Outbreak Investigations: 
Case Studies in Epidemiology

BIO 216 - Fall 2013 - Cedar Crest College

http://www.nytimes.com/2006/05/09/arts/television/09stan.html http://www.epidemiologist.com/images/hp_pic.jpg

BIO 216 Course Description

Outbreak Investigations: Case Studies in Epidemiology - 3 credits

At times, human societies have difficulty separating fact from fallacy.  This is especially true during times of stress, such as when the Spanish flu swept the globe killing millions of people in 1918-1919.  Uncertainties and false conclusions regarding the identity of the specific pathogen and the mode of transfer from one individual to another led to delayed or poor decisions that resulted in significantly more deaths. Health and human services were far exceeded and measures were taken that most would find unacceptable today. HIV/AIDS is another example of where the blend of fact and fallacy has led to the deaths of millions. Modern epidemiology has a set of approaches designed to help separate fact from fallacy and to help the human population effectively detect, identify, monitor, contain, prevent, and possibly eradicate a new or existing disease. In this course you will learn about these epidemiologic principles and concepts all within the context of case studies associated with outbreaks of toxic shock syndrome, Legionnaires' disease, measles, mumps, syphilis, yellow fever, Ebola hemorrhagic fever, and other diseases.

Website: http://www2.cedarcrest.edu/academic/bio/hale/epi/index.html

Instructor: Alan Hale, Ph.D. [SC 134; abhale@cedarcrest.edu; x3510]

Office Hours: Stop by during open times or stated office hours [my schedule].  If my door is closed, leave me a note. Setting up an appointment is also an option, but be sure to suggest a possible time after looking at my schedule.

Prerequisites: A genuine interest in learning about disease outbreaks and how epidemiologists investigate and work to minimize the impact of diseases on human populations; students from all disciplines are encouraged to participate in this course.

Class Time/Location:  W 4:15-6:45 PM / MIL 33

Dworkin, M.S. 2011.  Cases in Field Epidemiology, A Global Perspective.  Jones and Bartlett Publ. 477pp. (paperback)

Course Objectives
The course objectives are to help students (1) learn the tools used by epidemiologists and associated professionals to investigate and resolve disease outbreaks, (2) understand through numerous examples the diversity and complexity of outbreak investigations, (3) convey their interpretations of specific outbreaks to others, and (4) work as a team to investigate and control a hypothetical outbreak on campus. These work together to prepare a student to work effectively toward mitigating the impact of diseases on populations around the world.

Learning Outcomes & Assessment
A student who has completed this course will be able to explain: 
1. The numerous and multidisciplinary factors that come into play when investigating a new or existing disease.
Assessment: One examination, one discussion and one presentation.
2. The value of objectivity and unbiased data when searching for the truth behind an outbreak.
Assessment: One examination, one discussion and one presentation.
3. The basic principles, concepts and techniques used by epidemiologists.
Assessment: One examination, one discussion and one presentation.
4. The importance of basing one's convictions on credible data and then accurately sharing these ideas with others.
Assessment: One discussion, one presentation, and one group project involving an additional presentation.

Student Learning Outcomes: In BIO 216 Outbreak Investigations: Case Studies in Epidemiology material will be presented such that students can:
1. Apply the foundation concepts and principles of the Biological Sciences, including cellular structure and function, genetics and molecular biology, evolution and organismal diversity, and ecology. [DEPT SLO 1]
2. Discuss the interaction of science and society, including the ethical practice of science, within the local, national, and global community. [DEPT SLO 2]
3. Write about and interpret the methodologies of scientific research. [DEPT SLO 3]
4. Apply concepts and principles of the Biological Sciences beyond those that comprise the foundation. [BIO/IBO SLO 1]

Attendance is an important part of this learning experience. If for some reason you are unable to attend class, notify Dr. Hale as soon as possible. Keep in mind that with the one-class per week format, missing a class is equivalent to missing three classes of a typical course. If for some reason you don't get to class on time or you must leave before class is over, join us for the time you have available.


