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An Introduction to Epidemiology

 

This background piece provides several working definitions of epidemiology—the basic science of public health; an introduction to the different categories of epidemiology and types of epidemiological studies; and an overview of the disease transmission cycle. First, to set the stage, consider the three incidents that follow, stepping into the shoes of the public health officer who received the initial report and asking yourself the question, "What do I do now?" Some of these examples made national news and may be familiar to you.

First Incident

In March 1985, a nurse epidemiologist in a county health department noted, while reviewing surveillance data, three cases in a single month of hepatitis B of unusual origin. Hepatitis B, or serum hepatitis, is transmitted through sexual contact and by exposure to infected bodily fluids, but these three patients did not seem to have the usual risk factors. All three people did, however, indicate having received injections at the same health care facility.

The nurse's immediate questions were: Is this a coincidence? Did these three cases occur by chance or is there a link? In this instance, the nurse decided to pursue an investigation.

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Second Incident 

At 8:30 in the morning on August 2, 1976, Dr. Robert B. Craven of CDC's Viral Diseases Division received a call from a nurse at a Veterans' Hospital in Philadelphia, Pennsylvania. The nurse reported two cases of severe respiratory illness, one of which had been fatal. Both people had attended the annual American Legion Convention held July 21-24 . By the evening of August 2, 71 more of the people attending the convention had the same illness, with symptoms of acute onset of fever, chills, headache, malaise, dry cough, and myalgia. Further conversations with local and state public health officials revealed that between July 26 and August 2, 18 conventioneers had died. Deaths were due primarily to pneumonia. 

An intense investigation began immediately. The incident became known as the first outbreak of Legionnaires' disease and led to the discovery of the gram-negative pathogen, Legionnella pneumophila.

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Third Incident

On October 30, 1989, a New Mexico physician notified the state's health department of three patients with marked peripheral eosinophilia and severe myalgia. All three patients had been taking oral preparations of L-tryptophan, a nonprescription drug sold as a dietary supplement in health food stores. Despite extensive clinical evaluation and testing, the illness could not be identified. 

An investigation followed and resulted in the characterization of eosinophilia-myalgia syndrome, EMS. The investigation implicated a vehicle for exposure—L-tryptophan dietary supplements—before a suspected agent was identified, and the product was taken off the market. Eventually, the problem was traced to a contaminant that had been introduced by changes in the production process at a single manufacturing facility.

These three examples illustrate some of the key reasons for needing applied, or field, epidemiology:

  • They were unexpected.
  • They demanded a response.
  • The investigators had to go out into the field to solve the problem.

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