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Assignment Oswego Outbreak Investigation GCU Assignment Oswego Outbreak Investigation GCU Assignment Oswego Outbreak Investigation GCU NOTE: The following resource was created for class use by replicating portions of the Centers for Disease Control and Prevention’s (CDC) “Oswego – An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide” (CDC, n.d.), with the understanding that the CDC document is in the public domain and available for educational use. Background: On April 19, 1940, the village health officer in Lycoming, Oswego County, New York, notified the District Health Officer in Syracuse of an outbreak of acute gastrointestinal disease. An investigation was entrusted to Dr. A. M. Rubin, an epidemiologist-in-training. When Dr. Rubin arrived in the field, the health officer informed him that all of the people who were known to be sick had attended a church meal the night before, on April 18. Members of the family who did not attend the church supper did not get sick. As a result, Dr. Rubin narrowed his focus to the meal. He interviewed 75 of the 80 people who were known to have attended, gathering data on the occurrence and timing of symptoms, as well as the items consumed. gastrointestinal ailment was reported by 46 people out of 75 who were interviewed. Inquiry into the Oswego Outbreak Description of the disease: In all cases, the start of illness was sudden, with nausea, vomiting, diarrhea, and abdominal pain as the most common symptoms. None of the sick people had a fever, and they all got better in 24 to 30 hours. About 20% of those who were sick went to see a doctor. Inquiry into the Oswego Outbreak For bacteriologic analysis, no fecal specimens were obtained. The Supper’s Description: The meal took place in the town church’s basement. Several members of the congregation provided food items. The meal started at 6:00 p.m. and ended at 11:00 p.m. Oswego Outbreak Investigation laid food out on a table and ate it over several hours. The Excel “Oswego Line Listing Workbook” (CDC, n.d.) contains information about the beginning of illness and the food or water consumed by each of the 75 people interviewed. Only nearly half of the people who were sick with gastrointestinal problems had their approximate meal hour recorded. Conclusion: Dr. Rubin’s report contains the following passages, which are paraphrased here:   The Petrie sisters made ice cream in the following manner:   On the afternoon of April 17, raw milk from the Petrie farm in Lycoming was brought to a boil over a water bath, followed by sugar, eggs, and a pinch of flour to give the mixture body. Ice cream was made separately for the chocolate and vanilla flavors. Chocolate from Hershey’s has to be included in the mix. The two mixes were brought to the church basement in closed containers at 6 p.m. and left overnight. During this time, they were most likely unaffected by anyone. Investigating the Oswego Outbreak   Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix on April 18th, and three ounces of vanilla and one can of condensed milk to the chocolate mix on April 18th. The vanilla ice cream was then transferred to a freezing can and placed in an electrical freezer for 20 minutes before being retrieved from the freezer can and packed into another can that had previously been scrubbed with boiling water. The chocolate mix was then placed in a freezer can that had been washed with tap water and frozen for 20 minutes. Both cans were then covered and placed in huge wooden receptacles filled with ice Oswego Outbreak Investigation at the completion of the investigation. The chocolate ice cream was still in the single freezer can, as previously stated. The ice cream handlers were all investigated. There were no visible lesions or illnesses in the upper respiratory tract. Two of the people who made the ice cream had their nose and throat cultures taken. The Division of Laboratories and Research in Albany examined both ice creams for bacteriological contamination. “Large quantities of Staphylococcus aureus and albus were identified in the vanilla ice cream specimen,” their study reads. In the chocolate ice cream, there were only a few staphylococci.” “Staphylococcus aureus and hemolytic streptococci were identified from nose culture and Staphylococcus albus from throat culture of Grace Petrie,” according to the report of the nose and throat cultures of the Petries who created the ice cream. Marian Petrie’s nose culture yielded the bacteria Staphylococcus albus. The hemolytic streptococci were not of the type commonly found in infections in men, according to the Oswego Outbreak Investigation.”   