Disease Detectives B - Disease Detectives Dick Smith Invitational Test - Dick Smith Memorial - 12-11-2021

Welcome to the Disease Detectives Test!

Feel free to ask any questions via the chat window.

Remember:

Point values are written next to each question

You will not be penalized for incorrect answers, so try to answer all questions to the best of your ability. If you mess up the format, it will be marked wrong. However, directions are speci
enough that following them will ensure this doesn't happen.

There are three sections (part 1-3) each which consists of matching, multiple-choice, written responses, and calculations.

Calculator usage is allowed, in fact, it is necessary unless you are a math wiz.

Round all answers to 2 decimal places (if you know significant figures, go for it!)

Tiebreakers are decided from the bottom up, counting who gained the most points on the last question. If equal, it moves to the second-to-last, and so on until the tie is broken.

1. (1.00 pts)
In epidemiology, the interaction of three elements is assessed before developing control measures. This is often called the epidemiologic triad. What is the name of the missing
element in the diagram? (1 point)

(Mark ALL correct answers)

A) Microorganism

B) Reservoir

C) Environment

D) Surveillance

2. (1.00 pts) Which of the following determines what type of surveillance is used?(1 point)

(Mark ALL correct answers)

A) The type of information that is collected.

B) The type of diseases that are collected.

C) How the information is analyzed.

D) How the information is collected

3. (1.00 pts) What is the figure below most commonly called in epidemiology? (1 point)
(Mark ALL correct answers)
A) Outbreak curve

B) Epidemic curve

C) Bar Graph

D) Chloropleth

4. (1.00 pts) Using the figure above, what type of outbreak is represented?(1 point)

(Mark ALL correct answers)

A) Continuous common source outbreak

B) Intermittent common source outbreak

C) Propagated Outbreak

D) Point-Source Outbreak

5. (2.00 pts) From the distribution of cases on the map, which of the following most likely influences the number of cases in a given area (2 points):

(Mark ALL correct answers)

A) Population Density

B) Latitude
 C) Average Temperature

D) Sex

6. (2.00 pts) Using the figure above which age group of adults in Guam had the greatest percent increase in obesity from 2011 to 2014? (2 points)

(Mark ALL correct answers)

A) 18-24

B) 35-44

C) 55-64

D) 65+

7. (2.00 pts)
In 2013, 76.5% of high school students and 48.7% of adults from Guam reported not meeting aerobic physical activity guidelines. Research indicates that regular physical activity
helps improve your overall health and fitness, and reduces your risk for many chronic diseases. In fact, the more physically active you are, the lower your risk for many chronic
diseases becomes. What is this type of relationship called (2 points)?

A) Dose-response relationship

B) Inverse dose-response relationship

C) Association

D) Causation.

8. (1.00 pts)
A common problem with self-reported data is bias. A common type of bias found in obesity and physical activity data is social desirability. Which type of bias is also common in self-
reported data? (1 point)

(Mark ALL correct answers)

A) Selection bias

B) Information bias

C) Response bias

D) Recall bias

9. (1.00 pts) What type of bias may be introduced when selecting patients for a study? (1 point)

(Mark ALL correct answers)

A) Congruence bias

B) Confirmation bias

C) Reporting bias

D) Attrition bias

E) Recall bias

10. (10.00 pts) COVID-19 has been sweeping the world throughout the last two years. Answer the following questions about it in the text box below (2 points each).

a) Which nation has had the most overall cases?

 b) What is the name of the virus that causes COVID-19?

c) The vaccine for COVID-19 uses what type of molecule?

d) Give three symptoms of COVID-19

e) Where was the first case of COVID-19 reported?

Expected Answer: a) the United States b) SARS-CoV-2 c) mRNA d) Fevers, chills, cough, short breath, fatigue, muscle aches, headaches, loss of taste, loss of smell, sore throat,
congestion, nausea, diarrhea, vomiting, runny nose, pulmonary failure. e) Wuhan, China

11. (1.00 pts) Bioterrorism is a serious threat to national security. What is generally regarded as the most deadly form of bioterrorist activity? (1 point)

(Mark ALL correct answers)

A) Through the food supply

B) Through the water supply

C) Through nosocomial contact

D) Through vector transmission

E) Through human contact

12. (3.00 pts) Place either cohort or case-control in the appropriate space below (1 point per blank, 3 total)

(a) Which uses Relative Risk as a statistical measure?

