现场流行病学的基石—病例定义.ppt

* Now let’s get some examples of some case definitions. Here is the case definition for rabies for routine surveillance. Since all rabies cases produce obvious disease to the brain that results in death we can use a very limited clinical description of encephalitis leading to death within 10 days. The epidemiological information is the exposure to the animal bite. Now, we do need to be careful with this because some people may be bitten by small animals such as bats but not recognize the bite. Finally there is some very good laboratory tests that can be done including detection of rabies virus in the hair follicles or cornea of the living patient or from the brain of the dead patient. Antibody test are also valuable in an unvaccinated person. In this particular example we are saying that a confirmed case is clinical and epidemiological evidence plus laboratory criteria. We could make a probable case definition which could be clinical plus epidemiological. * * Now let’s try applying this case definition to the following line listing of people. The lecturer should go through this with the students. It is important to point out here that some elements of the case definition are not available because they were not done (ND) or are still in the laboratory (pending). The first case is clearly a probable case it has been confirmed. The second case is a probable case. The third person should be discarded because it fits none of the clinical, or epidemiologic criteria. The fourth person is a possible case but could become a confirmed case when the laboratory results are returned. * Another example is aseptic meningitis and encephalitis that follows mumps. In this example we are using some additional, general clinical laboratory tests on the cerebrospinal fluid to exclude a number of other causes of meningitis or encephalitis, particularly those caused by bacteria, from our case group. We are also using mumps disease during a limited time window before onset of t