PH 212-Surveillance, Identification and Management of an Outbreak

Course Description:
This course begins with a review of public health surveillance systems (PHSSs), their components and functions. Emphasis is placed on the fundamental role of a PHSS in detecting possible disease outbreaks. Students will learn the basic concepts and principles of outbreak identification and management. Basic principles on evaluation and possible solutions for improvement of public health surveillance systems, particularly those of the Pacific, are also discussed.

  • Prerequisite Courses: PH 111 or Instructor’s permission

A. PROGRAM LEARNING OUTCOMES (PLOS):
The student will be able to:

  1. Recognize, describe, discuss and research about the basic public health science facts and principles;
  2. List, discuss and demonstrate the essential public health functions and their interrelationships at community and district level;
  3. Describe, discuss and research adult, children and family health issues;
  4. Discuss and demonstrate an understanding and practice of some generic public health competencies;
  5. Demonstrate proper public health skills for public health practice in the community as a national public health officer;
  6. Discuss and demonstrate community and cultural sensitivity in the health care environment;
  7. Describe, discuss and research the determinants and problems of the health of adults, children and families;
  8. Demonstrate proper cardio-pulmonary resuscitation (CPR), first aid techniques, and other healing and patient care abilities;
  9. Demonstrate the ability and discuss how to make a community diagnosis based on the determinants of health in a community;
  10. Identify and demonstrate good public health practice;
  11. Have had work experience at a public health facility at community and national levels.

B. STUDENT LEARNING OUTCOMES (SLOS) - GENERAL
The student will be able to:

  1. Understand how Public Health Surveillance (PHS) works, including the basic surveillance wheel
  2. Get familiar with current PHSS operated in Micronesia and in the Pacific
  3. Be conversant with the basic steps in the management of an outbreak of a communicable disease and apply these steps to a practical situation
  4. Know some of the possible modes of intervention to prevent the spread of disease outbreaks and how they vary with the natural history of diseases
  5. Understand the relationship between a PHSS and the detection of disease outbreaks

SLO

PLO 1

PLO 2

PLO 3

PLO 4

PLO 5

PLO 6

PLO 7

PLO 8

PLO 9

PLO 10

PLO 11

1

ID

 

 

 

ID

 

D

 

ID

 

 

2

ID

 

 

 

ID

 

D

 

ID

 

 

3

ID

 

 

 

ID

 

D

 

ID

 

 

4

ID

 

 

 

ID

 

D

 

ID

 

 

5

ID

 

 

 

ID

 

D

 

ID

 

 

I = Introduced
D = Demonstrated
M = Mastered

C. STUDENT LEARNING OUTCOMES (SLOS) – SPECIFIC
The student will be able to:

General SLO 1: Understand how Public Health Surveillance (PHS) works, including the basic surveillance wheel.

Student Learning Outcomes

Assessment strategies

1.1 Explain the use of epidemiology in PHS and its interaction with PHS.

Group discussion and oral reports to be graded according to a specified rubric

Direct and multiple choice questions in examinations and quizzes

1.2 Describe the applications of epidemiology, using pacific- based examples.

Group discussion and oral reports to be graded according to a specified rubric

Direct and multiple choice questions in examinations and quizzes

1.3 Explain, with examples, the basic epidemiological measures

Group discussion and oral reports to be graded according to a specified rubric

Direct and multiple choice questions in examinations and quizzes

1.4. Describe the surveillance wheel: sequential components, mechanism of work, sectors involved, their functions and responsibilities.

Group discussion and oral reports to be graded according to a specified rubric

Direct and multiple choice questions in examinations and quizzes

General SLO 2: Get familiar with current PHSS operated in Micronesia and in the Pacific.

Student Learning Outcomes

Assessment strategies

2.1. Describe how the PHSS in Micronesia and the Pacific operate.

Group discussions and oral reports to be graded according to a specified rubric
Practical demonstration to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

2.2. List the obligations undertaken by public health services in Micronesia, as per the Law on Public Health, Safety and Welfare.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

2.3. Describe some of the data collection systems in common usage, such as Notifiable Diseases (ND) and Consolidated Monthly Returns (CMR).