Source of Bacterial Contamination in Vanilla Ice Cream: The source of the bacterial contamination in vanilla ice cream is unknown. Whatever mechanism the staphylococci were introduced by, it seems logical to conclude that happened between April 17 and April 18. There is no recognized cause for the contamination in vanilla ice cream.   CLICK HERE TO PURCHASE A PAPER WITHOUT PLAGIARISM.   The same scooper was used to distribute the ice creams. As a result, it’s not out of the question that some chocolate ice cream was contaminated in this manner. The illness in the three people who didn’t eat the vanilla ice cream appears to be the most likely explanation.   Control Measures: All remaining ice cream was condemned on May 19th. The rest of the food at the church supper was gone. Inquiry into the Oswego Outbreak   Following a church supper at Lycoming, an outbreak of gastroenteritis ensued. Contaminated vanilla ice cream was the root of the outbreak. The way ice cream is contaminated is a mystery. It’s impossible to say whether the Petrie family’s positive Staphylococcus nose and throat cultures contributed to the contamination.   Patient #52 received a bowl of vanilla ice cream at 11:00 a.m. on April 18, while watching the freezing procedure.   Addendum:   Certain laboratory techniques that were not available at the time of this inquiry could be extremely valuable in analyzing a similar epidemic now. Phage typing can be done at the CDC, and immunodiffusion or an enzyme-linked immunosorbent test (ELISA) can be used to detect staphylococcal enterotoxin in food (FDA). Inquiry into the Oswego Outbreak Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: Assignment Oswego Outbreak Investigation GCU If Grace Petrie was the source of infection, one would expect the staphylococci phage types isolated from her nose, vanilla ice cream, and vomitus or stool samples from unwell people affiliated with the church lunch to be identical. Distinctly different phage types Assignment Oswego Outbreak Investigation GCU would rule her out as the source (though differences could be due to sampling error) and point to the need for more research, such as cultures of others who may have come into contact with the ice cream during its preparation, or consideration of the possibility that contamination occurred due to the use of a mastitis-infected cow and that the only milk boiled was that used to make chocolate ice cream Oswego Ou Even if the contaminated food was sufficiently cooked to kill staphylococcal organisms but not toxin, toxin analysis (with the addition of urea) would still allow the cause of the epidemic to be identified. Nonviable staphylococci in contaminated food may also be detected using a Gram stain.   Reference   The CDC (Centers for Disease Control and Prevention) is a government-funded organization that works to prevent (n.d.). Student guide to an outbreak of gastrointestinal disease at a church lunch in Oswego (Case No. 401-303). https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf was retrieved from https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf Investigating the Oswego Outbreak Oswego Outbreak Investigation NOTE: The following resource was prepared for class use by replicating portions of the Centers for Disease Control and Prevention’s (CDC), “Oswego – An Outbreak of Gastrointestinal Illness Following a Church Supper: Student Guide” (CDC, n.d.), except for the “Questions” section, with the understanding that the CDC document is in the public domain and available for educational use. Background: On April 19, 1940, the local health officer in the village of Lycoming, Oswego County, New York, reported the occurrence of an outbreak of acute gastrointestinal illness to the District Health Officer in Syracuse. Dr. A. M. Rubin, epidemiologist-in-training, was assigned to conduct an investigation. When Dr. Rubin arrived in the field, he learned from the health officer that all persons known to be ill had attended a church supper held on the previous evening, April 18. Family members who did not attend the church supper did not become ill. Accordingly, Dr. Rubin focused the investigation on the supper. He completed interviews with 75 of the 80 persons known to have attended, collecting information about the occurrence and time of onset of symptoms, and foods consumed. Of the 75 persons interviewed, 46 persons reported gastrointestinal illness. Clinical Description: The onset of illness in all cases was acute, characterized chiefly by nausea, vomiting, diarrhea, and abdominal pain. None of the ill persons reported having an elevated temperature; all recovered within 24 to 30 hours. Approximately 20% of the ill persons visited physicians. No fecal specimens were obtained for bacteriologic examination. Description of the Supper: The supper was held in the basement of the village church. Foods were contributed by numerous members of the congregation. The supper began at 6:00 p.m. and continued until 11:00 p.m. Food was spread out on a table and consumed over a period of several hours. Data regarding onset of illness and food eaten or water drunk by each of the 75 persons interviewed [are provided in the Excel “Oswego Line Listing Workbook” (CDC, n.d.)]