From known to the unknown: investigating an unusual outbreak of viral exanthema in a secondary school in Abeokuta, Nigeria, 2015.

Investigating an outbreak of disease requires mastery of a set of skills and collaboration among different cadres of health workers. Although you want to focus on a specific disease, you need to keep your mind open to possibilities. This case study is based on investigation of an outbreak of rashes suspected to be measles but which proved to be otherwise. It reinforces the knowledge of the steps in outbreak investigation which should have been covered in classroom lecture or background reading. This case study is best suited for basic level of training in field epidemiology and can be completed within 2-3 hours.

Meningitis outbreak investigation in Nkoranza South Municipality in Brong Ahafo Region, Ghana, February, 2016.

The occurrence of communicable diseases highlights the need to have well-trained field epidemiologists at the forefront in the fight against these diseases, especially during an outbreak. Training for outbreak investigation is most effective when participants can develop their competencies in a practical exercise. This is a simulation of the steps in meningitis outbreak investigation conducted in Ghana in February 2016 by Ghana Field Epidemiology Training Programme (FELTP) residents and the public health technical team of the Nkoranza South Municipality as a field epidemiologist. This case study is suited to reinforce principles and skills already covered in a lecture or in background reading by providing a practical training beyond the scope of theoretical learning. It is primarily intended for training novice public health practitioners who should be able to complete the exercises in 3 hours.

Outbreak investigation of measles in Kaduna State, Northwestern Nigeria, 2015.

Sub-Saharan Africa reports repeated outbreaks of measles, a vaccine preventable disease, which is notifiable under the Integrated Disease Surveillance and Response strategy in Nigeria. Nigeria has reported several outbreaks of measles in the last three years. Poor immunization coverage and weak health systems have been related with measles. This case study is based on real events that occurred during the 2015 outbreak of measles in Kaduna state Northwestern Nigeria. This case study was based upon real events that occurred in community X in Igabi LGA of Kaduna state. However, some of the results were edited to allow the case study to be completed in a facilitated classroom session. Knowledge and practice of investigating outbreaks is a key public health function of public health workers. The purpose of this case study is to simulate outbreak investigation for teaching of postgraduate public health practitioners. The participants should have received lectures or other training on outbreak investigation without the practical experience of investigating an outbreak but are being prepared to investigate outbreaks in the field. This case study should be taken in a classroom setting and should take two hours to complete.

Investigating a cholera outbreak in Kaiso Fishing Village, Hoima District, Uganda, October 2015.

Globally, even though improvements have been made to effective surveillance and response, communicable diseases such as cholera remain high priorities for national health programs, especially in Africa. High-quality surveillance information coupled with adequate laboratory facilities are effective in curbing outbreaks from such diseases, ultimately reducing morbidity and mortality. One way of building this capacity is through simulation of response to such health events. This case study based on a cholera outbreak investigated by FETP trainees in October 2015 in Uganda can be used to reinforce skills of frontline FETP trainees and other novice public health practitioners through a practical simulation approach. This activity should be completed in 2.5 hours.

Outbreak of pertussis at community A in Dormaa Municipality, Ghana, August 2016.

Pertussis is a vaccine preventable disease (VPD) monitored by the World Health Organization (WHO). Despite a long-established Pertussis immunization system, the re-emergence of the disease in some countries stressed the need to have well-trained field epidemiologists at the forefront in the fight against these VPDs, especially during an outbreak. Practical, hands-on training is useful for clearer understanding of the principles and development of competencies relevant to outbreak investigation, which will enhance field practice; case method training using realistic public health scenarios helps trainees put into practice learned theory. As such, this case study was adopted from a real Pertussis outbreak investigation that was conducted by Ghana's Field Epidemiology Training Program residents, together with the rapid response team members of Dormaa Municipal health directorate in August 2016. It was primarily designed for training novice public health practitioners in a facilitated classroom setting. Participants should be able to complete the exercises in approximately 3 hours.

Unexplained haemorrhagic fever in Rural Ethiopia.

This case study was written based on events of an outbreak investigation of an unfamiliar disease in Ethiopia during October-December 2012. Ethiopia did not have reports of similar cases in the 50 years prior to this outbreak. In this case study, we recapitulate and analyse this outbreak investigation based on data gathered from the community, health facility, and laboratory systems. It can be used to teach: 1) the outbreak investigation process; 2) selection of appropriate epidemiological design for the investigation process, 3) basic statistical analysis of surveillance data, and 4) principals of disease control. The target audiences for this case study are officials working in public health and public health trainees. It will take at most 3.5 hours to complete this case study. At the end of the case study, participants should be able to apply the principals of outbreak investigation and use surveillance data to respond to an outbreak in their country-specific context.

An epidemic of spastic paraparesis of unknown aetiology in Northern Mozambique.

This case study is based on a real-life outbreak investigation undertaken in Mozambique in 1981. This case study describes and promotes one particular approach to unknown disease outbreak investigation. Investigational procedures, however, may vary depending on location and outbreak. It is anticipated that the epidemiologist investigating an unknown disease outbreak will work within the framework of a "multidisciplinary investigation team". It is through the collaborative efforts of this team, with each member playing a critical role, that outbreak investigations are successfully completed. Some aspects of the original outbreak and investigation have, however, been altered to assist in meeting the desired teaching objectives and to allow completion of the case study in less than 3 hours.

