Syllabus

Graduate Programs in Public Health

GPH 713: Infectious Disease Epidemiology – Summer B 2019

Credits - 3

Description

Course Description:

This course is an upper-level course designed for students who would like to continue studying epidemiology. This course includes: a historical perspective on infectious disease (ID) epidemiology, ethics of ID research, basic biostatistics and study design methods as they apply to ID outbreaks and epidemics, the multi-causal and social aspects of ID, surveillance, and control of epidemics. Emphasis will be placed on investigative techniques, epidemiological methodology, and critical thinking about epidemiological studies and data. 

Pre-requisite:

GPH 712 Principles of Epidemiology 

Materials

Required Textbook:

Nelson KE, Williams CM. Infectious disease epidemiology: Theory and practice. 3rd ed. Burlington, MA, United States: Jones and Bartlett Publishers; 2014.

ISBN-13: 978-1449683795

Required Software:

RedCap: This software is available free of charge through UNE. You will need to obtain a login and password by sending UNE username to: Michael Lawerence at mlawrence3@une.edu. Note that you are requesting a RedCap account.

Learning Objectives and Outcomes

Course Outcomes

  1. Describe the general principles of infectious disease epidemiology
  2. Analyze epidemiologic study designs and measures in the context of infectious diseases
  3. Apply outbreak investigation steps to an infectious disease outbreak
  4. Describe infectious disease dynamics
  5. Apply principles of disease transmission to develop disease prevention and control practices
  6. Design data collection tools to investigate an infectious disease outbreak using computer-based software
  7. Analyze quantitative data about infectious diseases using biostatistics
  8. Interpret results of data analysis in the context of infectious diseases
  9. Communicate audience-appropriate content reporting on an infectious disease through oral presentation
  10. Apply a systems thinking tool to analysis of an infectious disease within a system

Public Health Competencies

  • FC 1: Apply epidemiological methods to the breadth of settings and situations in public health practice
  • FC 2: Select quantitative and qualitative data collection methods appropriate for a given public health context
  • FC 3: Analyze quantitative and qualitative data using biostatistics, informatics, computer-based programming and software, as appropriate
  • FC 4: Interpret results of data analysis for public health research, policy or practice
  • FC 19: Communicate audience-appropriate public health content, both in writing and through oral presentation
  • FC 22: Apply systems thinking tools to a public health issue

Assignments

Forum Discussions: Each student is expected to post at least twice each week in response to forum questions on that week’s topic. Initial posts are due by 11:59pm ET on Sunday. Your response must be completed by 11:59pm ET Wednesday for credit. Because this is an online course, the online discussion portion is an important way to exchange ideas with your classmates. Students will be graded on their participation and effort of their posts. These posts will take time to complete but they are an essential part of this on-line course and a great way to get to know your colleagues. Please be familiar with the course material (readings/lectures) before posting each week. Full marks will be given to those who ask questions, bring in new data from the literature or other resources, and demonstrate a thorough understanding of the topics for the week.

Some discussions will require two posts, and some will require three. Please pay attention to the instructions of any prompt to avoid any confusion.

Interpreting Key Measures of Infectious Diseases – Week 2

Report on the measures of association for an infectious disease that has not yet been eradicated and for which there is no vaccine. Requires at least two peer-reviewed publications.  

Outbreak Investigation – Week 3

Respond in stages to a simulated disease outbreak investigation. You will not be able to see the prompts for the entire assignment at once; instead, additional stages will reveal themselves as you submit your responses to preceding stages. 

Week 5 and 6 Oral Presentations

Each presentation will put you in the position of communicating subject-specific information to a target audience. The audience for the first presentation is the general public, and the form of the presentation is a PSA, so you will need to communicate the information you are presenting in such a way that people from a wide variety of backgrounds will understand it. The second oral presentation is toward clinicians, in the form of an educational video for a technical audience, and so should be presented as though to an audience with a great deal of experience already in your field. 

