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MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE

SUMY STATE UNIVERSITY

MEDICAL INSTITUTE

DEPARTMENT OF INFECTIOUS DISEASES AND EPIDEMIOLOGY





Methodical recommendations to conducting of epidemiological analysis

for doctors, interns, students of senior courses of higher medical establishments of education III-IV level of accreditation


MINISTRY OF EDUCATION AND SCIENCE OF UKRAINE

SUMY STATE UNIVERSITY

MEDICAL INSTITUTE

DEPARTMENT OF INFECTIOUS DISEASES AND EPIDEMIOLOGY


Methodical recommendations to conducting of epidemiological analysis

for doctors, interns, students of senior courses of higher medical establishments of education III-IV level of accreditation


Sumy

2009

2604 Methodical recommendations to conducting of epidemiological analysis / Compilers: M.D. Chemich, G.S. Zaytseva, N.I. Ilina, V.V. Zahlebaeva, A.I. Piddubna – Sumy: Sumy State university publishing house, 2009. – 19 p.

Department of infectious diseases and epidemiology
^

TABLE OF CONTENTS

Epidemiological analysis, determination, tasks...........

3


Retrospective epidemiological analysis...........

3

Operative epidemiological analysis...................

4

Materials are necessary for the epidemiological analysis.......

5

Materials of epidemiological analysis must contain next sections........................


6

Method of epidemiological analysis.............

7


Analysis of dynamics of infectious morbidity.........

7


^ Study of distributing of infectious diseases on territory...

10


Analysis of the seasonal distributing of morbidity............

11


Analysis of age morbidity.................

13


Analysis of morbidity in the professional-domestic groups of population...........................


14

Analysis of sources and factors of transmission of infection........

15


List of literature.......................

18




^ Epidemiological analysis – study of complex of the epidemiological, clinical, laboratory and other data in relation to the specific infectious disease with the purpose of establishment of reasons of its distribution, prognostication of epidemic situation, determination of character and scales of necessary antiepidemiological measures. Conducting the epidemiological analysis, a doctor puts before itself such tasks:

  • to expose conformities to the law and features of epidemic process of separate infectious diseases at certain terms;

  • to find out their reasons;

  • to define factors which affect motion of epidemic process;

  • to learn efficiency of the prophylactic and antiepidemiological measures conducted in a previous year (or years);

  • to work out a plan of the measures directed on the decline or elimination of separate infectious diseases, with the account of features of epidemic process of concrete disease in specific terms.

The study of these questions is needed for correct organization of measures of fight against that or other infection, choice of basic link of measures of directed on the source of infection, ways of transmission, receptive organism), implementation of which can result in the decline of infectious morbidity, and on occasion – its elimination.

Methodology of epidemiological analysis foresees comparison of data on a separate infection on separate territory with data about the second nosology on this territory or with data about the same infection on other territory.

The epidemiological analysis retrospective and operative is distinguished.


^ Retrospective epidemiological analysis – it is the analysis of level, structure and dynamics of infectious morbidity, that is conducted with the purpose of the justification of strategic planning of preventive measures and antiepidemiological measures. More frequent all such analysis is conducted on results calendar year before planning of measures on a next year. During the retrospective epidemiological analysis the such methodical receptions are used: descriptive – evaluation, analytical, experimental, mathematical design.

The chart of retrospective epidemiological analysis in relation to separate groups and nosology forms of infectious diseases contains:

  • analysis of long-term dynamics of morbidity of population;

  • analysis of annual dynamics of morbidity of population from middle long-term data in the years of increase and decline of morbidity;

  • analysis of indexes of morbidity, dynamics long-term and annual in socially – age groups of population;

  • analysis of morbidity in separate collectives;

  • additional directions of analysis, necessary for achievement of ultimate goal.


The operative epidemiological analysis is logical continuation of retrospective epidemiological analysis and represents by itself dynamic estimation of the state and tendencies of development of epidemic process for clarification of measures of prophylaxis. In the operative epidemiological analysis two directions are selected:

1) analysis of information which directly represents the state and tendencies of development of epidemic process;

  1. analysis of information which contains the mediated signs of display of epidemic process.

