SPCI 505
Epidemiology of Biological and Chemical Hazards Mitigation I: Principles

Course Introduction

Course Overview

Epidemiology is the study of the distribution and determinants of diseases (for example, infections) or conditions, such as toxicities, in populations. We designed this course, Epidemiology of Biological and Chemical Hazards I: Principles, to provide you with the concepts and methods of epidemiology, as they apply to surveillance and investigation of health-related conditions or events. A common logo for epidemiology is the silhouette of Sherlock Holmes, the master criminal detective created by Sir Arthur Conan Doyle, a British physician. Just as criminal investigation seeks to detect the cause of a crime, epidemiology seeks to uncover the cause of medical conditions. Hence, if you like mystery, intrigue and discovery, you should enjoy this course in medical detection. And so, as Holmes would say, "Come, Watson, come! The game is afoot!"

The course consists of an introduction to epidemiology, surveillance for the detection of outbreaks, and outbreak investigation and control for infectious agents, toxins, and chemicals. You'll be introduced to case studies drawn from actual outbreaks that illustrate these essential epidemiological methods and will gain a good understanding of how to solve case studies. In the next course in this series—Epidemiology of Biological and Chemical Hazards Mitigation II: Applications—you will have the opportunity to apply what you have learned by more active participation in case studies.

Course Goals and Objectives

When you have completed this course you will be able to

• describe the key features and uses of descriptive epidemiology;
• describe the key features and uses of analytical epidemiology;
• calculate and interpret various statistical measures (ratios, proportions, rates);
• calculate and interpret measures of central location (mean, median, mode);
• calculate and interpret measures of dispersion (range, variance, standard deviation, confidence interval);
• correctly display data in tables, graphs and charts;
• define surveillance and its components;
• determine that an outbreak has occurred;
• describe the steps in the investigation of an outbreak;
• describe the natural history of and the chain of infection in infectious diseases; and
• classify toxic agents and their adverse effects in humans.

Required Materials

• U.S. Department of Health and Human Services. CDC Principles of Epidemiology, 3nd edition. Atlanta: Centers for Disease Control.
• Roueche, Berton. The Medical Detectives. New York: Truman Tally Books, 1991.

Principles of Epidemiology is an excellent introductory text and is used extensively by public health agencies to train personnel in epidemiology. It is a publication of the Centers for Disease Control, the primary federal agency involved in the surveillance and investigation of nationwide outbreaks. Note: you may downloaded this text free of charge from the CDC Publications site, although this version takes a while to download and print. Alternatively, you can purchase a print copy from the Public Health Foundation Learning Resource Center.

Berton Roueche is an investigative journalist par excellence, and The Medical Detectives is a compilation of his case studies that have appeared in popular magazines. These intriguing narratives of actual outbreaks are written in an engaging and instructive style that have become classics for anyone interested in human illnesses. It is intended to give you greater insight into how human cases of infectious diseases and toxicities are uncovered and controlled.

Recommended Text

The recommended text, Control of Communicable Diseases Manual, is the standard reference text of infectious diseases used by public health professionals. It is the "go to" manual when you are in need of any information about a disease. You may find it helpful to refer to this text to gain a better understanding of the many infectious diseases that are used in the course to illustrate epidemiologic principles.

Technology Requirements and Skills

See the Online Student Handbook for the technology requirements and skills necessary for this course.

Course Prerequisites

While a knowledge of outbreak investigation, descriptive epidemiology, hypotheses development and testing are not anticipated in students, skills in critical thinking, data analysis and statistics, laboratory procedures and microbiology will be useful in understanding the materials presented.

Course Organization

This is a group start course, meaning that we all begin and end at the same time. The course consists of nine lessons.

Exercises and Quizzes:The text, Principles of Epidemiology, is comprised of six lessons. Each of the lessons has exercises and a quiz. We ask you to complete the exercises and quiz questions relevant to this course. In addition, we ask you to respond to additional questions about the readings, and to submit them for grading. After you receive your grade, you can ask any questions or make any comments regarding the exercises or quizzes in an online forum.