Design Data Collection Tool for Infectious Disease Investigations

You will generate an online questionnaire and database using the software RedCap (see Week 2, “Thinking ahead” for instructions on how to obtain a RedCap account). For this questionnaire, imagine you are an infectious disease epidemiologist and you have confirmed an outbreak in your region. You have verified the diagnosis, and will need to select a study design and then design a questionnaire to collect risk information. 

Week 4 and Week 7 Quizzes: These quizzes cover information from Weeks 1 through 4 and Week 5 through 7, respectively. The quizzes will be taken in Blackboard and you will have a single attempt for each of them. They will not be available to take after the week in which they are due passes.

Grading Policy

Your grade in this course will be determined by the following criteria:

Grade Breakdown

AssignmentsTotal: 100 Points
Discussion Posts (2 x 4 points and 3 x 6 points)26
Written Assignments (2 x 10)20
Oral Presentations (2 x 10)20
Data Collection Tool Assignment14
Quizzes (2 x 10 points)20
Total100

Grade Scale

Grade Points Grade Point Average (GPA)
A 94 – 100% 4.00
A- 90 – 93% 3.75
B+ 87 – 89% 3.50
B 84 – 86% 3.00
B- 80 – 83% 2.75
C+ 77 – 79% 2.50
C 74 – 76% 2.00
C- 70 – 73% 1.75
D 64 – 69% 1.00
F 00 – 63% 0.00

Schedule

Course Calendar

Week 1: Jun 26 – July 3
Week 2: July 3 – July 10
Week 3: July 10 – July 17
Week 4: July 17 – July 24
Week 5: Jul7 24 – July 31
Week 6: July 31 – Aug 7
Week 7: Aug 7 – Aug 14
Week 8: Aug 14 – Aug 18 (Sunday)

Week 1: General Principles of Infectious Disease Epidemiology

Weekly Outcomes

  • Discuss infectious disease classification systems
  • Describe disease transmission
  • Describe the biological characteristics of infectious disease organisms
  • Describe the natural history of infectious diseases
  • Describe the relationship between incidence and prevalence

Readings

  • Textbook: Chapter 2 – Epidemiology of Infectious Disease: General Principles

Videos

  • Week 1 Lecture Part 1 – Introduction to GPH 713, Infectious Disease Epidemiology
  • Week 1 Lecture Part 2 – General Principles of Infectious Disease Epidemiology

Assignments

Introduction Discussion 

  • Introduce yourself to your instructor and peers. Where are you from? What interests you about infectious disease epidemiology? Also, tell your instructor and peers about one infectious disease you are especially interested in and explain why.

Week 1 Discussion 

  • Initial Post: Select an infectious disease of interest to you. Classify the infectious disease by each of the 4 classification systems. Next, describe the biological characteristics of the infectious agent including the infectivity, pathogenicity, virulence and immunogenicity. Lastly, describe the natural history of the disease, explaining the transmission mode in detail and noting the incubation period.

    Response 1: Consider the characteristics of a peer’s selected infectious disease, in particular the mode of transmission and the natural history. Imagine you are in the early stages of an infectious disease outbreak investigation and the disease has similar characteristics to that described by your peer. Name at least one other infectious disease you might believe to be the cause of the outbreak. Describe at least 2 similarities between the two diseases (the one you came up with and your peer’s) that would make distinguishing between them, without diagnostic testing, especially difficult.

    Response 2:  Using a high-quality resource, state the incidence and prevalence of the infectious disease described in another peer’s initial post. You may report the prevalence and incidence world-wide or for a specific country. Explain the mathematical relationship between incidence and prevalence in the context of this disease.

Week 2: Epidemiological Study Design and Key Measures for Infectious Diseases

Weekly Outcomes

  • Use the epidemiological triangle
  • Describe epidemiological study designs in the context of infectious diseases
  • Explain key measures of infectious disease
  • Interpret measures of association for infectious disease studies

Readings

  • Textbook: Chapter 3 – Study Design

Videos

  • Week 2 Lecture: Epidemiological Study Design and Key Measures for Infectious Diseases

Assignments

Week 2 Discussion 

  • Initial Post: Select an infectious disease for which at least one outbreak (defined as an unexpected increase in cases) has occurred in the last 10 years. Describe the epidemiologic triangle for the selected disease. Find at least one news article (not a journal article in a peer-reviewed publication) that reports on an outbreak of this disease. Report any measures of disease occurrence included in the news article. Include rates as well as raw counts. Select a different disease than what you chose in Week 1.