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

2.4 Discuss, analyze, and evaluate the components of a PHSS; suggest possible solutions for improvements.

Group discussions and oral reports to be graded according to a specified rubric
practical demonstration to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

2.5. Perform the basic steps in the evaluation of a PHSS performance.

Group discussions and oral reports to be graded according to a specified rubric
practical demonstration to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

General SLO 3: Be conversant with the basic steps in the management of an outbreak of a communicable disease and apply these steps to a practical situation.

Student Learning Outcomes

Assessment strategies

3.1 Describe some milestone events in the history of outbreak investigation.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.2 List and explain the nomenclature of outbreak investigation.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.3. Identify and discuss different channels through which a disease outbreak is recognized.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.4. State the purposes of outbreak investigation.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.5. List and explain the steps in a classical outbreak Investigation.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.6. Explain how epidemiological concepts and skills are employed in each step.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.7. Explain what a case definition is; the classification of case definitions.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.8. Demonstrate how descriptive epidemiology is applied in outbreak investigation, i.e. the use of line listings, epidemic curves, spot maps, etc.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.9. Construct epidemic curves; explain their different trends according to disease natural history and mode of transmission

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.10.Demonstrate how analytic epidemiology is applied in outbreak investigation.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.11.Explain, calculate, and interpret odds ratios (OR) and attack rates (AR).

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

3.12.Discuss the importance of disseminating the investigation findings.

Group discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

General SLO 4: Know some of the possible modes of intervention to prevent the spread of disease outbreaks and how they vary with the natural history of diseases.

Student Learning Outcomes

Assessment strategies

4.1 Describe the basic principles and strategies to control the occurrence and transmission of communicable diseases.

Groups discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

4.2. Describe and explain the chain of infection as the interaction between agent-host-environment.

Groups discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

4.3. Discuss the field epidemiology triangle: person-place-time.

Groups discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

4.4. Evaluate the efficacy of the implemented control measures.

Groups discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

4.5. Discuss the prominent problems of approaches to non-communicable diseases control.

Groups discussions and oral reports to be graded according to a specified rubric
Direct and multiple choice questions in examinations and quizzes

General SLO 5. Understand the relationship between a PHSS and the detection of disease outbreaks.

Student Learning Outcomes

Assessment strategies

5.1. Demonstrate some common diseases under surveillance in Micronesia and the Pacific.

Groups discussions and oral reports to be graded according to a specified rubric
Individual assignment
Practical demonstration to be grades accoding to a specific rubric
Direct and multiple choice questions in examinations and quizzes

5.2. Present and discuss the current surveillance and most recent outbreak investigations of some of the following diseases, as applicable:

  1. Dengue fever
  2. Tuberculosis
  3. Sexually Transmitted Infections (STIs)
  4. Filariasis

Groups discussions and oral reports to be graded according to a specified rubric
Individual assignment
Practical demonstration to be grades accoding to a specific rubric
Direct and multiple choice questions in examinations and quizzes

5.3. Perform three standard exercises on outbreak investigations, selected from: Measles, Hemorrhagic Fever, and Bladder Cancer in Chemical Workers, Dysentery in Pilgrims and others, as relevant.

Groups discussions and oral reports to be graded according to a specified rubric
Individual assignment
Practical demonstration to be grades accoding to a specific rubric
Direct and multiple choice questions in examinations and quizzes