Case Studies:Several of the lessons contain case studies in which you are given information about an outbreak, along with a number of questions, to which you should respond. The outbreak exercises are based on actual outbreaks and will follow the usual progression from detection to control. After you complete these exercises, you can ask any questions or make any comments regarding the case studies in an online forum.

Assignments:At the conclusion of some of the lessons, there will be an assignment that you will be requested to complete either individually or in groups. These assignments are to be submitted for grading. After you receive your grade, you can ask any questions or make any comments regarding the assignment in an online forum.

Online Discussions: After each lesson, you can ask questions or make comments in an online forum. In the forum, you will be interacting with other students and the instructor. In addition, if you have questions at any time about the materials you are reading, you should post a question to the forum. In order to maximize the usefulness of the forum, you should strive for clarity and succinctness in your questions/comments.

Course Components
Lesson	Topic	Readings from Texts
1	Descriptive Epidemiology	PE Lesson 1
2	Analytical Epidemiology	PE Lesson 1
3	Frequency Measures	PE Lesson 2
4	Measures of Central Location & Dispersion	PE Lesson 3
5	Organizing Epidemiologic Data	PE Lesson 4
6	Public Health Surveillance	PE Lesson 5
7	Investigating an Outbreak	PE Lesson 6
8	Principles of Toxicology	MD chapters 1, 10, 15
9	Principles of Infectious Diseases	PE Lesson 1 MD Chapter 3
PE—Principles of Epidemiology MD—Medical Detectives

Course Topics

The first half of the course consists of lessons that introduce epidemiologic concepts and methods,. The second half of the course consists of lessons devoted to surveillance, outbreak investigation , toxicology, and infectious diseases.

Lesson One

• Definition of epidemiology
• Key features and uses of descriptive epidemiology

Lesson Two

• Key features and uses of analytical epidemiology
• Components of the epidemiologic triad

Lesson Three

• Constructing a frequency distribution
• Calculating, interpreting, and applying frequency measures

Lesson Four

• Calculating, interpreting, and applying measures of central location of data
• Calculating, interpreting, and applying measures of dispersion of data

Lesson Five

Preparing and using tables, graphs, and charts

Lesson Six

• Definition of surveillance
• Purposes and uses of surveillance
• Sources of data for surveillance
• Conducting surveillance
• Evaluating surveillance systems
• Establishing surveillance systems

Lesson Seven

• Steps in the investigation of an outbreak
• Establishing the existence of an outbreak
• Establishing a case definition
• Describing the outbreak in terms of person, place, and time characteristics (descriptive epidemiology)
• Developing and testing hypotheses to identify the source of the outbreak (analytical epidemiology)

Lesson Eight

• Stages in the natural history of disease
• Host-agent relationship
• Chain of infection
• Epidemic disease occurrence
• Disease outbreak patterns

Lesson Nine

• Definition of the major classes of toxic agents
• Modes of exposure to toxic agents
• Spectrum of adverse effects of toxic agents in humans
• Mechanisms by which toxic agents cause adverse effects in humans
• Interaction of toxins inducing different effects

Assignments

Each of the six lessons in the text, Principles of Epidemiology, has exercises and quizzes. The exercises are short answers whereas the quizzes are short answers and multiple choices. Questions relevant to this course are drawn from these exercises and quizzes. Additional questions based on the readings are also presented and require short answers.

Assignments for the later lessons are in the format of case studies and require your response to questions based on the information that becomes available as the outbreak unfolds. These questions draw on the knowledge and skills you learned in the lessons on epidemiology, surveillance, and outbreak investigation.

Since there are nine lessons, each lesson will constitute 11% of your grade.

Your assignments are critiqued, and any errors are identified so you can learn from them.

Our hope is that you learn from this course by completing the readings, performing the exercises and quizzes, doing the case studies, and reviewing the comments made.

How Do I Submit Assignments?

You should submit assignments that require a written response as a Microsoft Word document.

When Should I Submit Assignments?