The first direction contains:

  • estimation and analysis of results of laboratory researches;

  • continuous supervision after morbidity and estimation of its dynamics;

  • epidemiology inspection of cells in connection with the origin of single cases of infectious diseases;

  • epidemiology inspection of cells of group diseases (outbreaks, epidemics).

The second direction foresees the dynamic estimation of implementation of the planned measures, which is conducted constantly with an accent on providing of complete their conducting on territories of risk, in groups and risk collectives and in a period of risk. The operative epidemiological analysis contains the continuous epidemiological supervision after epidemiology important objects, by the social and natural phenomenon, which can activate an epidemic process.

^ Materials are necessary for the epidemiological analysis:

  1. characteristic of locality in general (state of housing fund, water-supply, sewage systems and cleaning of territory, presence of objects of epidemiology risk and others like that);

  2. demographic data for a few years about an amount and age composition of population, birth rate, death rate, migration;

  3. data on social and professional composition of the population;

  4. sanitary condition of child's preschool establishments, schools, amount of children at them;

  5. condition of medical service:

  • bed fund, including the infectious hospitals;

  • presence of bacteriological laboratories;

  • information about immunization of population against separate infections;

  • provision of settlement diagnostic preparations for immunizations;

  • disinfection of state service;

  1. urgent reports about the infectious diseases (f. 58/o);

  2. magazine of registration of infectious diseases (f.60/o);

  3. reports about separate infections and parasitic diseases (f. № 1, 2);

  4. report about the prophylactic inoculations (f. 5);

  5. report about the contingent of children and teenagers, which is carried out inoculation against the infectious diseases (f. 6);

  6. report about the work of the sanitary-epidemiological (desinfection, antiplague) station (f. 40 - health);

  7. data about a death rate lethality from the infectious diseases;

  8. data of laboratory researches of material from people, from the objects of environment;

  9. epizootic data from the separate types of infections (quantity and morbidity of rodents, wild and domestic animals);

  10. entomologists data (quantity of mosquitoes, flies, ticks, their infection by the exciters of separate infections);

  11. epidemiology reviews and statistical forms for previous years;

The necessity of those or other materials at the epidemiological analysis of morbidity is determined by the purpose of analysis.


Materials of epidemiological analysis must contain such sections:

  1. Environmental conditions of territory (geographical location, topography, hydrography, meteorological factors, flora and fauna (in relation to species which have the epidemic value at the diseases with natural cell).

  2. Description of territory:

  • economic (presence of industrial objects from processing of agricultural product, forestry, artificial irrigation fields, ways of communication, big markets, etc.);

  • demographic (quantity, birth rate, death rate, density of population, age and professional composition, and migratory processes, etc.);

- sanitary (water and sanitation, housing characteristics, utility, food, school, industrial sanitation, etc.)

  1. Description of medical service of population.

  2. Comparing data about infectious morbidity.

  3. Analysis of morbidity and antiepidemiological measures separate nosology forms after basic epidemiology signs:

  • dynamics of morbidity, mortality and mortality by years;

  • analysis of morbidity on territories;

  • sources and ways of distribution of infection;

  • age structure of morbidity;

  • analysis of morbidity on the professional groups of population;

  • monthly dynamics of morbidity;

  • influence of living conditions for infectious morbidity;

  • analysis of cells;

  • short clinical description of diseases;

  • analysis of the measures directed on the removal of sources of infection;

  • analysis of the measures directed on breaking of mechanism of transmission;

  • analysis of the measures directed on forming of collective immunity;

  • general description of antiepidemiological measures.

  1. Conclusions.


Method of epidemiological analysis

The epidemiological analysis consists of a few sections. It begins from the detailed description of natural and domestic–economic features of the territory. In this part geographical position is described, climatic terms are characterized, fauna, flora, soil, settlement ponds, industrial objects, domestic et all establishments and demographic data are cited.