D. COURSE CONTENT

  1. Review of basic epidemiological concepts
    1. Brief history of epidemiology
    2. Uses of epidemiology
    3. Basic epidemiological measures
    4. Epidemiology and public health surveillance
    5. Criteria of disease causation
  2. Public Health Surveillance Systems (PHSS)
    1. Definition of PHSS
    2. Types of health surveillance
    3. The surveillance wheel: components, operational mechanism and functions
    4. Purposes and functions of PHSS
    5. Diseases under surveillance: categories, characteristics and reporting requirements
  3. PHSS and The Law on Public Health, Safety and Welfare – Data Collection
    1. The FSM Law on Public Health, Safety and Welfare (1997, updated August 2001)
    2. Data collection systems in common usage: Notifiable Diseases (ND), Consolidated Monthly Returns (CMR)
    3. Practical exercises: reviews of ND and CMR reports
  4. Evaluation and improvement of PHSS performance
    1. Evaluation of PHSS
    2. Operational structure of the system
    3. Objectives and usefulness of the system
    4. Quantitative assessment of PHSS
    5. Cost estimation for system operation
    6. Improving the system
    7. The economic benefits of an efficient operating PHSS
  5. Outbreak investigation
    1. Brief history of outbreak investigation
    2. Outbreak investigation and its nomenclature
    3. Purposes of outbreak investigation
    4. Recognizing a potential outbreak
    5. Initiating an outbreak investigation
    6. Outbreak investigation
      1. Steps in conducting outbreak investigation
      2. Epidemiological concepts and skills employed in each step
      3. Case definitions: definition and classification
      4. The use of descriptive epidemiology: line listing, epidemic curve, spot map
      5. How to construct and interpret epidemic curves
      6. The use of analytic epidemiology: case-control studies, hypothesis testing, tests of statistical significance
      7. Calculation and interpretation of odds ratio and attack rates
    7. Roles of the laboratory in outbreak investigation
    8. Collecting, organizing, and displaying epidemiologic data
    9. Reporting and disseminating investigation findings
  6. Control of outbreaks
    1. Control of communicable disease outbreaks
      1. Basic principles in the occurrence and transmission of communicable diseases:
        • Agent-Host-Environment
        • Person-Place-Time
      2. Basic control measures:
        • Targeting source(s) of infection, including reservoirs
        • Targeting modes of transmission (interrupting the transmission process)
        • Targeting susceptible hosts
    2. Evaluating control measure efficacy
      1. Prominent problems with approaches to the control of non-communicable diseases (NCD)Addressing risk factors
      2. From awareness to action
  7. The relationship between PHSS and the detection of disease outbreaks
    1. Surveillance data of commonly observed diseases in Micronesia and the Pacific
    2. Data from recent outbreak investigations in the Pacific
    3. How surveillance data reflects actual occurrence of diseases
    4. Class exercises on outbreak investigation data

E. METHODS OF INSTRUCTION

  1. Lecture: in-class lectures
  2. Group discussions and student activities on the PHSS project: each student will be tasked to obtain a minimum five-year surveillance data set on a specific disease or health condition (approved by the Instructor). The student is to carry out the data analysis and write a detailed report, addressing the following: the disease natural history, method and time interval of data reporting, epidemiological distribution and observed trends, possible determinant factors, proposed practical interventions to curb the disease occurrence and to improve the data reporting and recording practice.

F. REQUIRED TEXT AND COURSE MATERIALS
Ed Souares Y. (1998). Public health surveillance in the pacific. Noumea: SPC. (or most recent edition). Arias KM. (2000). Quick reference to outbreak investigation and control in health care facilities (1st Ed.). Burlington, Massachusetts: Jones and Bartlett. (Or most recent edition).

G. REFERENCE MATERIALS
Beaglehole R., Bonita R., Kjellstrom T. (2007). Basic epidemiology (2nd Ed.). Geneva, Switzeland: World Health Organization. (or most recent edition). Gregg MB. (2008). Field epidemiology (3rd Ed.). London, England: Oxford University Press. (or most recent edition) Donaldson RJ., Donaldson LJ. (1993). Essential public health medicine. Newbury, England: Petroc Press. (or most recent edition). Handouts data on disease outbreaks; FSM Law on Public Health, Safety and Welfare; ND and CMR report form.

H. INSTRUCTIONAL COST
none

I. EVALUATION
none

J. CREDIT BY EXAMINATION
None

 

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