EPID 7010 – Spring 2024 – Dr.

Lambert
Homework #1

Instructions: Please submit your Homework #1 via eLC by Tuesday, January 30th at 11 am. You may
work through the homework collaboratively, but you must turn in your own assignment showing your
own work and explaining concepts in your own words or you will receive a zero. Be sure to read the
case study details (gray boxes) carefully, as they have key information needed to answer the
subsequent questions. For calculations, provide responses to the requested decimal place and make
sure to use appropriate notation and express the answer correctly (e.g., %, ## cases per ## person-
years). If needed, you may upload your calculations separately. When submitting via eLC, please use
the following naming convention: “Last Name, First Name_Homework 1.” Please only upload your
homework as a PDF. Photos (jpeg, png, etc.) of your work are not accepted.

1. Which of the following does NOT fit our definition of epidemiology?

A. Epidemiology includes the study of the determinants of health outcomes in a population.
B. Epidemiology includes the study of the determinants of health outcomes in an individual.
C. Epidemiology includes the study of the distribution of health outcomes.
D. Epidemiology is concerned with the prevention and control of disease.

2. Prevalence is defined as:

A. Rate of existing cases per year
B. Number of existing cases divided by the size of the population
C. Total number of cases over a given time interval
D. None of the above

3. Which of the following is an example of active primary prevention?

A. Mammography to detect breast cancer
B. Immunization against HPV to prevent cervical cancer
C. Taking aspirin after a heart attack to prevent a second heart attack
D. Iodine added to salt to prevent goiter

4. The epidemiologic curve below (Figure 1) is typical of a(n):

A. Mixed epidemic
B. Common source epidemic
C. Propagated epidemic
D. Endemic

Figure 1. Epidemiologic Curve

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For each of the measures shown below (Questions 5-8), indicate whether it is cumulative
incidence, incidence rate, prevalence, or none of the above.

A. Cumulative incidence
B. Incidence rate
C. Prevalence
D. None of the above

Number of women in State A newly diagnosed with heart disease in 2022

5._______
The total number of at-risk women living in State A in 2022

Number of students at High School B who reported smoking cigarettes at

6._______ least once in the past month in a recent survey

Number students enrolled at High School B at the time of the survey

Number of new cases of pneumonia among study participants

7._______
Number of person-years contributed by participants at risk

Number of female UGA students who received the flu vaccine in 2022
8._______

Number of male UGA students who received the flu vaccine in 2022

For the questions below, match the historical figure with their contribution to the field.
9. _______ John Snow A. First randomized controlled trial (RCT)
10. _______ Benjamin Jesty B. Considered the father of demography
11. _______ John Graunt C. First case-control and cohort studies
12. _______ Robert Koch D. First use of immunization
13. _______ James Lind E. Considered the founder of vaccinology
14. _______ Edward Jenner F. Considered one of the founders of bacteriology

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Case Study #1: On March 15, 2003, a Boeing 737-300 carrying 120 persons (112 passengers,
6 flight attendants, and 2 pilots) flew for three hours from Hong Kong to Beijing. One of the
passengers was a symptomatic 72-year-old man who developed fever on March 11. He was
hospitalized on arrival in Beijing, where he was given a diagnosis of atypical pneumonia and
died on March 20. This passenger had visited his brother at the Prince of Wales Hospital in
Hong Kong several times between March 4 and the brother’s death on March 9. During this
time, there were known cases of SARS on the same ward as the brother. The niece of the 72-
year-old man, who had also visited her father in the hospital was later given a diagnosis of
SARS.

Instructions: Use the provided case study information above and the diagram in Figure 2 to
answer Questions #15-17 about the attack rates among the passengers and crew on the flight
from Hong Kong to Beijing. Note that Figure 2 details the number of probable cases. Review the
legend/key carefully.

15. Calculate the overall attack rate in Case Study #1 due to exposure on the plane (hint:
carefully consider who on the plane is at risk). Report your answer to 1 decimal place.

16. Calculate the attack rate among passengers on the plane in Case Study #1 (hint:
carefully consider who on the plane is at risk). Report your answer to 1 decimal place.