(b) Which uses Attack Rate as a measure?

(c) Which uses Odds Ratio as a measure?

Cohort Cohort Case-Control

13. (1.00 pts) Why should an investigator who has no clinical background nonetheless talk to a patient or two as an early step in the outbreak investigation? (1 point)

A) To advise the patient about common risk factors and the usual course of the illness, after reviewing such information in appropriate reference material.

B) To develop hypotheses about the cause of the outbreak

C) To learn more about the clinical manifestations of the disease

D) To verify the clinical findings as part of verifying the diagnosis

14. (2.00 pts) Define the difference between morbidity and mortality. (2 points)

Expected Answer: Morbidity refers to the prevalence or incidence of a disease, while mortality refers to the rate of death attributed to a certain condition or population.
15. (12.00 pts) What are the 6 steps for the chain of infection? Give an example for each step. (12 points)

Expected Answer: 1. agent 2. reservoir 3. portal of exit 4. means of transmission 5. portal of entry 6. susceptible host Examples may vary

16. (3.00 pts)

Please fill the term with the appropriate definition (8 points, 1 per blank)

Terms: Incidence Rate (IR), Prevalence Rate (PR), Mortality Rate (MR), Duration of the disease, Case Fatality Rate (CFR), Rate Difference (RD), Odds Ratio (OR), Rate Ratio (RR)

NOTE: It is recommended to copy-paste WITH THE ABBREVIATION in order to prevent typing errors.

_is an estimation of the proportion of a population that dies during a specific time period.

_is the proportion of a population that has a specific disease at a specific point in time.

_is the proportion of a population that will get a specific disease over a period of time. This is also referred to as the attack rate.

Mortality Rate (MR) Prevalence Rate (PR) Incidence Rate (IR)

17. (3.00 pts)

_is the average length of a disease and is calculated by dividing a disease’s prevalence by its incidence.

_is the risk among all persons who acquire a disease that they will subsequently die from. It is an indication of the severity of the disease.

_is the ratio of incidence rates between a group exposed to a disease-causing agent and a non-exposed group. It is used to measure the magnitude of the exposure's impact.

Duration of the disease Case Fatality Rate (CFR) Rate Ratio (RR)

18. (2.00 pts)

_is the ratio or odds of getting a disease between a group exposed to a disease-causing agent and a non-exposed group. It is used to measure the magnitude of association between
exposure to an agent and a disease outcome.

_is the difference of incidence rates between the exposed group and the non-exposed group. It is an indication of the proportional decrease in the incidence of a disease if the entire
population were no longer exposed to the suspected etiological agent.

Odds Ratio (OR) Rate Difference (RD)

19. (7.00 pts)

NOTE: Due to varied answers, the following fill-in-the-blanks are the short answer in format. They will be lettered. Please put the letter and your response in the text box below. 1
point each.

A disease that is transmitted indirectly by a live carrier, usually an arthropod, such as mosquitoes, fleas, and ticks is said to be ___a___

The study of disease is normally broken down into two distinct types. One deals with the“Who, what, when, and where” questions. What is this called? ___b___
The other deals with the “Why and how” questions. What is this called? ___c___

What is the term for the time from first contact with an infectious agent until the symptoms appear in the host? ___d___

What is the term when a living agent causes any observed effect in a host? ___e___

What is the term for the ability of the infected host to interact with the agent so that the agent is transmitted to another host and causes infection? ___f___

What is the term from the first contact with the nonliving agent until infection occurs? ___g___

Expected Answer: a) Vectors/Vector-borne diseases b) Descriptive Epidemiology c) Analytical Epidemiology d) Incubation Period e) Infection f) Infectiousness/Communicability g)
Latent Period

20. (2.00 pts) What is the difference between an epidemic and an endemic? (2 points)

Expected Answer: Epidemic-occurrence of more cases on a wide geographic scale; Endemic – the general rate of a disease

21. (2.00 pts) What are the advantages(s) of a spot map? (2 points)

Expected Answer: Allows easy assessment of where cases are occurring, especially identifying clusters.