. The approximate time of eating supper was collected for only about half the persons who had gastrointestinal illness. Conclusion: The following is quoted verbatim from the report prepared by Dr. Rubin: The ice cream was prepared by the Petrie sisters as follows: On the afternoon of April 17 raw milk from the Petrie farm at Lycoming was brought to boil over a water bath, sugar and eggs were then added and a little flour to add body to the mix. The chocolate and vanilla ice cream were prepared separately. Hershey’s chocolate was necessarily added to the chocolate mix. At 6 p.m. the two mixes were taken in covered containers to the church basement and allowed to stand overnight. They were presumably not touched by anyone during this period. On the morning of April 18, Mr. Coe added five ounces of vanilla and two cans of condensed milk to the vanilla mix, and three ounces of vanilla and one can of condensed milk to the chocolate mix. Then the vanilla ice cream was transferred to a freezing can and placed in an electrical freezer for 20 minutes, after which the vanilla ice cream was removed from the freezer can and packed into another can which had been previously washed with boiling water. Then the chocolate mix was put into the freezer can which had been rinsed out with tap water and allowed to freeze for 20 minutes. At the conclusion of this both cans were covered and placed in large wooden receptacles which were packed with ice. As noted, the chocolate ice cream remained in the one freezer can. All handlers of the ice cream were examined. No external lesions or upper respiratory infections were noted. Nose and throat cultures were taken from two individuals who prepared the ice cream. Bacteriological examinations were made by the Division of Laboratories and Research, Albany, on both ice creams. Their report is as follows: “Large numbers of Staphylococcus aureus and albus were found in the specimen of vanilla ice cream. Only a few staphylococci were demonstrated in the chocolate ice cream.” Report of the nose and throat cultures of the Petries who prepared the ice cream read as follows: “Staphylococcus aureus and hemolytic streptococci were isolated from nose culture and Staphylococcus albus from throat culture of Grace Petrie. Staphylococcus albus was isolated from the nose culture of Marian Petrie. The hemolytic streptococci were not of the type usually associated with infections in man.” Discussion as to Source: The source of bacterial contamination of the vanilla ice cream is not clear. Whatever the method of the introduction of the staphylococci, it appears reasonable to assume it must have occurred between the evening of April 17 and the morning of April 18. No reason for contamination peculiar to the vanilla ice cream is known. In dispensing the ice creams, the same scooper was used. It is therefore not unlikely to assume that some contamination to the chocolate ice cream occurred in this way. This would appear to be the most plausible explanation for the illness in the three individuals who did not eat the vanilla ice cream. Control Measures: On May 19, all remaining ice cream was condemned. All other food at the church supper had been consumed. Conclusions: An attack of gastroenteritis occurred following a church supper at Lycoming. The cause of the outbreak was contaminated vanilla ice cream. The method of contamination of ice cream is not clearly understood. Whether the positive Staphylococcus nose and throat cultures occurring in the Petrie family had anything to do with the contamination is a matter of conjecture. Note: Patient #52 was a child who while watching the freezing procedure was given a dish of vanilla ice cream at 11:00 a.m. on April 18.     Epi Curve     Addendum: Certain laboratory techniques not available at the time of this investigation might prove very useful in the analysis of a similar epidemic today. These are phage typing, which can be done at CDC, and identification of staphylococcal enterotoxin in food by immunodiffusion or by enzyme-linked immunosorbent assay (ELISA), which is available through the Food and Drug Administration (FDA). One would expect the phage types of staphylococci isolated from Grace Petrie’s nose and the vanilla ice cream and vomitus or stool samples from ill persons associated with the church supper to be identical had she been the source of contamination. Distinctly different phage types would mitigate against her as the source (although differences might be observed as a chance phenomenon of sampling error) and suggest