    Response Post: Read the news article cited in a peer’s post. Using a reputable source, identify the annual incidence of the disease in the locale on which the news article reports. If the incidence is not available for the specific locale, you can use a similar locale or larger region (e.g., if the outbreak occurred in a city, you may need to report on the incidence in that state). Interpret the annual incidence of the disease in the context of the information reported in the news article. What other information would you add to the news article to help people understand the severity (whether it is high or low) of the outbreak? Make sure you are responding to a post on a disease that you did not report on this week or in Week 1.

Week 2 Written Assignment: Interpreting Key Measures of Infectious Disease

  • In this week’s assignment you will report on an infectious disease that has not been eradicated and for which there is no vaccine currently available. Select from the following list of infectious diseases: Chagas disease, Chikungunya, Chlamydia, CMV, HIV, Malaria, or RSV.

    Identify two peer-reviewed publications that report on measures of association for the selected disease. Each study should report measures of association for at least two exposures. Exposures can include sociodemographic characteristics, individual behaviors, environmental factors, genetics, etc.  For each study:

    Describe the study, including the: study design, target population, persons (i.e., sociodemographic characteristics), place, and time of the study. Further details found in Week 2 Module.

Week 3: Outbreak Investigations

Weekly Outcomes

  • Evaluate the results of an outbreak investigation
  • Analyze the steps involved in conducting an investigation of the outbreak of an infectious disease
  • Conduct an outbreak investigation

Readings

  • Textbook: Chapter 5 – Outbreak Epidemiology

Videos

  • Week 3 Lecture: Outbreak Investigations

Assignments

Week 3 Written Assignment: Outbreak Investigation

  • This week’s written assignment simulates a disease outbreak investigation. The assignment is broken into 4 sections. You will not be able to see the prompts for the entire assignment at once; instead, additional sections will unveil themselves as you submit your responses. Once you submit one section and move forward to the next section, you will not be able to go back to the previous section and change your response. Each submission of a response is saved, though, so you can leave and return to where you left off at any time. But you must finish before the week is out. Further instructions in the Week 3 Module.

Week 4: Infectious Disease Dynamics

Weekly Outcomes

  • Describe the determinants of epidemic growth
  • Interpret an epidemic growth curve
  • Describe the differences between incubation, latent and infectious periods

Readings

  • Textbook: Chapter 6 – Infectious Disease Dynamics
  • Optional: Re-read pages 119-120 describing epidemic curves

Videos

  • Week 4 Lecture: Infectious Disease Dynamics

Assignments

Quiz 1

  • This week you will complete a quiz on content from Weeks 1-4. This is an open book quiz. You can save your answers at any time and return to the quiz later. However, you only have one opportunity to submit the quiz; once submitted, you cannot change your answers.

Week 5: Prevention and Control Measures

Weekly Outcomes

  • Describe individual- and community-level disease control practices
  • Describe the role of vaccination in disease control and prevention
  • Describe the disease prevention and control practices for healthcare-acquired infections
  • Apply knowledge of the principles of disease transmission to recommend disease prevention and control practices
  • Compose an oral presentation for a public audience

Readings

  • Textbook: Chapter 4 – Prevention of Infectious Diseases
  • Textbook: Chapter 11 – Vaccines: Past, Present and Future (only pages 273-282 are required)
  • Textbook: Chapter 14 – Healthcare-Associated Infections

Videos

  • Week 5 Lecture: Preventing and Controlling Infectious Diseases

Assignments

Week 5 Discussion (6 points)

  • Initial Post: For this week’s discussion, we will use an online, interactive tool called Twine. Twine will allow you to “choose your path” to develop and implement an infection control plan to reduce the rate of hospital-acquired infections (HAIs).