22. (2.00 pts) What are the disadvantages (s) of a spot map? (2 points)

Expected Answer: Does not account for the size of the population at risk cannot show the risk of the event occurring at that particular space. Heavy clustering of events may simply
mean there is a higher density of susceptible people

23. (2.00 pts) How can the diagram be modified to account for the disadvantage(s) suggested in the previous question? (2 points)

Expected Answer: dots could be modified to indicate a case per 10,000 population (though it will no longer be a spot map) color the states based on population density and keep the
dots indicate whether any states had no data collected. Indicate where population is susceptible (not for lyme disease, but it is possible that susceptibility could vary by state for a
disease where vaccination is mandated by certain states but not others)
24. (2.00 pts)
Suppose an individual in New Mexico has the same risk of acquiring Lyme Disease as an individual in Pennsylvania. Please provide TWO (2) possible explanations for these findings
(2 points)

Expected Answer: No data from New Mexico Lyme Disease not being reported in New Mexico Disease diagnosed at a much lower rate

25. (3.00 pts)

For the following scenarios, write the type of surveillance most appropriate for the situation. Write ONLY the type, not the word surveillance (active NOT active surveillance). Worth 3
points.

a. 9/11

b. E. coli outbreak

c. HIV in New York City over 10 years

Syndromic Active Passive

26. (3.00 pts) Give three reasons that a cluster of diseases can appear as an outbreak (3 points)

Expected Answer: Batch reporting, Laboratory error, Actually an outbreak, accept all reasonable answers.

27. (3.00 pts)

Matching time! Write the letter (ONLY THE LETTER, or else it will be marked wrong). Word bank is below, along with the associated letter. The entire matching section is 24 points,
with 1 point per blank.

A: Agent

B: Sentinel Surveillance

C: Passive Surveillance

D: Observational Study

E: Experimental Study

F: Cohort Study

G: Case-Control Study

H: Analytic Study

I: Reservoir

J: Pandemic

K: Point-Source Outbreak

L: Outbreak
M: Odds Ratio

N: Infant Mortality Rate

O: Crude Mortality Rate

P: Incubation Period

Q: Incidence

R: Fomite

S: Descriptive Epidemiology

T: Analytic Epidemiology

U: Infectivity

V: Quarantine

W: Virulence

X: Pathogenicity

1 . A study where the researcher intervenes to change something (e.g., gives some patients a drug) and then observes what happens.

2. A sudden increase in occurrences of a disease in a particular time and place.

3. Selected reporting units, with a high probability of seeing cases of the disease in question, good laboratory facilities, and experienced well-qualified staff, identify and notify on
certain diseases.

E L B

28. (3.00 pts) 4. A measure of association between an exposure and an outcome.

5. The number of deaths of infants under one-year-old per 1,000 live births.

6. A factor that is essential for a disease, chronic condition, or injury to occur. Examples include microorganisms, chemical substances, and forms of radiation.

M N A

29. (3.00 pts) 7. A study that compares exposures of people who have a disease or condition with people who do not have the disease or condition.

8. The mortality rate from all causes of death for a population during a specified time period.

9. Gathers disease data from all potential reporting health care workers without prompting

G O C

30. (3.00 pts) 10. The period between exposure and onset of clinical symptoms.

11. An epidemic of infectious disease that has spread through human populations across a large region.

12. The number of new cases of the disease in a defined population over a specific time period.

P J Q

31. (3.00 pts)

13. The study of the amount and distribution of a disease in a specified population by person, place, and time.

14. A study where the researcher observes and systematically collects information, but does not try to change the people.
15. Any nonliving object or substance capable of carrying infectious organisms, such as germs or parasites, and hence transferring them from one individual to another

S D R

32. (3.00 pts) 16. The study of epidemiology is concerned with the search for causes and effects, or the why and the how.

