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Outbreak Investigation: A Cheat Sheet

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With the approaching release of the movie Contagion, I thought it would be appropriate to post my cheat sheet on how to investigate a disease outbreak. Aspiring disease detectives take notes!

Hollywood has done their best to capture what an outbreak is…but here are the facts. An outbreak, or epidemic, occurs when there are more cases of disease than would normally be expected in a specific time and place. The disease may be something doctors have already seen before just in a new form or abnormally high numbers, such as foodborne or healthcare-associated infections, or it may be an emerging disease that we don’t know much about like SARS. Either way, we need to investigate to determine why it is happening and how to prevent other people from getting sick or dying.

So how do you figure out the who, what, when, and where of a disease outbreak? We usually teach our disease detectives a 10-step process for investigating outbreaks, which I’ve condensed into 5 steps below. When we investigate outbreaks they are often in urgent situations with patients and their families wanting immediate answers and the news media asking why we are not working hard and fast enough. This can be a lot of pressure when you are trying to make sure you gather all the clues and piece them together properly. If you’re wrong, not only do more people die, but you may implicate the wrong product, microbe, or disease transmission (such as the false accusation of Spanish cucumbers as the cause of the recent European E. coli outbreak). For that reason it’s important you follow each step.

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