Outbreak Investigations: 
Case Studies in Epidemiology

BIO 216 - Fall 2011 - 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 [my schedule] or send me an email.  If my door is closed, leave me a note. Setting up an appointment is also an option. Be sure to suggest a possible time.

Prerequisites: A genuine interest in learning more 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:  MW 1:00-2:15 PM / SC 139

Textbook:
Dworkin, M.S. 2011.  Cases in Field Epidemiology, A Global Perspective.  Jones and Bartlett Publ. 477pp.

Course Objectives
The mission of the Global Diseases minor is to provide our society with individuals who have an enhanced awareness of global diseases, a sincere interest in finding solutions to the many problems associated with these diseases, and the skills and initiative required to effect change.  Key to the success of the graduates of this minor is an understanding that no discipline stands alone in solving global problems. BIO 216 is a required course for the minor; the course objectives, as they relate to the overall mission, 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, and (3) convey their interpretations of specific outbreaks to others. This course is just one piece of the puzzle within the overall set of requirements for the minor; together they 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: Two examinations, one discussion and one presentation.
2. The value of objectivity and unbiased data when searching for the truth behind an outbreak.
Assessment: Two examinations, one discussion and one presentation.
3. The basic principles, concepts and techniques used by epidemiologists.
Assessment: Two examinations, 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 and one presentation.

Attendance
Attendance is expected. Few people would buy tickets for a movie at a theatre and then choose, instead, to toss the tickets in the trash and then sit home and read the movie reviews. Given the cost of college these days, missing classes is no different; make the most of your investment. If, for some reason, you are unable to attend class, notify Dr. Hale as soon as possible. Under some circumstances (e.g., student presentations), a written assignment would be an appropriate substitute.

Final Examination & Travel Plans
BIO 216 has a final examination; the date and time are set by the Registrar. If you must make travel arrangements prior to the release of the final examination schedule, be sure to schedule your flight/ride after the end of the exam period. You are expected to take the final as scheduled by the Registrar. Special situations (e.g., early departure dates for organized Cultural Experiences) should be brought to Dr. Hale's attention early in the semester.

Grading

ONLINE GRADES

Activity
Points
Session/Info
Midterm Examination 
100
 Session 11
75 minute written examination; Coverage: Sessions 1-9
"Campus Outbreak"
 71
 Session 17 - Site visit, overview of the "campus outbreak,"
and preliminary data
Written class report due Session 27
Format of Written Report: Similar to chapters/investigations in course textbook, though an appendix should be added to include survey form(s), large sets of data, information relevant to the study, but should not be posted online, etc.
Submitted report will be posted online, but without the appendix; community participating in the "outbreak" may be interested in the outcome.
Outbreak Investigations: Student Lecture & Discussion
100
 Topic: Selected chapter or an outbreak not addressed in the textbook;
if the latter, talk with Dr. Hale at the time of sign-up.
Discussion Format/Focus: presenter's choice
Outbreak Investigations: Online Summary &
Discussion Questions
 25 A concise summary (~1/2 page/single space) of the presentation topic,
plus a list of discussion questions (1 file in Word format) for posting online.
Include the chapter title & author, your name, and preferably an image related to the topic
Due date: 1 week before presentation/discussion
Final Examination 
100
 Final Exam Period
Design of Exam: Investigation/Scenario
Participation in Student-Led, Class Discussions
 50
 5 pts./session
Attendance 54 Minus 2 points per absence

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.