17. A study that evaluates the association between exposure to hazardous substances and disease by testing scientific hypotheses.

18. capacity to cause infection in susceptible hosts.

T H U

33. (3.00 pts)

19. the separation of well persons who have been exposed or are suspected to have been exposed to a communicable disease, to monitor for illness, and to prevent the potential
transmission of infection to susceptible persons during the incubation period.

20. The habitat in which an infectious agent normally lives, grows, and multiplies.

21. the ability of infectious agents to cause severe disease.

V I W

34. (3.00 pts)

22. An outbreak in which persons are exposed to the same source over a brief time, such as through a single meal or at an event. The number of cases rises rapidly to a peak and
falls gradually.

23. A study that samples a group of people who share a defining characteristic, typically who experienced a common event in a selected period.

24. A study that samples a group of people who share a defining characteristic, typically who experienced a common event in a selected period.

K F X

Case Study: 01092022

Mark’s Authentic Italian

NOTE: This case study is fictional, looked into by Mr. Micheal Mayweather. Any resemblance to real people is a coincidence.

As the holidays wrap up in Philadelphia, Mr. Mayweather, head of the PA Department of Health (PA DOH), hoped that there were no notable outbreaks within the state this year and
that the transition after the new year would be smooth and uneventful. Unfortunately for him, this was not the case, for quite the nasty outbreak was starting in the Lehigh County of
PA. From 1/2/22-1/9/22 (NOTE: outbreak did NOT end on 1/9/22, but this is the date that PADOH was notified and began preparations for the outbreak.), more than 95 probable and
confirmed cases of Salmonella have been reported within Lehigh County (average is 2 a week), mainly among primary residents of the area. Symptoms include diarrhea, chills, fever
nausea, and abdominal cramps. As head of PA DOH, Mayweather has been tasked with getting to the bottom of this sudden spike of disease.

35. (3.00 pts) Give 3 reasons why epidemiologists would want to look into this situation (3 points).

Expected Answer: Test surveillance, prevent/control outbreak, public pressures, training, learning
36. (4.00 pts) What are some professionals that Mayweather would want to bring with him to Lehigh? Give two and an explanation for each. (4 points)

Expected Answer: Accept logical answers and explanations. Be generous, but realistic. Examples may include laboratory officials, food-borne disease specialists, staffers from
Lehigh County, etc.

37. (4.00 pts) Write a case definition for this outbreak. (4 points)

Expected Answer: Must follow Person, Place, Time, Person. The person is those of Lehigh, Place is Lehigh, time and symptoms are in the text block.

38. (3.00 pts) Is there enough information to classify this cluster as an outbreak? Why or why not? (3 points)

Expected Answer: Yes, there is enough information to verify it is an outbreak because of the large spike in disease over a short period of time above baseline, satisfying outbreak
criteria. (1 point yes, 2 points explanation)

39. (3.00 pts) What are three questions you would like to ask the residents of Lehigh? (3 points)

Expected Answer: Any logical answer gets point. 1 per question.

40. (2.00 pts) Based on the symptoms, what mode of spread is likely utilized? (2 points)

Expected Answer: Food-borne

After preparations were made, Mayweather flew down to Whitehall, PA, located in Lehigh County, to meet up with Mrs. Mason, head of the Lehigh Department of Health. Together,
they gathered information from the cases in order to determine the descriptive characteristics of the outbreaks. The following table was drawn from this data:

Based on the data above and assuming that the data is representative of the entire case sample, calculate the following (Show your work!) (6 points, 2 per part)

41. (2.00 pts) Male-Specific Attack Rate

Expected Answer: 8/16=50%

42. (2.00 pts) Incidence on 1/2/22

Expected Answer: 3/16=18.75%

43. (2.00 pts) Juvenile (up to but excluding 18) Attack Rate

Expected Answer: 4/16=25%

44. (1.00 pts) Based on the data above and assuming that the data is representative of the entire case sample, what was the peak of the outbreak? (1 point)

Expected Answer: 1/3/22

45. (4.00 pts)
The incubation period for this disease is approximately 24-48 hours, with the average falling around 36 hours. Using this data and the table, give the approximate period of exposure
(4 points).