Midterm Examination 
Session 9
1 hour written examination; Coverage: Sessions 1-8
Student-Selected Chapter
Summary & Questions
Select one of the chapters within your textbook other than Chapters 1, 2, 4, 5, 11 & 12. Indicate your choice on the sign-up sheet outside SC 134.
Online Summary & Questions: One week before your presentation, submit your summary and discussion questions. Dr. Hale will post these online and link them to the class schedule. Format: See Sample Summary and Discussion Questions
Presentation: Convey to the class in your chosen manner (e.g., PowerPoint, song, play, or whatever works for you) the major points in the selected chapter (approximate length: 25 min).
Discussion: Following your presentation, engage the class in an informative and enjoyable discussion on your chosen chapter and related information (approximate length: 20 min).
Matching Madness Exam 50
An enjoyable challenge to see how well you recall the content of student-selected chapters, the presentations, and their associated discussions. This is a short written examination to test your recall and interest in the chapters discussed.
"Campus Outbreak"
Written Report (group)
Newscast and Q&A (group)
Participation (peer-defined)

"Campus Outbreak" is a hypothetical disease outbreak on the Cedar Crest campus. Your mission is to investigate the outbreak and ultimately stop the spread of the pathogen. The fate of the members of the Cedar Crest community and the outside communities depends on your skills.
Format of Electronic Written Report: Similar to chapters/investigations in course textbook, though a good example (minus the appendix) is the report submitted by the 2011 class. An appendix should be added to include survey form(s), large sets of data (if available), and other information that is relevant to the study. The submitted report will be posted online so all participants involved in the outbreak, including the deceased, will see the ultimate outcome of your efforts.  The appendix, however, will not be posted online in order to preserve confidentiality.
Newscast and Q&A with "Reporters": Reporting to the public on specifics of a disease outbreak can be very challenging. Your message should be trusted by the public, but too much detail or too much hesitation or uncertainty may prompt fear among the population and thus create problems. Your newscast (~20 min) plus a Q&A session with "reporters" (~15 min) will be videotaped and reviewed.
Participation: Teamwork is essential in order to investigate and stop an epidemic. The investigation requires a good bit of work, much of which occurs outside of class, and therefore Dr. Hale would be a poor judge of individual contribution. Consequently, each person will submit a grade for each member of the investigative team, including themselves. Grades should be an objective evaluation of a person's contribution (time, effort, enthusiasm, teamwork) to the investigation.
Class Participation
180 Learning should be fun. If not, the mind will find other things to do. This course has a number of activities that will help you understand the skills and concepts associated with epidemiology. They include movie discussions, a scavenger hunt, a game-show competition, a group teaching session, an outbreak investigation (noted above), opportunities to speak to "reporters", a round table discussion, a board game, and presenting a topic followed by leading a discussion. Some of these may push the limits of your comfort zone, but please keep in mind that professional and personal growth comes from doing just that.
The more you participate in these activities, the more you will learn. It will also increase the enjoyment of the course by all. Given that everyone needs a prod now and then, points will be assigned for class participation. And as you will learn in this course, the success of an investigation commonly depends on a conglomeration of perspectives. Three perspectives will ultimately determine your class participation grade: your perspective (60 pts.), that of your classmates (60 pts.), and finally how your instructor perceived the quality and quantity of your contributions (60 pts.). Statistical analyses will be conducted to determine whether there is agreement among the contributing perspectives.
If relevant seminars are scheduled for fall semester, extra credit will be assigned if you attend. Extra credit opportunities will be announced in class or via email.

Disability Accommodation
Students with documented disabilities that have been processed by the Office of Academic Services should contact Dr. Hale early in the semester to discuss appropriate accommodations.

Honor Code and Academic Standards of Integrity
Students enrolled in BIO 216 are expected to abide by the Cedar Crest College Honor Code and the Academic Standards of Integrity, as described in the college catalog and in A Student's Guide to CCC.  Plagiarism and poor classroom behavior will be dealt with harshly; the former resulting in a grade of "F" for the course and a report sent to the Office of the Provost. Regarding the topic of plagiarism, it is always wise and good to give credit where credit is due, and not just at college.

Lecture Schedule - Fall 2013

Session Date Topic Readings
1 Aug 28 Introduction to Course
Note: Posted Sign-Up for Presentation/Discussion Topic & Date

Quick Assessment of Current Understanding (short assessment test)

Introduction to the Field of Epidemiology - "Contaminated Lunches Kill 22 Children in India"

Distribute "Basic Terminology...always a Challenge" and explain plan for next session.