    Download the Twine file and open it on your computer; it should open in your Internet browser.

    As you move through the scenario in Twine, be sure to take notes to answer the prompt below.

    For your initial post:

  • Describe the path that you took to get to the “Congratulations” page. Did you try different solutions first, or did you end up there right away?
  • Was there any step that was significantly more difficult than the others? Were they all relatively hard/easy? Why?

    Note that you will be able to go through the exercise in Twine as many times as you want, choosing different paths each time. However, your initial post should focus on a single path—your first one. There is not a single “correct” path. You are not being graded on the path you chose, but rather on your ability to critically analyze your choices, what went into those choices, and their apparent consequences.

    Response 1: Examine the path chosen by one of your peers. Identify at least one instance in which your peer may have been challenged by a hypothetical colleague for the choice they made—in other words, a hypothetical colleague collaborating with your peer in the scenario, who believes your peer should have chosen a different step in that instance. State specifically what the colleague might say is the better choice, and how they might support alternative path. Cite peer-reviewed publications to justify the alternative path.

    Response 2: Review the initial post from a different peer as well as the response(s) to that peer’s post. How might your peer respond to the colleague’s challenge? In other words, how might your peer justify their original path, given the arguments presented against that path? Then, thinking more broadly, state at least two challenges hospitals face in reducing HAIs successfully. Why do you think these challenges are particularly difficult to overcome?  

Oral Presentation 1: Public Service Announcement to Prevent Spread of an Infectious Disease 

  • For this presentation, you will compose a 3-minute public service announcement (PSA). The goal of this PSA is to provide the public with information on how to prevent and control the transmission of the selected infectious disease. This PSA will air on local public television and is directed to a general audience.

    Select a disease that is endemic to a region of your choice from the following list: Chlamydia, Dengue fever, Chikungunya, Cytomegalovirus, Leishmaniasis, or Malaria. You should select a disease that you have not reported on for any previous assignments.

    The local health department is actively trying to reduce the incidence of the selected disease. You must apply the principles of disease transmission to develop a prevention and control plan. The PSA’s function is to describe both individual prevention and control measures, as well as any community-level measures that will be put into place by the public health department.

Week 6: Identifying and Analyzing Infectious Disease Data

Weekly Outcomes

  • Identify infectious disease data
  • Analyze infectious disease data
  • Calculate sensitivity, specificity, positive predictive value, and negative predictive value in the context of infectious disease diagnostic tests
  • Interpret results of analysis of infectious disease data
  • Interpret sensitivity, specificity, positive predictive value, and negative predictive value in the context of infectious disease diagnostic tests
  • Compose an oral presentation for a technical audience

Readings

  • Readers’ Guide: Understanding Weekly and Annual National Notifiable Diseases Surveillance System WONDER Tables
  • Optional: If you are interested in the molecular biology behind diagnostic tests for infectious disease, read Chapter 9

Videos

  • Week 6 Lecture: Identifying and Analyzing Infectious Disease Data
  • Sensitivity, Specificity, PPV and NPV

Assignments

Week 6 Discussion: 

  • Initial post: As described in the Week 3 lecture, the Centers for Disease Control and Prevention publish data for notifiable conditions, many of which are infectious diseases. For the purposes of this assignment, you will use data from the weekly WONDER data tables or the annual MMWR Summary of Notifiable Diseases. You may choose any infectious disease that is classified as notifiable in the US that you have not previously reported on. However, you need to ensure that you select a disease for which there are sufficient data to conduct the analysis. This analysis requires that at least 10 people were infected during the selected time interval; you can choose to examine data by the week or by the year (i.e., ≥10 cases per week for each of 10 weeks, ≥10 cases per year for each of 10 years). 

    Once you select your disease, select two geographies to compare (e.g., two states, one state and the nation, a region and the nation, etc). For the initial post, you will obtain data for 10 time points, either weeks or years. You will then graph these data in a format you believe to be useful based on this week’s lecture.

    For the most recent time point, compare the incidence of the disease between the two geographies. Use an online calculator (for example, MedCalc) to test for significant differences between the incidence in the two geographies. Finally, offer an interpretation of your results. 

