key: cord-0844682-xdfbdqgx
authors: Pratiti, Rebecca; Sud, Parul
title: A Call for Epidemic Assessment Questionnaire
date: 2020-09-02
journal: Environ Res
DOI: 10.1016/j.envres.2020.110150
sha: 707ff445c06caa384f15dd3f3ffd5588d7cb84c5
doc_id: 844682
cord_uid: xdfbdqgx

Epidemic outbreaks are a part of population and public health. The epidemiological triad of host, agent and environment are changing in their interaction with each other in the recent years. As health care professionals lack training and time to assess risk factors of epidemic, important information about epidemic source identification may be missed. Newer biological and chemical agents are continually being added in our environment with potential to cause acute or subacute epidemic of diseases. These factors should motivate us to draft and implement an accessible universal epidemic outbreak questionnaire with a good online database for early epidemic source identification. We have tried to formulate a universal questionnaire that, if needed may be used by providers if they suspect unusual occurrence of cluster of cases.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

All data cited confirms to Helsinki Declaration on human experiments. Being a review article, no institutional review board approval was obtained.

Abstracts: Epidemic outbreaks are a part of population and public health. The epidemiological triad of host, agent and environment are changing in their interaction with each other in the recent years. As health care professionals lack training and time to assess risk factors of epidemic, important information about epidemic source identification may be missed. Newer biological and chemical agents are continually being added in our environment with potential to cause acute or subacute epidemic of diseases. These factors should motivate us to draft and implement an accessible universal epidemic outbreak questionnaire with a good online database for early epidemic source identification. We have tried to formulate a universal questionnaire that, if needed may be used by providers if they suspect unusual occurrence of cluster of cases.

Merriam-Webster defines epidemic as a disease affecting or tending to affect a disproportionately large number of individuals within a population, community, or region at the same time.("Epidemic," 2020) Epidemics may be communicable or non-communicable, biological or non-biological cause, infectious or noninfectious, acute or subacute, natural or manmade, unifactorial or multifactorial; one thing they have all in common. Their significant effect on population health and their mitigation by identifying and removing the source. The branch of epidemiology is the study and analysis of the distribution, patterns and determinants of health and disease conditions in defined populations. (Rothman, 2012) Through centuries, many epidemiologists have strived to identify epidemic sources to improve population health. The renowned example being John Snow who is the 'Father of Epidemiology' for his pursuit in J o u r n a l P r e -p r o o f trying to prove cholera was caused by contaminated water even before the establishment of Germ theory. (Ruths, 2009 ) Some preventive measures derived from epidemiology may save money and improve health. While some measures may not save money though give substantial health benefit. (Cohen, Neumann, & Weinstein, 2008) Adding to this confusion is the basic training for epidemiology in health care professionals.

Barriers to epidemic source identification Health care professionals are trained to think of patient as a unit for treatment and the history is focused towards diagnosis and treatment. Because of this perception and time inadequacies; health care professionals may not capture disease related data that possibly may help an epidemiologist to deduct the cause of disease in a population. Eventually, patients may also forget key events and recall bias could influence data collection later.

Other than the non-communicable subacute epidemics of obesity, diabetes, heart disease, etc. most epidemics are rapidly progressive. Epidemics that are more localized have been observed around the world caused by a wide variety of organisms. From jaundice outbreak in India to Diphtheria outbreak in Kazakhstan, freshwater puffer poisoning in Bangladesh to the novel severe acute respiratory syndrome coronavirus 2 (SARSCoV 2) in China, it is not only arduous but almost impractical for health professionals to find the cause of epidemic at the beginning. By the time, when epidemiologists are involved to analyze data for identifying pattern; significant time, window of opportunity for disease prevention and valuable data may be lost adding to the burden of the disease. The worse part being some of these localized epidemics may spread and involve a large geographical area and possibly become pandemics. Epidemiology helps us to deduct the epidemic source related factors by statistical correlation testing. Correlations and causality not being same, poses the biggest challenge to epidemiology. And unfortunately; we J o u r n a l P r e -p r o o f still don't have a good mathematical formula or statistical test to confirm situation where correlation becomes causality. Unlike microbiology wherein Koch's postulates help us to some extent to prove causality of organism causing a particular disease.