Lecture Schedule - Fall 2011

Session Date Topic Readings
1 Aug 29 Introduction to Course
Note: Posted Sign-Up for Presentation Topic & Date
Discussion of Student Interests & Directions
Assessment of Current Understanding
 		Syllabus
2 Aug 31 Helpful Resources (HealthMap, FreeMind, Blogs, Literature...)
 -
3 Sept 7 An Overview of Outbreak Investigation* Preface & Chapter 1
4 Sept 12 How an Outbreak is Investigated Chapter 2
5 Sept 14 Basic Methods and Concepts in Epidemiology
 -
6 Sept 19 Cholera for a Dime
Chapter 4
7 Sept 21 Legionnaire's Disease: Investigation of an Outbreak of a New Disease
 Chapter 5
8 Sept 26 What Went Wrong? An Ancient Recipe Associated with
Botulism in Modern Egypt
 Chapter 11
9 Sept 28 Basic Methods and Concepts in Epidemiology -
10 Oct 3  Controlling an Outbreak of Shigellosis with a Community-Wide
Intervention in Lexington County, Kentucky
 Chapter 12
11 Oct 5 Midterm Examination
 Sessions 1-9
-
 Oct 10
 [Fall Break]
 -
12 Oct 12 Eschar: The Story of the New York City Department of Health
2001 Anthrax Investigation
 Chapter 17
13 Oct 17 What Do People Eat When They Have No Food? A Tragic Story
of Poverty, Monsoon Floods, and Weeds
 1st Set of Student Lecture/Discussion Questions Due
 Chapter 25
14 Oct 19 Basic Methods and Concepts in Epidemiology
 -
15 Oct 24 Toxic Tryptophan? Investigating the Eosinophilia
Myalgia Syndrome in Minnesota (Erin Studer) 		Chapter 26**
16 Oct 26 Something Borrowed, Something Blue:
A Wedding to Remember (Areaona Roberson)
 Chapter 22
17 Oct 31 "Campus Outbreak" Site Visit, Overview, Preliminary Data
 -
18 Nov 2 Ebola Hemorrhagic Fever in Gabon: Chaos to Control (Shannon Ronca) Chapter 18
19
 Nov 7
 Emergency Yellow Fever Mass Vaccination in
Post-Civil War Liberia (Samantha Huey) 		Chapter 20
20
 Nov 9 Investigations of Attitudes Toward Immunization
in an Old-Order Amish Community (Samantha Korpics) 		Chapter 34
21
 Nov 14 A Community Outbreak of Hepatitis A Involving Cooperation Between Public
Health, the Media, and Law Enforcement, Iowa, 1997 (Emily Haner) 		Chapter 15
22
 Nov 16 Tracking a Syphilis Outbreak Through Cyberspace (Nicole Rodriguez) Chapter 16
23
 Nov 21 Why Have the Children of Chernivtsi Lost All of Their Hair? (Tara Bruckler) Chapter 30
-
 Nov 23
 [Thanksgiving Break]
 -
24
 Nov 28 A Mumps Epidemic - Iowa, 2006 (Kathaleen Deane) Chapter 21
25
 Nov 30 Sex, Drugs, and Community-Based Ethnography: Field Investigations
Involving Difficult-to-Reach Populations Around the World (Karen Sanchez)
 Chapter 33
26
 Dec 5 Toxic School Lunch: Chemical Poisoning of Elementary
School Children in Joliet, Illinois (Amber Green)		 Chapter 23
27
 Dec 7 Pork Tapeworm in an Orthodox Jewish Community: Arriving
at a Biologically Plausible Hypothesis (Melody Nyoni)
***"Campus Outbreak" Report Due***
 Chapter 13
28
 Dec 12 Make-up, Review & Photo
 -
Final
 TBA
 Final Examination
 Full Semester - Scenario Based
*Session topics, if italicized, match chapter titles within the course textbook.
** Pool of Topics Available for Student Presentations: Book Section/Chapter Numbers and Titles Below
First Come/First Served

[If a student prefers to report on a different epidemiological study of an outbreak, this option exists.
However, it should be noted that the investment of time could be considerable.]
II. OUTBREAK INVESTIGATIONS OF INFECTIOUS DISEASES
3. Leptospirosis at the Bubbles
6. The Investigation of Toxic Shock Syndrome in Wisconsin, 1979-1980 and Beyond
7. The Early Days of AIDS in the United States: A Personal Perspective
8. Verify the Diagnosis: A Pseudo-outbreak of Amebiasis in Los Angeles County
9. Measles Among Religiously Exempt Persons
10. An Outbreak of Fulminant Hepatitis B in a Medical Ward in Israel
13. Pork Tapeworm in an Orthodox Jewish Community: Arriving at a Biologically Plausible Hypothesis
14. The Massive Waterbourne Outbreak of Cryptosporidium Infections, Milwaukee, Wisconsin, 1993
15. A Community Outbreak of Hepatitis A Involving Cooperation Between Public Health, the Media, and Law Enforcement, Iowa, 1997
16. Tracking a Syphilis Outbreak Through Cyberspace
18. Ebola Hemorrhagic Fever in Gabon: Chaos to Control
19. Whipping Whooping Cough in Rock Island County, Illinois
20. Emergency Yellow Fever Mass Vaccination in Post-Civil War Liberia
21. A Mumps Epidemic - Iowa, 2006

III. OUTBREAK INVESTIGATIONS OF INTOXICATIONS AND OTHER NONINFECTIOUS CAUSES
22. Something Borrowed, Something Blue: A Wedding to Remember
23. Toxic School Lunch: Chemical Poisoning of Elementary School Children in Joliet, Illinois
24. When Your Food Glows Blue
26. Toxic Tryptophan? Investigating the Eosinophilia Myalgia Syndrome in Minnesota
28. "We're Prepared to Believe You" - Investigating Cancer Cluster Reports

IV. CASES IN ENVIRONMENTAL AND OCCUPATIONAL HEALTH
30. Why Have the Children of Chernivtsi Lost All of Their Hair?
31. Not in My Backyard: An Investigation of the Health of a Community Living Near a Landfill

V. INVESTIGATING HARD-TO-REACH AND SPECIAL POPULATIONS
32. Back to School: Using Basic Epidemiologic Data on Asthma in Urban School Children to Improve Respiratory Health
33. Sex, Drugs, and Community-Based Ethnography: Field Investigations Involving Difficult-to-Reach Populations Around the World
34. Investigations of Attitudes Toward Immunization in an Old-Order Amish Community
35. Performing a Seroprevalence and Ocular Study in Rural Guatemala - Toxoplasmosis, a Chronic Infectious Disease

                                        

HELPFUL & INFORMATIVE LINKS

Textbook       
Global Disease Alert Map


Alan B. Hale (abhale@cedarcrest.edu)
Last updated: 21 November '11