Response to an unusual outbreak in a high-risk situation.

In 2010, a series of lead poisoning outbreaks linked to artisanal gold processing killed at least 400 young children in Zamfara State in northwestern Nigeria. There were several efforts to respond to the outbreaks as they occurred. Subsequent recurrence of lead poisoning outbreaks within Zamfara and beyond suggested that there were no efforts to mitigate the outbreaks as recommended for disaster management. This case study, to be completed within 3 hours, is suitable for senior level public health officials and those training for such positions. It enables participants to review and apply epidemiological principles for managing disasters and suggest steps toward development of policy recommendations based on the context of environmental lead exposure. It will serve as a generic training module for managers/responders of other natural (floods, heat stroke) and man-made disasters (civil strife, conflict, insurgency) based on the general/standard principle of the complete disaster management cycle.

Detecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.

An essential component of a public health surveillance system is its ability to detect priority diseases which fall within the mandate of public health officials at all levels. Early detection, reporting and response to public health events help to reduce the burden of mortality and morbidity on communities. Analysis of reliable surveillance data provides relevant information which can enable implementation of timely and appropriate public health interventions. To ensure that a resilient system is in place, the World Health Organization (WHO) has provided guidelines for detection, reporting and response to public health events in the Integrated Disease Surveillance and Response (IDSR) strategy. This case study provides training on detection, reporting and analysis of priority diseases for routine public health surveillance in Liberia and highlights potential errors and challenges which can hinder effective surveillance. Table-top exercises and group discussion lead participants through a simulated verification and analyses of summary case reports in the role of the District Surveillance Officer. This case study is intended for public health training in a classroom setting and can be accomplished within 2 hours 30 minutes. The target audience include residents in Frontline Epidemiology Training Programs (FETP-Frontline), Field Epidemiology and Laboratory Training Programs (FELTPs), and others who are interested in this topic.

Antiretroviral therapy outcomes among HIV infected clients in Gweru City, Zimbabwe 2006 - 2011: a cohort analysis.

The government of Zimbabwe began providing antiretroviral therapy (ART) to People Living with HIV/AIDS (PLHIV) in public institutions in 2004. In Midlands province two clinics constituted the most active HIV care service points, with patients being followed up through a comprehensive patient monitoring and tracking system which captured specific patient variables and outcomes over time. The data from 2006 to 2011 were subjected to analysis to answer specific research questions and this case study is based on that analysis. The goal of this case study is to build participants' capacity to undertake secondary data analysis and interpretation using a dataset for HIV antiretroviral therapy in Zimbabwe and to draw conclusions which inform recommendations. Case studies in applied epidemiology allow students to practice applying epidemiologic skills in the classroom to address real-world public health problems. Case studies as a vital component of an applied epidemiology curriculum are instrumental in reinforcing principles and skills covered in lectures or in background reading. The target audience includes Field Epidemiology and Laboratory Training Programs (FELTPs), university students, district health executives, and health information officers.

Investigating an outbreak of measles in Margibi County, Liberia, October 2015.

The emergence and re-emergence of infectious diseases highlights the need to have well-trained field epidemiologists who will be at the forefront in the fight against these diseases, especially during an outbreak. Training for outbreak investigation is most effective when participants can develop their competencies in a practical exercise. To that end, this case study was based on a measles outbreak investigation conducted in Liberia during October 2015 by Liberia Frontline Field Epidemiology Training Program (FETP) residents, simulating steps to perform outbreak investigation in a real-life situation as a field epidemiologist. This case study is ideally suited to reinforce principles and skills already covered in a classroom lecture or in background reading by providing a practical training beyond the scope of theoretical learning. It is primarily intended for training novice public health practitioners who should be able to complete the exercises in approximately 3 hours.

Detecting, reporting, and analysis of priority diseases for routine public health surveillance in Liberia.

Public health officials depend on timely, complete, and accurate surveillance data for decision making. The quality of data generated from surveillance is highly dependent on external and internal factors which may either impede or enhance surveillance activities. One way of identifying challenges affecting the quality of data generated is to conduct a data quality audit. This case study, based on an audit conducted by residents of the Liberia Frontline Field Epidemiology Training Program, was designed to be a classroom simulation of a data quality audit in a health facility. It is suited to enforce theoretical lectures in surveillance data quality and auditing. The target group is public health trainees, who should be able to complete this exercise in approximately 2 hours and 30 minutes.

Conducting a surveillance problem analysis on poor feedback from Reference Laboratory, Liberia, February 2016.

The laboratory plays a major role in surveillance, including confirming the start and end of an outbreak. Knowing the causative agent for an outbreak informs the development of response strategies and management plans for a public health event. However, issues and challenges may arise that limit the effectiveness or efficiency of laboratories in surveillance. This case study applies a systematic approach to analyse gaps in laboratory surveillance, thereby improving the ability to mitigate these gaps. Although this case study concentrates on factors resulting in poor feedback from the laboratory, practise of this general approach to problem analysis will confer skills required in analysing most public health issues. This case study was developed based on a report submitted by the district surveillance officer in Grand Bassa County, Liberia, as a resident of the Liberian Frontline Field Epidemiology Training Program in 2016. This case study will serve as a training tool to reinforce lectures on surveillance problem analysis using the fishbone approach. It is designed for public health training in a classroom setting and can be completed within 2 hours 30 minutes.