You should submit all assignments prior to the beginning of the next lesson unless otherwise instructed. Submit only the assignment due.

Late Assignments

To earn credit, you must complete all parts of each assignment, including all required reading and exercises, on time.

If unforeseen circumstances prevent you from completing an assignment on time, please contact your instructor before the assignment is due to obtain permission for a late submission. Without such permission, your assignment will not be accepted.

When Will You Respond to My Assignments?

All assignments are reviewed and returned within one week of submission.

We provide brief comments on each submitted assignment. Do not feel badly if you receive extensive comments. The purpose is to learn the material, which necessitates feedback. We strive to ensure that all feedback is in the form of constructive criticism.

Am I expected to participate in group activities or discussions?

• A threaded online discussion list is available for you to ask questions of the entire class. These questions should be related to the class.
• This threaded discussion list is asynchronous. This means that we'll not all be on-line in the discussion forum at the same time, so responses will be delayed. Expect that.
• We recommend that when starting a new topic (or thread), use a title that is truly descriptive, not generic. Some people (myself included) usually won't read a thread unless it looks like something they are interested in or will benefit from.
• We reserve the right to post your questions to me on the thread, if we deem them sufficiently important enough that the entire class would learn from them. If we do this, we will remove the sender's name, thereby making the question anonymous.
• As a way to make sure everyone is able to access the discussion forum, we would like everyone in the class to start a thread, providing your name, where you live (city and state), a brief biographic description, what experience/training you have in the subject of the course, and what you hope to obtain from the course.
• Read the others' bios to gain an understanding of where everyone is coming from. This will prove useful to you later in the class (maybe earlier than you think).

Grading

This is a credit/no-credit course. If your assignments overall are satisfactory, you will receive three graduate credits for this course.You will not receive a numeric grade, although assignments will be graded on a numeric scale, using the following criteria:

4.0	Excellent and exceptional work for a graduate student. Work at this level is consistently creative (where appropriate), thorough, well-reasoned, insightful, well written and shows clear recognition and incisive understanding of the important materials and issues. All assignments submitted are of good professional quality. The value of individual contributions to this course is considerable and positively affects the learning of all participants.
3.8	Strong work for a graduate student. Work at this level sometimes shows signs of creativity, is thorough and well reasoned, and demonstrates clear recognition and good understanding of the important materials and issues. Assignments submitted lack professional quality but demonstrate effort and concern for quality. The value of individual contributions to the course is strong and occasionally significant.
3.5	Competent and sound work for a graduate student. Work is well reasoned and thorough but not especially creative or insightful. The student shows adequate understanding of the important materials and issues although that understanding may be somewhat incomplete. Work submitted is competent but not remarkable. The value of individual contributions to the course is such that they do not influence the quality of the course one way or the other. This grade indicates neither exceptional strengths nor exceptional weaknesses, but is the grade for "average" graduate performance.
3.0	Adequate work for a graduate student. Work is moderately thorough and well reasoned, but with some indications that some of the important materials and issues is less than complete and perhaps inadequate for graduate study. The value of individual contributions to the course is minimal. However, the work is above the minimal expectations for the course.
2.7	Borderline work for a graduate student. Work barely meets the minimal expectations for the course and may occasionally fall below them. Understanding of the important materials and issues is incomplete or has not been demonstrated. There is little positive value in the individual contributions to the course and there may even be negative effects on the overall learning. Consistent overall performance at this level would be below that of adequate graduate student performance.

How to Study for this Course

This course is designed to help you learn about epidemiology, specifically how descriptive and analytical epidemiological methods are used for surveillance and outbreak investigation. There will be no examinations. All exercises, quizzes, and case studies are basically open book. The only memorization we hope you develop from this is the memory of what you are doing, and why you are doing it.

Here are some hints:

• Pace yourself. Don't try to do everything at once, especially right before the assignment is due.
• Set aside time each week that is dedicated exclusively to this course. If you set the time up early, it'll give you more incentive to do the work.
• Do the readings first, then answer the exercises and quizzes. This will enhance retention.
• Read the text before doing the online portion of the course and refer to the appropriate sections in the text when doing the online lessons.
• Use all available resources. We are not the only resource available to you; consider consulting your classmates also.
• If you run into something you don't understand and cannot figure out a satisfactory answer yourself, post a thread.

