B11 - Policy - before epi

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The Importance of Epidemiology

Epidemiology is the study of the origin and causes of
diseases in a community. It is the scientific method of
investigation problem-solving used by disease detectives—
epidemiologists, laboratory scientists, statisticians,
physicians and other health care providers, and public health
professionals—to get to the root of health problems and
outbreaks in a community.

Example of an outbreak investigation
In February 2009, when two fatal cases of meningitis occurred
at Fort Leonard Wood, MO, an Army training center, it was
time for disease detectives to get to work. The investigation
would identify the cause of the outbreak and lead to
interventions to prevent further cases of the disease.

The outbreak
◊ Two previously healthy trainees were diagnosed with
Streptococcus pneumonia meningitis and died

◊ Both trainees belonged to Alpha Company, which
consisted of 303 trainees total
◊ The number of cases of pneumonia increased during this
time period
◊ The outbreak occurred during February 6-14, 2009
Epidemiologists needed to consider important information
about the case, such as the number of people at Fort Leonard
Wood (FLW) training camp, the routine vaccinations trainees
and staff receive at and before arrival at FLW, and the housing
and training separated by different companies within the
554th Battalion at FLW.

Gathering information
Epidemiologists collected data on symptoms, past medical
history, laboratory testing, exam findings, and recent
treatments that trainees and training staff had received. They
reviewed medical records from the training camp and civilian
hospitals, including a list of trainees who were too ill to
participate in routine training and medical charts of patients
with pneumonia in the troop companies.

Centers for Disease Control and Prevention
Office of the Director
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The Importance of Epidemiology
Investigation period
During the investigation period, February 1-21, 2009,
epidemiologists surveyed all trainees and training staff of the
554th Battalion, and trainees who came to the camp from
their homes in the community. Nasal and throat swabs were
collected from certain trainees and staff.
The survey collected:
◊ Demographic information
◊ Information on symptoms of illness
◊ Health care use
◊ Influenza vaccination status
◊ Treatment with antibiotics during the investigation
period
After the data were collected, the epidemiologists created
a database with the information. The data were analyzed to
determine trainee and training staff characteristics thought to
be associated with the infection.

Results
Epidemiologists determined that the two fatal cases of
meningitis were the only meningitis cases identified during
the investigation period, and 72 cases of pneumonia were
identified among all the trainees. They were able to rule out
the following risk factors as not being associated with getting
sick: taking antibiotics, living in a bay (more than four trainees
per room), smoking, having one or more illness symptoms,
and living on a particular floor of the barracks.

Conclusions
The epidemiologists used what they learned to prevent
future outbreaks from occurring. They were able to stop the
outbreak after trainees and training staff received vaccinations
and antibiotics, and after hand hygiene and cough etiquette
were strengthened. The information gained from this
investigation will improve outbreak detection and timely
response at military training installations, and new vaccines
may provide opportunities to reduce pneumonia among
military trainees in the future.
Dawood et al.: Outbreak of Pneumonia in the Setting of Fatal Pneumococcal Meningitis among US Army Trainees: Potential Role of Chlamydia pneumonia Infection. BMC Infectious Diseases 2011 11:157
For more information on epidemiology, visit www.cdc.gov or call 1-800-CDC-INFO.
To view this fact sheet on the web, visit http://www.cdc.gov/24-7/CDCFastFacts/epidemiology.html