PART II

Case Information: You are told that there are $4$ male and $3$ female cases, ranging in age from $18$

to $66$ years. All are Asian and are native to the island. You are told that two of the men operate

printing presses, filling them with ink and using solvents for occasional cleaning. One additional

male worker is a typesetter, who is also exposed to solvents. The fourth affected male employee

is a maintenance worker, who repairs the presses and uses solvents to clean the machines on a

daily basis. The three ill female workers are proof$-$reader, an office worker, and the cafeteria

cook. None of the women are exposed to chemicals in the plant. The cook was the first to

become ill and was one of the hospitalized cases. You are told that there are $40$ employees in

total. The plan manager gives you a personnel list that includes names, age, sex, job title, work

area, job duties, and job duration of each worker.

Your first calls are to the physicians who are treating the two hospitalized workers. They tell you

that the presumptive diagnosis in both cases is botulism. Laboratory confirmation is pending but,

meanwhile, both patients are being treated for botulism.

You define a case of botulism as anyone with two or more of the symptoms on the list in the box,

Seminal Facts on Botulism $($Table $2).$ All $7$ workers who were initially identified by the plant$$s occupational physician as recently ill met this definition.

Results of the questionnaire were obtained for $39$ of the $40$ workers at the plan. Six ill employees ate at the factory cafeteria on September $27$ 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 admissions.

Question $2$: Set up a $2$ X $2$ table, showing the number of workers with disease vs$.$ those

without disease, and the number of exposed $($i$.$e$.$ ate in cafeteria vs$.$ did not eat in cafeteria$).$

You calculate the attack rate, and the relative risk of getting botulism after eating at the

factory cafeteria on September $26$ and $27.$

a$.$ Construct a $2$ X $2$ table using results of the questionnaire noted in the case

information

b$.$ Calculate the attack rate. Show all work

c$.$ Calculate the relative risk associated with eating in the factory cafeteria. Show all

work