EPIDEMIOLOGY

TOPIC: ACUTE NEUROLOGIC EPIDEMIC OUTBREAK IN A FACTORY

YOU ARE A PUBLIC HEALTH NP. YOU RECEIVE A CALL ON OCTOBER 10 FROM AN OCCUPATIONAL HEALTH NP WHO TELLS YOU ABOUT AN OUTBREAK O UNUSUAL ILLNESS THAT BEGAN THE LAST WEEK OF SEPTEMBER AMONG WORKERS IN A FACTORY. SHE TELLS YOU THAT A NUMBER OF WORKERS BECAME ILL WITHIN A 2 TO 3 DAY PERIOD. THEIR SYMPTOMS INCLUDE DOUBLE VISION, DROPPING EYELIDS, MUSCLE WEAKNESS, AND PROGRESSIVE RESPIRATORY WEAKNESS. TWO WORKERS HAVE BEEN HOSPITALIZED AND ARE ON MECHANICAL VENTILATION TO ASSIST IN BREATHING.YOU ARE TOLD THAT THERE ARE 4 MALE AND 3 FEMALE CASES, RANGING IN AGE FROM 18 TO 66 YEARS. THERE ARE 40EMPLOYEES TOTAL.

AFTER PRELIMINARY WORK, AND BASED UPON THE SYMPTOMS, YOU DEFINE THIS OUTBREAK AS BOTULISM. ALL 7 WORKERS WHO WERE INITIALLY IDENTIFIED BY THE PLANT'S OCCUPATIONAL NP AS RECENTLY ILL MET THIS DEFINITION.

RESULT OF A QUESTIONNAIRE WERE OBTAINED FOR 39 OF THE 40 WORKERS. SIX ILL EMPLOYEES AT THE FACTORY CAFETERIA ON SEPTEMBER ON SEPTEMBER 26 AND 27, COMPARED TO 7 OF 32 NON-STRICKEN WORKERS WHO ATE AT THE FACTORY CAFETERIA ON BOTH DAYS. YOU ALSO LEARN THAT THE FACTORY COOK DIED FROM RESPIRATORY COMPLICATIONS 3 WEEKS AFTER HOSPITAL ADMISSION.

QUESTION 30; CONSTRUCT A 2X2 TABLE USING THESE DATA.

QUESTION 31; CALCULATE THE ATTACK RATE

QUESTION 32; CALCULATE THE CASE FATALITY RATE

QUESTION 33; USING THE 2X2 TABLE YOU CONSTRUCTED IN QUESTION 30, CALCULATE THE RELATIVE RISK ASSOCIATED WITH EATING IN THE FACTORY CAFETERIA