Film: Snow, Epidemiology Begins (22 min) & Discussion
"It is the summer of 1854 and a violent cholera outbreak has decimated the unseemly district of Soho, London. While the source of the outbreak remains unclear, the leading medical authorities blame the miasma, or poisonous air, which emanates from the nearby bone boiling establishments. When an unlikely physician, Dr. John Snow, uncovers an entirely different theory, he must piece together a scientific puzzle that will culminate in one historic moment anointing Dr. John Snow as "Father of Modern Epidemiology."


Text: Preface and About the Editor

Contaminated Lunches...


Snow Article
2 Sept 4
Basic Methods & Concepts in Epidemiology
(Ockham's Razor,... Induction and Refutationism)

Demonstration of what is important in epidemiology:
Scavenger Hunt
[Test of skills; dress accordingly (field)]

Basic Terminology in Epidemiology - Group Teaching Session

3 Sept 11
Clue(less) Challenge
- A Team Sport & Game Show Format
(disease symptoms, geographical locations, logical thinking, terminology, pathogens, data interpretation, etc.)

An Overview of Outbreak Investigation*

How an Outbreak is Investigated

The Role of Field Work and the Value of Experience
Short Segment of Outbreak - Pre-flight to Response

Cholera for a Dime - An Example of an Outbreak Investigation

Chapter 1 & 2

Outbreak Trailer

Chapter 4
4 Sept 18 Film: Contagion (1 hr 46 min)
Discussion (Realistic? Good epi response?, ...)
Contagion Trailer
5 Sept 25

Introduction to Campus Outbreak
(Preliminary Information and Goals)

Accessing Information Online - Related to Outbreak and Beyond (e.g., NYT)

Group Discussion - Approach to Investigating the Campus Outbreak

Facing the Media
Legionnaire's Disease: Investigation of an Outbreak of a New Disease

Review Campus Outbreak 2011

The New York Times
The Washington Post

Chapter 5
6 Oct 2
A Round Table Discussion of:
What Went Wrong? An Ancient Recipe Associated with
Botulism in Modern Egypt

(and the value of understanding different cultures)

Community Involvement
Controlling an Outbreak of Shigellosis with a Community-Wide
Intervention in Lexington County, Kentucky

Chapter 11

Chapter 12
7 Oct 9
Basic Statistics in Epidemiology

Install Data Analysis
8 Oct 16
More Statistics in Epidemiology

9 Oct 23 Midterm Examination (1 hr)

A Session of
"As skilled members of a disease-fighting team, you must keep four deadly diseases at bay
while discovering their cures. You and your teammates will travel across the globe, treating
infections while finding resources for cures. You must work as a team to succeed. Pandemic
is a cooperative game, all players win or lose together."

1st Set of Student Summary/Discussion Questions Due
Sessions 1-8

Pandemic (a cooperative board game)

Sample Summary/Discussion Questions
Oct 30 Dworkin Chapter Presentations & Discussions (3) - Student-Led Student-Selected Dworkin Chapters
Online Summaries and Discussion Questions
Nov 6 Dworkin Chapter Presentations & Discussions (3) - Student-Led Student-Selected Dworkin Chapters
Online Summaries and Discussion Questions
Nov 13 Dworkin Chapter Presentations & Discussions (3) - Student-Led Student-Selected Dworkin Chapters
Online Summaries and Discussion Questions
Nov 20 Dworkin Chapter Presentations & Discussions (2) - Student-Led
Student-Selected Dworkin Chapters
Online Summaries and Discussion Questions

Nov 27 [Thanksgiving Break - Enjoy!] -
Dec 4
Matching Madness - Readings Recall - 30 Minute Exam
(Why Matching Madness? It includes a mega-matching question. Thanks for asking.)

Campus Outbreak
Conveying the findings of your investigation to the "general public" followed by a Q&A with "news reporters."
Videotaped and subsequently reviewed by team (below).

Completion of Participation Grade Forms
(Campus Outbreak; Set of Course Activities; forms will be provided)

Photo Session - Smile!

Review of "Campus Outbreak Newscast"... with Refreshments (put in your requests ahead of time)

Written Campus Outbreak Report (Electronic) is due tomorrow, December 5th, by 5 PM

Matching Madness - Coverage:
Chapters Presented & Discussed
*Session topics, if italicized, match chapter titles within the course textbook.


Global Disease Alert Map Helpful Resources

Alan B. Hale (abhale@cedarcrest.edu)
Last updated: 4 August '13