Outbreak investigations in atypical locations

What stories do you have of conducting outbreak investigations in atypical locations? How did you adapt your methods to the context?

One of Applied Epi’s own lead instructors @arranh is covered in US media conducting a norovirus outbreak investigation in the remote backcountry areas of Washington State (the Pacific Crest Trail).

@arranh how did your team adapt its epidemiological investigation methods to this context?

I think the most important thing we did during our outbreak investigation is we worked with people who knew the disease, and people who knew the context.

From conversations with subject matter experts at the CDC, we knew what could potentially be an environmental reservoir (water sources, pit latrines, shared facilities), but over a trail of hundreds of miles within Washington we had far too many locations to sample.

When we spoke with Pacific Crest Trail (PCT) hikers, it gave us a lot more context for where people where meeting, where they were getting water, and what facilities they were interacting with on the trail.

This was information we couldn’t get from just looking at a map. The trail specific knowledge, combined with the epidemiology, narrowed down hundreds of miles of trail to only a few locations where we conducted environmental sampling.

Working with hikers also meant that when we gave recommendations, we could make sure they were useful.

And of course another adaptation was that we took a lot more photos of the beautiful surroundings!



Thank you for sharing! Looking forward to more posts like this.

This collaboration between two groups demonstrates how epidemiology benefits from the cooperation of diverse groups to effectively address significant health issues.

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