Writing an Outbreak Report

Dr Noorhaida UjangEpid Officer

MuarAlor Setar, 2013

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Learning Objectives

• Understand the role of outbreak investigation reports

• Recognize elements to include in outbreak investigation reports

Basic Steps of an Outbreak Investigation

1. Verify the diagnosis and confirm the outbreak2. Define a case and conduct case finding3. Tabulate and orient data: time, place, person4. Take immediate control measures5. Formulate and test hypothesis6. Plan and execute additional studies7. Implement and evaluate control measures8. Communicate findings

Why Communicate the Findings?

• Document for action• Share new insights• Record of performance• Substantiate recommendations

In order to…• Prevent future outbreaks• Assist in investigation and control of similar

incidents• Provide a document for potential legal issues

When is the Report Written?• When the investigation is ‘complete’

• When the investigation is ‘ongoing’

– “Further analysis of data collected in this investigation may require revision of these findings and recommendations.”

– “Because of the preliminary nature of this investigation, future correspondence, MMWR articles, or other published reports might present results, interpretations, and recommendations that are different.”

Who Writes the Report?• The field epidemiology / outbreak team

– Visiting EIS officer

• Other authors as assigned

All participating agencies must agree with what is in the report.

Structure of Report

• Summary• Background• Methods• Results• Discussion• Recommendations

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Linking Sections• Start with the end• Recommendations are based upon conclusions• Conclusions are based upon data and limitations

of data• Data collected is based up methods used• Method used is based on study objectives• Objectives are linked to the problem and be

linked to the conclusions and recommendations

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Order of Writing

1. Background2. Methods3. Results4. Conclusions5. Discussion6. Summary7. Title

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Summary• Newspaper article – who, what, when, where• One page• 1st parargraph

– 1st sentence is general problem statement– 2nd sentence is specific problem.– Following sentences describe problem – outbreak potential– End with objectives

• 2nd paragraph methods• 3rd paragraph results• 4th paragraph recommendations• 5th paragraph actions taken

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Background

• Describe disease – sources, transmission, outbreak potential

• Describe population and place of outbreak• Historic surveillance information• Previous outbreaks• Describe facility• Maps

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Outbreak Description

• How was reported• Steps to confirm• What was known to date• Why was an investigation undertaken• Objectives• Who was on the team• Describe initial reported cases

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Methods• Epidemiology

– Case definition– Case finding– Study design– Describe target and study groups– Sample size– Data collection– Plan of analysis

• Laboratory– Sample collection– tests

• Environmental studies– Site visits

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Results

• Include findings that lead to the conclusions. Rule in and rule out

• Response rate• Number of cases identified• Overall attack rate• Descriptive epidemiology• Hypothesis generated• Analytical results

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Table 1: Characteristics of people injured or killed by a landmine or ordnance explosion: May 1996-June 1998, Kabul City,

Afghanistan

Characteristic Landmine Ordnance Total (278) (293) (571)

SexFemale 36 36 72 (13%)Male 241 253 494 (86%)Unknown 1 4 5 (1%)Mean age in years (SD)* 24·3 (15·7) 14·6 (11·9) 19.3 (14.7)Mean educational level (SD)* 4·0(4·8) 2·1 (2·5) 2.7 (3·5)Primary occupation Daily worker* 41 17 58 Farmer 8 2 10 Housewife 11 6 17 Shepherd 12 16 28 Student* 30 77 107 Teacher 7 0 7 Unemployed 58 40 98 Other 33 31 64 Unknown 78 104 182

*(p<0·01, t test)

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Victims of landmine and ordnance explosions differed in several ways. The mean age in years at time of injury or death and years of education were lower in people injured or killed by ordnance explosions than by those injured or killed by landmine explosions. The victims’ occupation differed strikingly. The most common occupation was a daily work or unemployment for the landmine victims and overwhelmingly students for the ordnance victims (Table 1).

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Table 1: Characteristics of people injured or killed by a landmine or ordnance explosion: May 1996-June 1998, Kabul City,

Afghanistan

Discussion• 1st paragraph. Summarize key results• 2nd paragraph and beyond. Are results similar or

different to other studies?• Third to last paragraph. Limitations and how

affected investigation and interpretation of results.

• Second to last paragraph. Lessons learned• Last paragraph. Overall significance of

investigation.

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Recommendations

• What was done to control outbreak• How to prevent future outbreaks• Make realistic recommendations

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Other sections

• Acknowledgements• References• Appendix

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Frequent Problems with Writing an Outbreak Report

• Timeliness• Confidentiality• Legal

Comparison of Case Study Reports

• Both outbreak reports included the major elements:

– Introduction and Background– Outbreak Description– Methods and Results– Lessons Learned– Recommendations

• Complexity of the report depends on the type of investigation, the extent of the outbreak, and the audience of the report

Summary• Outbreak reports are the final step in

completing your investigation.

• Outbreak reports serve many purposes, both internally and externally.

• Though outbreak reports may differ in purpose and audience, reports generally follow a basic structure.