    Be sure to cite your sources of data correctly, and include links to the sources of data for the sake of your classmates.

    Response 1: Thinking specifically about the disease selected by a peer: do you believe that the disease incidence calculated using these data is lower, higher or about equal to the true incidence in the two populations? Justify your answer, citing high-quality peer-reviewed journal publications to support your justification. 

    Response 2: Review another peer’s initial post. Assume the true incidence is lower or higher than that calculated using the provided data. Consider two scenarios: a) the error in the incidence is systematic (always low or always high) among geographies and over time and b) the error is random and varies among geographies and over time. Compare and contrast these two scenarios. State whether or you think it matters if the calculation if the calculation is wrong and if you opinion differs for scenario a and scenario b. 

Oral Presentation 2: Creating an Educational Video for a Technical Audience 

  • You are an infectious disease epidemiologist who specializes in the development of new diagnostic tests. A new infectious disease was recently discovered (feel free to name it). You developed a diagnostic test (which you may also name) for this disease. Your test is relatively painless and inexpensive compared to the only other known diagnostic test, imaging that requires intravenous dye.

    You have been asked to develop an educational video for clinicians that describes the accuracy of your diagnostic test, as well as its predictive values. The results from your latest study, a population-based sample of 10,000 people, are below.  You will use these data to report the sensitivity, specificity, and positive and negative predictive values for the test. Your presentation should also interpret these values and provide guidance for clinicians in regards to how to explain the results to their patients. (These values, and further directions, are presented in the Week 6 Module).

    The presentation should be no more than 5 minutes long. Make sure the video is geared towards clinicians, a technical audience (i.e., physicians and nurses). You may use the software Screencast-o-matic, or any other software you are comfortable with, to create the video. You can use only slides, only video of yourself or a mix of both, but ensure the video is professional (e.g., dress appropriately, format your slides for an audience, etc). Upload your completed video to YouTube and submit the URL (make sure your YouTube account is not set to private).

Week 7: Designing Data Collection Tools for Infectious Disease Investigations

Weekly Outcomes

  • Design a questionnaire to collect infectious disease risk information using RedCap
  • Design a database to house infectious disease risk information collected using RedCap

Readings

  • Optional: Re-read pages 174-177 in the text (“Collecting Risk Information”).

Videos

  • Week 7 Lecture: Collecting Risk Information for Infectious Disease Investigations
  • Detailed Overview of RedCap
  • Basic Features and Functionality of RedCap (5 videos)
  • Single Survey Project

Assignments

Written Assignment: Designing Data Collection Tools for Infectious Disease Investigations 

  • This week’s assignment requires you to generate an online questionnaire and database using the software RedCap (see Week 4, “Thinking ahead” for instructions on how to obtain a RedCap account). For this questionnaire, imagine you are an infectious disease epidemiologist and you have confirmed an outbreak in your region. You have verified the diagnosis, and will need to select a study design and then design a questionnaire to collect risk information.

    For this assignment, you may choose from the following list of diseases for the outbreak: diphtheria, hepatitis B, measles, meningitis, mumps, pertussis, rubella, tuberculosis, and yellow fever.

    Your online survey should include 15 to 20 questions that will aid in establishing the what, when, where and who of the outbreak. You should assume you have some information and should be using primarily close-coded questions. You may identify and use questions from previously created surveys published online by reputable sources (e.g., CDC, WHO), but at least 30% of your questions (4 to 6) should be original (created by you). At least one question should require the use of branching logic. At least one question should allow participants to “Select all that apply,” and at least one question should require the participants to select only one answer. Your instructor will provide their RedCap user name. You should add your instructor as a “user” of your survey so they can access the online designer and see your work.

    You will submit 3 items for this assignment: 1) the URL to your RedCap survey, 2) a pdf copy of the survey database, and 3) a document that lists your references as well as which questions (by number) are from what source, and which questions are original and developed by you.  