Traditionally, epidemiology triad had focused on host, agent and environment factors. In the modern world, all these factors are changing dynamically individually and in their interaction with each other. The major changes being seen in environment. Urbanization and deforestation cause closer contact with animal host, insect vectors and higher contaminations possibility.

Deforestation does not only affect some trees and its habitat, they have far more effect on the whole ecological system. These effects are being augmented by the climate changes with warmer temperatures affecting viability of organisms. Some of the outbreaks related to these factors include the Hantavirus outbreak in Four corners area, West Nile Fever in United States, etc. (Engelthaler et al., 1999; Petersen et al., 2013 ) Some known viruses are being established in new geographical areas and some new viruses are being discovered that have not caused diseases till now. Adding to this is the environment pollution hazards caused by a countless number of novel chemicals. Minamata disease, Bhopal gas tragedy or BP oil spills, it is further difficult to characterize each chemical component and assess their effect on health. (Harada, 1995; Sharma, 2016 ) While some of these chemical effects may be found acutely, a vast majority have subacute presentation and hence establishing causality takes time. There are around 84,000 chemicals currently in market and possibly only about 13% or fewer have been studied for acute toxicity. (Binetti, Costamagna, & Marcello, 2008 Thus, an optimal universal questionnaire should include detailed evaluation of not only food and water source but also details of skin contact, chemical and work exposure. Answers for section one may not be entered in database to remove patient identifiers for data sharing. The epidemic questionnaire could be retained as a part of patient's medical records and the database entry could be done simultaneously or later if more clusters of cases are detected. A Google form database version for the epidemic questionnaire could be obtained by writing to the corresponding author.

The above discussion suggests a substantially critical condition, due to the significant increase in agent factors during the recent decades. It is evident that the scientific knowledge and regulatory systems are lagging behind about information on the exposures because of requirement of multidisciplinary approach, high amount of expertise, cost issues and time constraints. (Binetti et al., 2008) The solution of this problem though complicated, could arise from technological and methodological improvement. Organized national and international cooperation prioritized to a scale up strategy is required to progressively resolve epidemic related public health problems. (Koopmans et al., 2003 ; "Outbreak investigation questionnaire-Repository of questions (tool 5a),") The health field professionals and insurance companies may also spearhead changes to have in-built surveillance system to alert epidemic outbreaks with immediate access J o u r n a l P r e -p r o o f to data, knowledge sharing and expert advice in epidemiology in a Health Insurance Portability and Accountability Act (HIPAA) compliant way to help prevent future major outbreaks. In summary, a universal epidemic outbreak questionnaire may act as an adjunct tool for early epidemic source identification for mitigating its effect on public health.

A modelling approach for correcting reporting delays in disease surveillance data

Exponential growth of new chemicals and evolution of information relevant to risk control

Visceral leishmaniasis diagnosis and reporting delays as an obstacle to timely response actions in Nepal and India

Does preventive care save money? Health economics and the presidential candidates

Climatic and environmental patterns associated with hantavirus pulmonary syndrome, Four Corners region, United States

The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak-an update on the status

Minamata disease: methylmercury poisoning in Japan caused by environmental pollution

Timeliness of Measles Laboratory Reporting and Factors Associated with Delays

The challenge: chemicals in today's society. Paper presented at the Identifying and Reducing Environmental Health Risks of Chemicals in Our Society

Early identification of common-source foodborne virus outbreaks in Europe

Estimated cumulative incidence of West Nile virus infection in US adults

Epidemiology: an introduction

The lesson of John Snow and the broad street pump

A tale of two tragedies: Bhopal gas leak in India and BP oil spill in US: Indian Institute of Management

Assessing reporting delays and the effective reproduction number: The Ebola epidemic in DRC

J o u r n a l P r e -p r o o f

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f