The basic section of work is devoted to the detailed analysis of morbidity. The study of morbidity, its estimation and comparison of different indexes, must be conducted on the basis of data which it is possible between itself to compare. For this purpose absolute indexes do not suit. They can be used in those case only, when in quantitative composition of population there is no substantial difference.

As a rule, the analysis of infectious morbidity must be conducted not on the basis of absolute values which in most cases are not correlative, and in relative indexes which are calculated on the same amount of persons. That is, for greater exactness it is necessary to use relative values which are a basis for conducting of epidemiological analysis.


^ Analysis of dynamics of infectious morbidity. For the analysis of infectious morbidity on years it is necessary to use intensive indexes (index of morbidity, index of prevalence).

Index of morbidity – medical-statistical index, which determines the aggregate of the diseases first registered for the certain interval of time among the population of concrete territory. Settles accounts after a formula:

amount of patients__ 100000

quantity of population


At determination of index of age-old morbidity in the formula in a numerator the number of patients of the given age group is marked, and in a denominator – quantity of population of the same age group.

Morbidity characterizes frequency of origin of new cases of disease among the population.

^ Index of prevalence – intensive index which is used at the analysis of chronic diseases. It is determined by the amount of patients, which are found on an account on January, 1 of financial year (regardless of date of disease and date of account of these patients), taken on a 100000 population (index of prevalence in the moment of time). The index of prevalence shows, what part of population suffers from the given population on the certain moment of time.

At the choice of indexes it is necessary to remember for the analysis, that by means the indexes of morbidity it is possible to estimate the risk of disease, and by means the index of prevalence – to define action of disease on the population.

For estimation of intensity and dynamics of epidemic process more frequent the indexes of morbidity are used.

It is necessary to analyse morbidity for a few years, as here more precisely direction of epidemic process, its recurrence shows up (tabl. 1).


Table 1 - ^ Morbidity on viral hepatitis A in S. 1964-2008 years.

Year

Index per 100 thousand

Year

Index per 100 thousand

1964

224,0

1987

111,7

1965

172,0

1988

101,5

1966

180,1

1989

86,4

1967

98,2

1990

115,3

1968

72,0

1991

197,3

1969

72,0

1992

325,6

1970

78,1

1993

280,7

1971

248,0

1994

196,5

1972

142,9

1995

176,6

1973

271,9

1996

192,4

1974

172,3

1997

110,0

1975

130,9

1998

40,7

1976

259,7

1999

50,8

1977

157,0

2000

34,8

1978

242,5

2001

57,7

1979

182,1

2002

56,2

1980

284,0

2003

30,4

1981

356,6

2004

33,2

1982

559,9

2005

10,5

1983

417,0

2006

11,3

1984

277,8

2007

13,5

1985

236,2

2008

13,2

1986

145,1








For comfort and evident expediently to represent data of morbidity graphicly. Estimating linear chart visually retraces the trend of the epidemic process. For more evident reflection the tendencies conduct smoothing of the crooked morbidity.



It is not necessary at the analysis of index of morbidity of current year to compare it only with the index of previous year or with average. Expediently to estimate it in relation to the indexes of similar phases of previous cycles (years of the high getting up, years of the moderate getting up, years of decline) and with the forecast morbidity.

Studying the level of epidemic process in a dynamics after years, it is necessary to make to attempt to find out the reasons of its increase or decline in a concrete period.

Index of lethality – is the amount of death cases from the concrete disease per 100 patients with this infection. An index is intensive, is expressed in %. It is determined after a formula:

amount of dead 100

amount of patients

Index of mortality is the amount of death cases from the concrete disease per 100000 of population. An index is intensive, is determined after a formula:

amount of dead___ 100000

quantity of population

Specific gravity (extensive index) of that or other infectious disease in all aggregate of diseases is determined after a formula:

amount of cases of the given disease____ 100

amount of cases of infectious diseases

Determination of specific gravity of every nosology form gives imagination about the structure of infectious morbidity, but does not represent frequency of origin of every infection among the population. The size of extensive index can not be a criterion for reasoning about the level of morbidity, as it relies not only on morbidity by the given infection, but also from the level of morbidity by other infections.