the need for further investigation, such as cultures of others who might have been in contact with the ice cream in preparation or consideration of the possibility that contamination occurred from using a cow with mastitis and that the only milk boiled was that used to prepare chocolate ice cream. If the contaminated food had been heated sufficiently to destroy staphylococcal organisms but not toxin, analysis for toxin (with the addition of urea) would still permit detection of the cause of the epidemic. A Gram stain might also detect the presence of nonviable staphylococci in contaminated food. Reference Centers for Disease Control and Prevention. (n.d.). Oswego – An outbreak of gastrointestinal illness following a church supper: Student guide (Case No. 401-303). https://www.cdc.gov/eis/casestudies/xoswego.401-303.student.pdf Oswego Outbreak Case Study (Example) Document Preview: Report of Disease Outbreak Outbreak in common language is defined as the occurrence of situation that was not expected affected a group of people in short period. According to the epidemiology the outbreak is defined as the sudden occurrence of disease in a specific place and time affecting either a small group of the people or even thousands of people within the whole world. Therefore our case meet the definition of the outbreak as it occurs sudden. The disease affected scooper used to dispense the vanilla ice cream was the same that was used to dispense other ice cream. According to the information of the outbreak various control measure should be put in place to prevent further spread of the disease to the people. Therefore I would recommend that all remaining food that was taken that day should dispose properly. I would also recommend that the affected people to be separated from others until they are treated from the disease. […] Order Description: Read the “Oswego Outbreak Investigation,” located in the Topic Materials. Part 1 Complete the following: Using the line listing in the Excel “Oswego Line Listing Workbook,” calculate the attack rate ratios for each food item using the table in the Excel “Oswego Attack Rate Table.” Create a separate 2×2 table for the food item you think is responsible for the outbreak and interpret the attack rate ratio for this food item. Refer to the “Creating a 2×2 Contingency Table” resource for guidance. Using the line listing in Excel “Oswego Line Listing Workbook,” construct an epidemic curve by the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission? Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the Topic Material, “Compendium of Acute Foodborne and Waterborne Diseases”). Discuss your rationale. Part 2 In a 500 word paper, evaluate the situation and present your findings. Including the following: Does this case meet the definition of an “outbreak?” Why or why not? Identify the steps required to investigate an outbreak. How did these steps help in investigating the Oswego event? Include the relevant information needed for each step to be successful. Discuss the possible routes of transmission for the expected agent. Based on this information, what control measures would you recommend? State whether they are primary, secondary, or tertiary prevention strategies. General Requirements Prepare this assignment according to the guidelines found in the APA Style Guide Oswego Outbreak Investigation Read the “Oswego Outbreak Investigation,” located in the study materials. In a 750-1,000 word paper, evaluate the situation and present your findings. Include the following: Refer to the “Oswego Outbreak Investigation.” Read the scenario and review the epidemic curve that describes the time of onset of illness. What does this curve tell you regarding the average incubation period, source, and transmission? Using the incubation range and clinical symptoms, identify potential infectious agents that could be responsible for the outbreak (refer to the study material, “Compendium of Acute Foodborne and Waterborne Diseases”). Provide an explanation for your findings. Why is this considered an outbreak? Discuss the criteria for why it is considered an outbreak. Describe the steps required to investigate an outbreak and apply each step to the Oswego event. Include the relevant information needed for each step to be successful. Discuss the possible routes of transmission for the expected agent. Based on this information, what control measures would you recommend? State a control measure for each prevention level: primary, secondary, and tertiary prevention. You are required to cite to a minimum of three sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and public health content. Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. You are required to submit this assignment to LopesWrite. 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