暴露.pptVIP

* This is an outbreak of a disease Shigellosis, with a short incubation period – the secondary HUS cases are scattered over a 2-month period. There are more cases in Bashash but you ma tell the class that the main outbreak of 800 + diarrhea/dysentery cases also centered in this community. The age and sex distribution is not remarkable for HUS except for the fact that 5year old predominate (rates would not be more revealing in such a small group). No student will notice the fact that no case was admitted with HUS. They all developed HUS after hospitalization. Don’t give the class the answer now. See if one of them will suggest to sort and rearrange the line listing. If nobody says this then ask them if they want to rearrange the line listing and go to the next slide to see the line listing rearranged. * Sorting by onset and rearranging the columns to compare onset of dysentery, onset of HUS and date of hospitalization helps identify a key pattern in time. Can anybody see it? (in the past one trainee from the 6th cohort [Shi Ying] and Lu Mei noted the pattern). Onset of HUS always follows hospitalization – i.e. no HUS developed unless the patient was first hospitalized. How could the doctors anticipate that a patient would develop HUS? Additional questioning and review of admission notes revealed that the doctors did not anticipate development of HUS in these patients. Indeed it was the first time that most of them had ever seen a patient with HUS. Moreover several of these patients had been admitted for social rather than medical reasons. * A refinement of the table sorted by days from hospitalization to onset of HUS reveals a consistent 2-5 day delay between hospital admission and HUS. As an additional point one can compute the variance and the variance/mean or SD and CV for each of the 3 delays. Note that the more narrow delay (smallest variance or variance/mean ratio) is usually more directly associated with the cause. The variance is sma