^ Study of distributing of infectious diseases after territory

The index of morbidity does not always represent evenness of distribution of infection, especially when estimation of morbidity on large territories is conducted.

During the analysis it is necessary to select the most staggered settlements, areas of city, districts and others like that and to analyse morbidity at them. Getting up of morbidity can be linked both with bringing in the epidemic process of greater amount of settlements, and by intensification of epidemic process in some localities (tabl. 2).


Table 2 - ^ Morbidity of population of the L. and N. districts on viral hepatitis A in 2007

L. district

N. district

Settlements

Index of morbidity per 100 thousand

Settlements

Index of morbidity per 100 thousand

v. A.

70,3

v. R

0

v. P.

0

v. Sh.

0

v. G.

3,2

v. In.

0

v. H.

17,6

v. In.

0

v. T.

32,1

v. O.

0

c. F.

12,9

c. N

82,5

all

22,5

all

22,5


It is necessary to define settlements with the greatest and lowest morbidity, explaining the reasons of its different level.

For evident of study of morbidity on territory the sketch-maps of settlements are used with causing on them of morbidity.


^ Analysis of the seasonal distributing of morbidity. At the analysis of morbidity the large value has the increase of morbidity in the proper months of year (seasonality). It is known, that seasonality of infection can rely on climatic terms (Russian tick-borne encephalitis, malaria, Dengue fever, etc.), when the value of virus tank and carries of infection rises in distribution of diseases, and also from industrial and domestic activity (tularemia, brucellosis, etc.).

The study of the seasonal distributing of morbidity is conducted by determination of specific gravity of morbidity each month in annual morbidity. In the case of absence of sharp vibrations in the seasonal distributing of diseases specific gravity each month will make 8,3 % (100 % : 12 months = 8,3 %).

Opposite, at presence of the expressed seasonal vibrations in distributing of diseases extensive indexes for separate months will sharply differ one from other. Those months which will have specific gravity more than 8,3 %, will make the period of seasonal increase of level of morbidity.

Duration of this period must be determined from data of morbidity for a few years (5-10), to eliminate the element of chance.

Thus defined length of the seasonal increase morbidity and compare its period of seasonal increase morbidity in a given year, we can conclude about changes in the character of the period of seasonal rise of morbidity.

^ Specific gravity of the diseases caused by influencing of seasonal factors is determined after a formula:


S= V-(A-V):(12-M)*М 100

A

where: A - amount of diseases for a year;

V - amount of the diseases registered during the period of seasonal increase of morbidity;

M – duration of period of seasonal increase of morbidity in months;

S – specific gravity of the diseases caused by influencing of seasonal factors.

The index testifies, how many percents the morbidity would be on below, if it was succeeded to withdraw influencing of seasonal factors.

For example, in a settlement A. on dysentery 4186 persons became ill for a year, in months:

I - 81

II - 89

III - 110

IV - 85

V - 121

VI - 164

VII - 572

VIII - 1245

IX - 730

X - 542

XI - 296

XII - 151

Average monthly morbidity made: 4186 : 12 = 349. The seasonal increase of morbidity is marked from July for October. Duration of seasonal period of M =4.

V= 572+ 1245+730+542=3089.

We put the number values in a formula, we calculate. S=60,7 %. That is, 60,7 % all cases of dysentery in a settlement A. are related to action of seasonal factors.


Analysis of age morbidity. Analysing morbidity, a doctor must define, how often the persons of a different age are ill. It allows correctly to organize work from the decline of morbidity among separate age groups taking into account intensity of their defeat. We will assume that at the analysis of morbidity it is set on diphtheria, that the greatest index of morbidity in age 13-14 years, that is the children of this age group more frequent all are ill this infection. It above all things forces to pay attention to organization of conducting of inoculations among the children of this age.