Expected Answer: 1/1/22-1/7/22 (2 per date)

46. (1.00 pts) What type of map is displayed above? (1 point)

Expected Answer: Spot Map

47. (2.00 pts) Based on the map above, what region(s) are likely centers for the outbreak to occur? (2 points)

Expected Answer: Lower Milford, Allentown, Catasauqua, Washington (.5 per)

48. (3.00 pts) 11. Is this situation an epidemic? Why or why not? (3 points)

Expected Answer: Yes, due to the wide geographic distribution and the sudden spike in cases (1 point Yes, 2 points per part of reasoning)
 After conducting descriptive epidemiology, Mayweather noted that the cases were not clustered around a single area, but rather multiple distinct regions. Additionally, variance via
age and gender is limited. As he sat at his desk, pondering what could explain this, one of Mayweather’s colleagues, Mr. Remy, enters your office.

Remy: “Mayweather, there seems to be nothing connecting the cases biologically or physically other than the disease. However, the majority of cases reported eating at a place
called Marc’s Authentic Italian around the holidays due to their New Year’s Promotion.”

Mayweather conducted some research into this Italian place, and noted that they have locations matching with the clusters of case’s location, and held the promotion from 1/1/22-
1/8/22.

49. (3.00 pts) Based on this revelation, name three items/locations that might warrant testing via your crew? (3 points)

Expected Answer: Accept all reasonable answers as pertaining to a restaurant.

50. (2.00 pts) What are two potential reasons that you would want to immediately shut down the restaurants? (2 points)

Expected Answer: Prevent further spread, reprimands, figure out the true source. Accept all logical answers.

51. (2.00 pts) What are two potential reasons that you would NOT want to immediately shut down the restaurants? (2 points)

Expected Answer: Loss of jobs, may not be from restaurant practices but other sources. Accept all reasonable.

After interviewing the 95 cases and an appropriate control group, he gathered and organized the data about exposure status to the restaurant chain. 83 of the 95 cases and 34 of the
95 controls ate at least one of Marc’s Authentic Italian restaurants.

52. (1.00 pts) What type of study is being conducted? (1 point)

Expected Answer: Case-Control Study

53. (2.00 pts) Calculate that attack rate, and show your work (2 points)
Expected Answer: 83/117=70.94%

54. (10.00 pts)

Calculate the appropriate measure of association for the outbreak. To receive credit, type out the measure’s name, the formula for the said measure, the formula with the correct
numbers substituted in, and the final answer. Lastly, interpret your results in the context of the outbreak, and clearly state if the restaurant chain is a likely source for the outbreak. (10
points)

Expected Answer: The measure should be OR. a=83, b=34, c=12, d=61. AD/BC= (83)(61)/(34)(12)=12.41. A person who was exposed to Marc's Authentic Italian restaurants was
12.41 times more likely to get ill (be generous with wording here). 1 point using OR, 4 points per letter, 1 point formula, 1 point substitution (can get letter points here too), 1 point fina
answer, 2 points explanation.

After concluding that the restaurants are indeed a potential source of the outbreak, he starts to form potential hypotheses. To do so, Mayweather met with the owner himself, Mr. Marc
Verazzano. Thankfully, Mr. Verazzano was very cooperative in the outbreak, though was upfront that he would not be closing the restaurants, as it would ruin his livelihood.

Mr. Verrazano informed Mayweather about the details of the promotion. The promotion allows customers to purchase off of a specialty menu, with each meal intending to be a great
discount from normal prices. Additionally, Mr. Verrazano stated that the restaurant received an extreme jump in traffic during the promotion due to the number of families celebrating
the holidays without COVID restrictions.

55. (3.00 pts)

Based on the above information, what are three control measures you can take that would help control/prevent the spread of the disease and not be in conflict with Mr. Verrazano’s
wishes? (3 points)

Expected Answer: Accept all reasonable OTHER than having the restaurant shut down. Writing this after the fact to clarify: Food-borne illnesses are NOT spreading direct person-to
person, so all measures regarding direct person-to-person spread are rejected.