Quiz 2 

  • This week you will complete a quiz on content from Weeks 5-7. This is an open book quiz. You can save your answers at any time and return to the quiz later. However, you only have one opportunity to submit the quiz; once submitted, you cannot change your answers.

Week 8: Systems Thinking and Infectious Disease Epidemiology

Weekly Outcomes

  • Describe systems thinking in the context of infectious disease epidemiology
  • Use a systems thinking tool to visualize an infectious disease within a system

Readings

  • Peters, DH. The application of systems thinking in health: why use systems thinking? Health Res Policy Syst. 2014:12(15).  

Assignments

Week 8 Discussion

  • Initial post: Identify and review a peer-reviewed publication that reports on a study that uses one of the systems thinking methods (shown in Table 1 of this week’s reading by Peters) to evaluate an infectious disease. In the context of the infectious disease in the article, describe three ways the study builds on studies that used more traditional epidemiological methodologies (e.g., case-control and cohort studies, randomized controlled trials). You must submit your initial post in order to view your peers’ submissions.

    Response: Review the publication identified by a peer. Considering the systems thinking methodology used, name another infectious disease you might be able to investigate that would leverage the work done in your peers’ study. In other words, for which infectious disease could the model generated in the study be re-used or adapted? Next, create a stock and flow diagram of the system in which this disease is transmitted and/or intervened upon. Your diagram should be specific to the disease you select and should include at least 3 stocks, at least 3 flows and at least two converters and connectors.

Student Resources

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Policies

AMA Writing Style Statement

The American Medical Association Manual (AMA) of Style, 11th edition is the required writing format for this course. Additional support for academic writing and AMA format is provided throughout the coursework as well as at the UNE Portal for Online Students.

Online resources: AMA Style Guide

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The College of Professional Studies uses Turnitin to help deter plagiarism and to foster the proper attribution of sources. Turnitin provides comparative reports for submitted assignments that reflect similarities in other written works. This can include, but is not limited to, previously submitted assignments, internet articles, research journals, and academic databases.

Make sure to cite your sources appropriately as well as use your own words in synthesizing information from published literature. Webinars and workshops, included early in your coursework, will help guide best practices in APA citation and academic writing.

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Course Evaluation Policy

Course surveys are one of the most important tools that University of New England uses for evaluating the quality of your education, and for providing meaningful feedback to instructors on their teaching. In order to assure that the feedback is both comprehensive and precise, we need to receive it from each student for each course. Evaluation access is distributed via UNE email at the beginning of the last week of the course.

Late Policy

Students are responsible for submitting work by the date indicated in Brightspace.

Quizzes and Tests: Quizzes and tests must be completed by the due date. They will not be accepted after the due date.

Assignments: Unless otherwise specified, assignments will be accepted up to 3 days late; however, there is a 10% grade reduction (from the total points) for the late submission. After three days the assignment will not be accepted.

Discussion posts: If the initial post is submitted late, but still within the discussion board week, there will be a 10% grade reduction from the total discussion grade (e.g., a 3 point discussion will be reduced by 0.3 points). Any posts submitted after the end of the Discussion Board week will not be graded.

Please make every effort ahead of time to contact your instructor and your student support specialist if you are not able to meet an assignment deadline. Arrangements for extenuating circumstances may be considered by faculty.

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Student Handbook

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Academic dishonesty includes, but is not limited to the following:

  1. Cheating, copying, or the offering or receiving of unauthorized assistance or information.
  2. Fabrication or falsification of data, results, or sources for papers or reports.
  3. Action which destroys or alters the work of another student.
  4. Multiple submissions of the same paper or report for assignments in more than one course without permission of each instructor.
  5. Plagiarism, the appropriation of records, research, materials, ideas, or the language of other persons or writers and the submission of them as one's own.

Charges of academic dishonesty will be reviewed by the Program Director. Penalties for students found responsible for violations may depend upon the seriousness and circumstances of the violation, the degree of premeditation involved, and/or the student’s previous record of violations.  Appeal of a decision may be made to the Dean whose decision will be final.  Student appeals will take place through the grievance process outlined in the student handbook.