Most of all—enjoy the class. We realize that learning new things can be difficult, but since this class involves medical detection, we recommend viewing it as an adventure in discovery. As indicated in the course overview, epidemiology has parallels to the investigation of a crime; hence consider yourself a detective seeking to uncover the causes or factors responsible for disease incidents.

About the Course Developers

Ronald DiGiacomo, V.M.D., M.P.H.

Ronald DiGiacomo is a Professor in the Department of Epidemiology, School of Public Health and Community Medicine, University of Washington. He received his veterinary degree from the University of Pennsylvania and his M.P.H. degree, in Epidemiology, from the University of Washington. Dr. DiGiacomo has taught courses in epidemiology at the University of Washington for almost thirty years and has served as Thesis/Dissertation Committee Chairperson/Member for over 20 students. He has published over 100 articles and book chapters, mainly in the area of infectious diseases epidemiology, and is a Fellow in the American College of Epidemiology. As a member of the Northwest Center for Public Health Practice, University of Washington, he developed curricula in epidemiology for training public health workers.

Mark Oberle, M.D., M.P.H.

Mark Oberle is the Associate Dean for Public Health Practice, and Professor of Epidemiology and Health Services in the School of Public Health and Community Medicine, University of Washington. He has served for 21 years as a Medical Epidemiologist, most recently with the Public Health Practice Program Office, Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. He received his M.D. degree from Johns Hopkins University and his M.P.H. degree from the University of California at Berkeley. He is board certified in Preventive Medicine. Dr. Oberle has directed epidemiological studies and program evaluations in infectious diseases and reproductive health in 14 countries and directed epidemiology programs in state health departments. Dr. Oberle founded the Northwest Center for Public Health Practice at the University of Washington that currently works with six northwestern states, and was Director of the UW Preventive Medicine Residency. He has taught epidemiology in continuing education programs for public health workers in several states.

Andy Stergachis, Ph.D., R.Ph.

Andy Stergachis is a Professor of Epidemiology with the Northwest Center for Public Health Practice, and Affiliate Professor with the Program in Pharmaceutical Outcomes Research and Policy, University of Washington. Previously, Doctor Stergachis was Vice President and Chief Pharmacist at drugstore.com. Before that he was Chairman of the Department of Pharmacy, founding Director of the Program in Pharmaceutical Outcomes Research and Policy, and Professor of Pharmacy and Epidemiology at the University of Washington. Dr. Stergachis earned his pharmacy degree from Washington State University and an M.S. and Ph.D. from the University of Minnesota. He was the 1990 Burroughs Wellcome Scholar in Pharmacoepidemiology. The American Association of Pharmaceutical Research Scientists awarded Dr. Stergachis the 1994 Research Achievement Award in Economic, Marketing and Management Sciences. In 1999, American Druggist selected him as one of the most influential pharmacists in the U.S. He was awarded the 2002 Pinnacle Award by the American Pharmaceutical Association Foundation for career contributions towards improving quality of care through the medication use process. Dr. Stergachis served as a member of the Institute of Medicine Committee to Study the Interactions of Drugs, Biologics, and Chemicals in Deployed U.S. Military Forces and advised the U.S. State Department on assembling the U.S.-Switzerland Joint Economic Commission Panel on Bioterrorism held in conjunction with the World Economic Forum in 2002. He serves as a member of NCQA's Asthma Measurement Advisory Panel, the Agency for HealthCare Research and Quality Health Systems Research Study Section, and the Institute of Medicine Committee on Poison Prevention and Control. He has published over 100 articles and book chapters, including work in drug safety, and he has published in journals such as the New England Journal of Medicine, JAMA, and Medical Care.

---

©2003–2007, University of Washington. All rights reserved.
No part of this publication may be reproduced in any form or by any means without permission in writing from the publisher.