With this in mind and with Mr. Verrazano's help, Mayweather was able to produce the table below. Note that the control size has been increased to 87 to balance the two groups.

56. (8.00 pts)

Calculate the appropriate measure of association for each food. Show your work for the Cheese Pizza and ONLY the Cheese Pizza (other work will not be scored, so placing it as
safety will not help. Make sure you show the formula and substituted numbers to receive full points). (8 points)

Expected Answer: The measure should be OR. a=74, b=81, c=9, d=6. AD/BC= (74)(6)/(81)(9)= 0.61 Cheese Pizza= 0.61 Meat Lasagna=4.86 Fiorentina Steak= 0.23 Risotto= 0.67
Carbonara= 4.79 Tiramisu= 0.74 1 point using OR, 1 point per work other 5 work, 1 point for cheese pizza work, 1 point for cheese pizza answer.
57. (2.00 pts) Draw conclusions about the food most likely for the outbreak from your calculations in number 18. (2 points)

Expected Answer: Accept answers as long as Meat Lasagna and Carbonara are implied as sources. 1 point per food.

58. (4.00 pts) Name two sources of error that may have been involved in the collection of data for the table above, and explain how each of them fits into the scenario. (4 points)

Expected Answer: Accept all reasonable. Examples include interviewer bias, recall bias, confounding bias, etc.

As Mayweather made his conclusions, Remy reported that the restaurant used Citterio Salami Sticks in some of the meals on the menu. This alarmed him, as there was a recall for
the food products back in November for Salmonella. There, epidemiologists took the necessary steps to help limit the spread and prevent future spread. Mr. Verrazano stated that he
has not heard of the recall. Testing confirmed that the disease is indeed Salmonella. All salami sticks have been disposed of from the store, yet interestingly enough the sticks were
produced last week (12/28/21), and had their best by date far past what the recall recommended.

59. (2.00 pts) What are the four food-related preventative measures that Verrazano’s restaurants could have taken to prevent Salmonella infection? (2 points)

Expected Answer: Cook, chill, clean, seperate. Can be reworded, but the general idea must be the same. .5 for each.

60. (3.00 pts) What are three control and prevention measures that the public can benefit from in regards to the outbreak (3 points)?

Expected Answer: Accept within reason. 1 per.

61. (2.00 pts) Should Marc’s Authentic Italian Restaurants shut down in order to prevent spread? Why or why not (2 points)?

Expected Answer: No, BUT accept yes if logic applies well (I'm not sure how they would do so, but always keep an open mind). For the expected no, it should be because of the fac
that the salami sticks themselves are at fault, not the resturant.
62. (2.00 pts) Should quarantines/isolations be implemented? Why or why not? (2 points)

Expected Answer: No, as food-borne illnesses like Salmonella do not typically spread person-to-person, making these measures useless.

63. (2.00 pts) Does the factory that produced the salami sticks warrant investigation? Why or why not? (2 points)

Expected Answer: Yes, as there still seems to be an issue with the factories. Due to the further out expiration date, it is unlikely that it was an old product; therefore, the factory
warrants investigation.

At last, this situation has come to an end. Maybe Mayweather could finally take that vacation to the Bahamas he’s been saving up for….

64. (2.00 pts) Not all cases were clustered around the restaurant locations. Provide three alternate explanations that could explain why there were geographic outliers. (3 points)

Expected Answer: Accept all reasonable answers. Samples include that cases may have used the sticks personally, that they drove a distance to the restaurant, or they are
unrelated cases.

65. (18.00 pts)

Look back on the entire case study. Use all the data that you have collected and prior knowledge to complete the table above. If there is no proof, then say no evidence for the
explanation. (18 points)

Expected Answer: Strength Association- Yes, ORs Consistency- No Specificity- No Temporality- Yes, salami sticks were eaten before salmonella Biological Gradient- No Biological
Plausibility- Yes, makes biological sense Experimental Evidence- No Analogy- No Coherence- Yes, makes sense with current sciences
 Congratulations on completing the 2021-2022 Disease Detectives Test! Good luck with your other events.

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