Medical Geography is an important part of investigating an outbreak. In medical geography, the investigator uses tools and approaches of geography to tackle health related questions. The variation of disease occurrence over space, location, direction and place are investigated. The investigator uses maps to explore spatial pattern in the occurrence of disease. The map will provide the distribution pattern of the disease. On seeing the distribution, the investigator will investigate the kind of natural and artificial environment in these places. From the map, I understand that the disease is affecting only a few in the population and the disease is localized to people in the mining area. The human activities in these regions could to some extent help define the diseases. The disease is common among miners. The disease outbreak occurred during the rainy season. Physical factors like precipitation and temperature, can influence the survival and spread of the etiological agent. In addition to physical factors, the spatial location of the town and its connectivity to other regions can influence the spread of the disease. Employing a combined approach that in-cooperates social, ecological, spatial queries in the investigation will be useful in the investigation. I will use a questionnaire in the investigation. In addition to biological factor, social interactions in the locality can influence the spread of diseases. For example, lack of a health care facility or vaccination among people in a locality, can increase susceptibility to the disease. (Rupke)
Epidemiological studies help understand the pattern in which a disease occurs. It can help identify the cause of a sudden outbreak of a known disease or unknown disease that occurs in the population. An outbreak was reported in the small mining town of West Virginia. The disease is non-fatal and mildly debilitating. The presence of environmental factors has been ruled out. The people of the town are shy and unwelcoming to strangers. As the environmental cause of the disease is ruled out, the next possible cause of the disease is infectious cause. The aim of the investigation will be to identify biological, social and economic factors that promote the disease. An outbreak may last for a few days, if it is from a common source (like contaminated food), or may last longer like weeks (viruses that are seasonal) or it may last for years (e.g. AIDS).
Physicians, nurses, certain astute citizens, laboratory worker, school principals, day care workers are the individuals who usually identify a certain pattern in the disease occurrence and report an epidemic or outbreak. The local health department and public disease surveillance system will also help to report the disease in real time. An investigation into the outbreak, will help identify the mode of disease transmission, severity of disease, it’s potential for spreading to the rest of the population as well. This information will help in the development of prevention and control measures. (Arias and Cameron)
Establishing contacts is very important to begin with the investigation. Considering that the people of the town are unwelcoming to strangers, it would be ideal if the investigator is known to the people or the investigator has a good rapport with someone who can help him with the investigation. Information can be sought from different agencies that maintain health record of the people as well. Health care and diseases surveillance agencies can also help verify the diagnosis and confirm outbreak. Reports are collected from all appropriate sources and this is the first step in the investigation. These reports are confidential and the investigator must be aware of this.
An outbreak occurs because the susceptible people in the population have been exposed to the etiological agent. The people have either travelled to the source of the etiology or the etiology may have travelled to the susceptible agent through a carrier like animals/ insects. I started by comparing the number of cases in the past, with the number of cases that are in the present and will try to understand its pattern. This process, will help decide whether the disease rate is decreasing or increasing. Certain outbreaks are self-limiting. My next aim will be to analyze the medical records to determine the age group and gender that are predominantly affected. Information on disease rate, age, gender and occupation of the people affected can help draw some preliminary conclusion about the source of diseases and its transmission pattern. If the outbreak is self-limiting, the disease rate will begin to subside as there is no more susceptible individual or no more source to contaminate the people. (Arias and Cameron)
The next step of the investigation is to identify the symptoms of the disease. Gastrointestinal symptoms are common in intoxication or food poisoning. In the given scenario, there is no gastrointestinal symptom. The key symptom in the present outbreak was debilitating fever. Sample collection and laboratory investigation will be done to identify the etiological agent. Laboratory diagnosis and confirmation of diagnosis will help in defining the case. Based on the investigation done so far, the diseases will be defined as a clinically compatible case or a confirmed case or as a probable case. In clinically compatible case, the symptoms fit the clinical presentation of disease. Confirmed cases are clinically compatible and are confirmed by laboratory diagnosis or epi-linked. Probable cases are not confirmed through laboratory diagnosis or epi-linked. The disease matches the clinical case definition and thus treated as a probable case. Epi-linked case is a person who gets the disease due to contact with the disease affected person. It’s important to have a case definition. This will help identify if a new case matches the disease being investigated. It is not necessary that all cases must have a confirmed laboratory diagnosis. It can be called a case, if symptoms are matching. The third part of the investigation is to identify the high risk population and also to identify if the diseases can be transmitted from person to person. (Arias and Cameron)
Work cited
Arias, Kathleen A Meehan, and Miriam AL. Cameron. "Outbreak Investigation, Prevention and Control In Health Care Settings: Critical Issues In Patient Safety, 2Nd Edition Outbreak Investigation, Prevention And Control In Health Care Settings: Critical Issues In Patient Safety, 2Nd Edition By Bartlett Publishers, Sudbury, Massachusetts, 2010. 435
Rupke, Nicolaas A. Medical Geography In Historical Perspective. London: Wellcome Trust Centre for the History of Medicine at UCL, 2000. Print.
