SPCI 507
Epidemiology of Biological and Chemical Hazards II: Applications

Course Introduction

"Lethal bioterrorism has become a stark reality, and our ability to detect and counter this danger depends on having reliable, up-to-date knowledge."
—Tommy Thompson, former Secretary of Health and Human Services, http://www.hhs.gov/news/press/2001pres/20011206a.html

"The traditional public health response—surveillance, prevention, detection, response, recovery—is the paradigm for the national response not only to all forms of terrorism, but also to emerging infectious diseases."
— Committee on Science and Technology for Countering Terrorism, Institute of Medicine, 2002

"The most menacing bioterrorist is Mother Nature herself."
— Madeline Drexler, Author of Secret Agents: The Menace of Emerging Infections, 2002

Welcome to SPCI 507! During this course, we'll focus on the application of the principles of epidemiology covered in Epidemiology of Biological and Chemical Hazards I: Principles. The quotations at the top of this page illustrate that natural and intentional biological (and chemical) incidents generate a considerable amount of concern among emergency management planners, health care providers, and public health workers. The emergence of West Nile Virus and anthrax-laced mail raised awareness that the health care system needs to be better prepared for the possibility of terrorism as well as other emergent public health threats. Improving preparedness became an urgent national security issue. In response, considerable resources and effort have been directed towards improving coordination and communication, enhancing information systems for the timely detection of outbreaks, bolstering medical preparedness and response, and training the health care workforce. Of interest as well is the identification of scores of new infectious agents that have emerged or re-emerged in human populations in the past three decades. Throughout this course, we will study cases, drawn from actual outbreaks, that use the epidemiological methods and skills you have learned.

Course Objectives

When you have finished this course, you will be able to

• compare and contrast the occurrence of various biological and chemical agents;
• apply your knowledge of epidemiological methods to solve outbreaks caused by biological and chemical agents;
• propose interventions for the control of outbreaks; and
• formulate strategies for preventing outbreaks.

Required Textbooks

This course includes few specific reading assignments from the required texts. Rather, you should use the two textbooks as reference materials to help you solve the case studies.

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 should use it as a reference text to gain a better understanding of the many infectious diseases that are used in the case studies. Hence, you should use it to read about the diseases whenever you first encounter them in the lessons.

You will have further reading in one of the texts required for SPCI 505, The Medical Detectives. 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.

Technology Requirements and Skills

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

Prerequisites

The only prerequisite for this course is SPCI 505—Epidemiology of Biological and Chemical Hazards I: Principles.

Course Organization

This is a group start course, meaning that we all begin and end at the same time. There are nine lessons; each contains a case study; all are based on actual outbreaks.

Case Study Questions

As you receive information about each outbreak, you will encounter questions that will require you to apply your knowledge toward solving the outbreak; these questions will follow the usual progression of an outbreak from detection to control. Use your textbooks, the knowledge you gained in Epidemiology I, and any other resources available to you to answer the questions.

It is imperative that you answer the questions in order. The questions test your analytical abilities and the epidemiology skills and knowledge you acquired in Epidemiology I. Also, your understanding of the case study progresses through the lesson, as each question builds on previous ones.

Your responses to these questions will not be graded. Links to the answers for case studies in Lessons One through Eight are provided within the lesson. For the case study in Lesson Nine, you will provide the answers (see Final Case Study below).

Course Topics

The course covers the following areas:

• Biological agents
  o person-to-person exposure
  o airborne exposure
  o food-borne exposure
  o water-borne exposure
  o vector exposure
• Toxins
• Chemical agents
  o nerve agents
  o other chemical agents
• Emerging infections

Within each lesson, you will be challenged to use information provided in the core content of the case study to determine the type of biological or chemical agent, based on the epidemiology, microbiology, toxicology, and/or clinical presentation. The lessons also cover basic information about treatment, prevention, prophylaxis, infection control, and/or decontamination.

The types of biological and chemical agents we will cover include those that could be easily disseminated to many people in a given area, with the potential for causing a major public health impact. We will also cover agents that need a vehicle to spread (such as food or water), and would be expected to result in low mortality rates (such as Cryptosporidium).

Assignments

Assignments for this course include:

• postings to discussion forums;
• written assignments; and
• completion of a final case study.

Discussion Forums

Each lesson includes an online discussion forum where you will post your responses to one or more questions. You are also encouraged to respond to the postings of other students.

You must make at least one posting to the week's discussion forum on or before the due date, or you will receive a grade of zero for that week's posting.

Written Assignments

The first eight lessons each include a short written assignment in which you will answer questions similar to the case-study questions, and submit your responses to your instructors. Your responses should be no more than a few sentences for each question.

Final Case Study

Lesson Nine is a case study similar to those in the first eight lessons. In this lesson, however, you will respond to all questions in the lesson, in writing, and submit your responses to your instructor.

Late Assignments

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

No credit will be given for partial completion or late work. If a genuine emergency prevents you from completing a lesson on time, please contact your instructor about the emergency so you can make up the work due.

Weighting of Assignments

Your assignments are weighted as follows:

Component	Percentage of final grade
Eight discussion forums	25%
Eight written assignments	25%
Final case study	50%

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.

Submitting Assignments

Please submit written assignments according to the instructions found in "About Your Instructor" in your online course syllabus.

Study Tips

This course is designed to help you apply the epidemiologic methods you have learned to actual outbreaks of diseases in populations. More specifically, you will use descriptive and analytical epidemiological methods to analyze and interpret the occurrence of outbreaks. Exercises, assignments , and the final case study are "open book." The only memorization we hope you develop from this course 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.
• Each week, dedicate some time exclusively to this course. If you set the time up early, it'll give you more incentive to do the work.
• Use all available resources. Your instructors are not the only human resources 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.

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. He has taught courses in epidemiology at the University of Washington for almost thirty years and has served as chair or committee member of thesis or dissertation committees for over 20 students. Dr. DiGiacomo 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.

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, Dr. 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, published in journals such as the New England Journal of Medicine, JAMA, and Medical Care.

---

©2006, 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.