional
analysis
• A document that will help others
investigate and control future bioterrorist
attacks
46

Guide For Laboratory Diagnosis in Herd Problem Investigations

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Guide For Laboratory Diagnosis in Herd Problem Investigations

Uploaded by

Copyright:

Available Formats

Overview of

• Specific agent might not be known

• When did patients first start

You might also like