Morbidity after age groups is studied, as a rule, in intensive indexes (for example, per 100 thousand of population of the proper age group). The absolute numbers of diseases, as well as extensive indexes, for the analysis are not recommended. The analysis of age morbidity in extensive indexes allows to judge only about the relative closeness of age group in annual morbidity, but can not show frequency of morbidity in different age groups. For example, for a year in town S. 100 cases of diphtheria are registered. In age 3-4 years 20 persons (20 % from all diseased) became ill, in age 14 years and senior 40 persons became ill (40 % from all diseased). At the first look there can be the impression, that greater morbidity among the population 14 years and senior. But, taking into account, that the amount of children 3-4 years made 10 000 persons the age, and persons in age 14 years and senior – 220000, the indexes of morbidity accordingly will make 200 and 22,7 per 100 thousand That is, the children of a 3-4 annual age are ill diphtheria almost in 9 times more frequent, than persons in age 14 years and senior. Such result of analysis requires finding of reasons of high level of morbidity out in age 3-4 years and application of additional preventive measures.

Age groups can change depending on an infection in the analysis of age morbidity. More frequent the analysis is conducted after age groups: to 1 year, 1-2 years, 3-6 years, 7-14 years, 15-17 years, 18-19 years, 20- 29 years, 30-39 years, 40-49 years, 50- 59 years, 60 and senior.


^ Analysis of morbidity in the professional-domestic groups of population. Study of morbidity in different professional – domestic groups of population allows a doctor to expose groups most impressionable by that or other illness. For the analysis it is necessary to use intensive indexes (for example, per 100 thousand of persons of the proper group). For example, at comparison of indexes of morbidity by viral hepatitis B in different professional groups it was set, that the greatest levels of morbidity were registered among medical workers (tabl. 3).


Table 3 - ^ Morbidity of workers from different professional groups on viral hepatitis B (per 100 thousand of contingent)

Professional groups

1999 year

2000 year

2001 year

Workers of laundries

0

31,1

16,9

^ Medical workers

42,0

53,1

181,1

Workers of hairdressers

23,6

11,3

29,9

Workers of shelters

26,1

18,2

7,9

Workers of public utilities

18,9

33,3

0

General index

24,6

31,2

31,6


At each infection expediently to analyse morbidity in separate professional (social) groups. For example, at the analysis of morbidity by typhoid fever it is necessary to pay the special attention to morbidity of workers of food items, public food consumption, child's, medical establishments. Analysing morbidity by the infections of respiratory tracts, it is important to find out its level among the children of preschool establishments, schools, shelters and others like that.

Later the analysis of morbidity is conducted in separate collectives. The organized collectives are the epicentre of development of epidemics. In a number of collectives there is the protracted saving of infecting agent and its activating. Such collectives are determined as risk collectives.

It is necessary to use data of analysis for planning of preventive and antiepidemiological measures among the most staggered groups.


^ Analysis of sources and factors of infection transmission.

Exposure of infection sources, which resulted in appearance of a new case of disease, and also determination of ways of transmission, which help in distribution of infection, – is the important section of the epidemiological analysis. The careful epidemiological inspection, and at some infections with the use of laboratory methods of research, allows in most cases to expose the source of infection or define the credible factors of infectinion. For comfort of search of transmission factors, generalization and analysis of data (especially at sharp intestinal infections) expediently to use the compatible list of credible factors of transmission (tabl. 4).


Table 4 - ^ The reference list of food products which can become the factor of transmission at intestinal infections

Number

Food products



Producer.

Place of acquisition

Violation of term

realization and terms

saving

Violation of technology of preparation

1

Milk domestic – raw, boiled, sour












Milk from a market - raw, boiled, sour












The milk from an elemental trade - raw, boiled, sour












Milk of industrial production - raw, boiled, sour












Child's milk in bottles, cheeses










2

Child's soul-milk products












Dry child's mixtures. Can for child's food (meat, vegetable)












Foods from child's milk kitchen










3

Sour cream of the factory making in packages, other capacities










4

Sour cream from the market at persons from the own economies










5

Yogurt et other whole milk products and lactic products










6

Domestic cheese, factory. Cheese in packages or by weight










7

Cheese, butter by weight, packed up










8

Ice-cream, packaged through frizer, milk cocktails










9

Meat products:













- sausages, meat grocery store, pates, ready-to-cook foods










Continuation of table 4




- meat cookery













- meat - chicken, goose, duck, turkey-cock













- game










10

Use of one board for cutting of the products prepared and raw










11

Fish:













- boiled, stewed, fried, pickled













- smoked (cold, hot), dried













- fish can (to name from what fish), caviar










12

Eggs are chicken, duck, quail, domestic, from the shop, market (raw, washed or unwashed, boiled, fried, as seasoning for foods, etc.)