17. Calculate the attack rate among crew on the plane in Case Study #1. Report your
answer to 1 decimal place.

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Case Study #2: During a 2-week summer camp attended by 100 children (40 males, 60
females), there was an outbreak of a diarrheal disease. Cases included 18 male children and 6
female children.

18. What is the total cumulative incidence (among all children) of diarrheal disease at the
summer camp? Report your answer to 1 decimal place.

Case Study #3: A cohort study assessing HPV infection was conducted among 700 women
who were 20-24 years of age at enrollment. At baseline, 155 women tested positive for HPV.
During the 2-year follow-up period, 80 new HPV infections were detected.

19. What was the baseline prevalence of HPV in this study? Report your answer to 1
decimal place.

20. Calculate the cumulative incidence of HPV, assuming all participants completed the
entire study (i.e., there is no lost-to-follow up or withdrawals). Report your answer to
1 decimal place.

21. Calculate the incidence rate (cases per person-year), assuming that at-risk
participants contributed a total of 1,200 total person years during follow-up. Report
your answer to 3 decimal places.

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Case Study #4: Questions 22-24 are based on the information from Figure 3 & Table 1.

Figure 3. Cohort Diagram

Table 1. Measurement of Person-Time at Risk in Hypothetical Cohort.

Status at End of Person-time at
Participant Time of Entry Time of Exit
Follow-up Risk
1 i
2 iii
3 iv
4 ii

22. Choose the best answer to complete the cells in Table 1 (above) based on the
information provided in Figure 3:
A. i. 0 years, ii. Year 3, iii. Endpoint of interest, iv. 2 person-years
B. i. Baseline, ii. Year 3, iii. Censored (Administrative), iv. 3 person-years
C. i. Baseline, ii. Year 2, iii. Endpoint of interest, iv. 36 person-months
D. i. Baseline, ii. Year 2, iii. Censored (Administrative), iv. 24 person-months

Case Study #4 (Cont.): Participants 1,3, and 6 (see Figure 3) are classified as exposed at
baseline by study investigators. The others are considered unexposed. Exposure status does
not change over the course of the study.

23. How much person-time is contributed by the three participants who are exposed?

24. How much person-time is contributed by the five participants who are unexposed?

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Case Study #5: A group of 20 students from UGA went on a spring break trip to Cancun.
Unfortunately, due to contamination of the local desalination plant, 10 of the students became
infected with invasive E. coli bacteria that caused severe, bloody diarrhea on the final day of
their trip. They returned home, where they infected an additional 120 of their roommates,
friends, and family members with E. coli via fecal-oral contamination.

25. Who are the secondary cases?

A. All of the students on the trip to Cancun
B. The 10 students who became infected with E.coli
C. The 120 roommates, friends, and family members that are infected with E.coli after
the group returns home
D. None of the above

Case Study #6: A study about the long-term outcomes of tobacco use includes 100 men and
200 women. Among the participants, 50 men and 50 women are smokers.

26. What is the ratio of men to women participating in the study?

27. What proportion of women in the study are smokers?

28. What is the prevalence of smoking among all participants in the study?

29. Diabetes is a chronic condition, which is broadly defined as conditions that last a
year or longer and require ongoing medical care and/or limited daily activities.
Patients diagnosed with diabetes typically live many years after a diagnosis is made.
Based on this knowledge, which of the following is true about the prevalence and
incidence rate of diabetes?
A. The prevalence and incidence rate of diabetes are likely to be similar.
B. The prevalence is much lower than the incidence rate of diabetes.
C. The prevalence is much higher than the incidence rate of diabetes.
D. It is not possible to predict whether the prevalence or incidence is higher for a chronic
disease.

30. In a cohort study assessing one type of herpes simplex (HSV-2), the main cause of
genital herpes, 650 participants between the ages of 20 and 30 years were enrolled,
and 79 participants tested positive for HSV-2 at baseline. Participants were monitored
over a two-year period for new HSV-2 infection, with 61 participants developing HSV-2
infection during this time period. What is the annual risk for HSV-2 in the study
population? Report your answer to 1 decimal place.