13

Mayonnaise










14

Patties (with what filling), pizza other










15

Salad










16

Cream-pastry wares, jellies










17

Drinks: juices, cold tankards, kvass (packaged, unbottled)










18

Feed in dining-rooms, restaurants, cafes (to specify the name and address)










19

Berries, vegetables, fruits, salad, mushrooms










20

Water drinkable: from central water supply, from a mine well, raw or boiled










21

Participation in dinners solemn, ceremonial










22

Collective departures in a forest, on a hunt, fishing, in tourist trip and other











On the basis of the conducted epidemiological analysis it is possible to form hypotheses about territories, groups of population, collectives, time and risk factors of distribution of infection and justify necessity of conducting of antiepidemiological measures, marking, where, when and what exactly measures must be conducted.


^




LIST of literaturE


  1. Івахів О.Л., Грицко Р.Ю., Кіселик І.О. Кабінет інфекційних захворювань: Навчальний посібник. - Тернопіль, Укрмедкнига, 2006. – 233 с.

  2. Інфекційні хвороби в загальній практиці та сімейній медицині / За ред. М.А. Андрейчина. – Тернопіль: ТДМУ, 2007. – 500 с.

  3. Законодавча база України. За ред. Т.С. Гребенюка – Київ: Здоров’я, 2003. – 987 с.

  4. Зуева Л.П., Яфаев Р.Х. Эпидемиология: Ученик. – СПб: ФОЛИАНТ, 2005. – 752 с.

  5. Інфекційні хвороби: ситуаційні завдання: Навчальний посібник / М.Д. Чемич, Н.І. Ільїна, А.О. Сніцарь та ін. – Суми: Вид-во СумДУ, 2000. – 175 с.

  6. Епідеміологія / За ред. Ю.Д. Гоца, І.П. Колеснікової, Г.А. Мохорта. – Київ: Асканія, 2007. – 360 с.

  7. Епідеміологія екстремальних умов з курсом військової епідеміології / За ред. М.А. Андрейчина. – Тернопіль: Укрмедкнига, 2002. – 270 с.

  8. Епідеміологія / За ред. К.М. Синяка, В.М. Гиріна. – Київ: Здоров’я, 1998. - 464 с.

  9. Москалев А.В., Сбойчаков В.Б. Инфекционная иммунология: Учеб. пособие. – СПб.: ФОЛИАНТ, 2006. - 172 с.

  10. Організація протиепідемічних заходів при надзвичайних ситуаціях (Конспект лекцій) / Укладач М.Д. Чемич. – Суми: Вид-во СумДУ, 2007. – 50 с.

  11. Офіційний сайт МОЗ України // www. moz.gov.ua

  12. Соціальна медицина та організація охорони здоров’я / За ред. Ю.В. Вороненка, В.Ф. Москаленка. – Тернопіль: Укрмедкнига, 2000.– 677 с.

  13. Шляхов Э.Н. Практическая эпидемиология. Кишинев: Штиинца, 1986. - 532 с.

  14. Эпидемиология: Учебное пособие / Под ред. Н.Д. Ющука, В.В. Бушуева, В.Н. Колесова. – М.: Медицина, 1993. – 336 с.
^

Educational edition



2604 Methodical recommendations

to conducting of epidemiology analysis

for doctors, interns, students of senior courses of higher medical establishments of education III-IV level of accreditation


Accountable for the issue M.D. Chemich

Redactor P.M. Efimenco

Computer making I.V. Pavlovska



Pidp. before the seal 05.05.2009.

Format 60х84/16. Paper of ofs. Garnitoura Times New Roman Cyr. Seal of ofs.

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It is printed in a printing-house Sumy State University

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