EPIDEMIOLOGY

3

Epidemiology

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Several factors can help account for an increased rate of the spread of E.Coli. Consumption of cattle products within the United States is one of the low hanging fruits. Generally most fast foods have a beef component in them. Most of the fast foods are usually produced in highly integrated production systems that make it easy for cross contamination. Milk and milk products are also a possible source of E.Coli. Poor cooking techniques can easily result in the E.Coli being undestroyed as it is taken up by the human being. In a scenario where those infected are unrelated it could stem from a product bought in a production line with low titers of the bacterium that became clinically relevant in those with weaker immune systems.

Human beings once infected are a mode of transmission of E.Coli. This mode could also account for increased infection rates. More devastating results are associated with food handlers when they are infected (Coggon, n.d.). However in a food handlers scenario it is easier to trace since those infected are likely to report as having been at a similar shop or outlet. Poor hand hygiene can easily result in the bacteria finding its way in the foods being prepared. In cases where animal refuse is used as manure. It is very possible to have E.Coli on the various vegetables being grown using that said manure. There are instances where lettuce has been found contaminated with E.Coli. Other channels for the spread of E.Coli would be through contaminated water systems. This means that if there are shortcomings in the integrity if a piping system, E.Coli can easily make its way into the water supply and affect multitudes of water users. Swimming pools can also act as reservoirs of E.Coli when introduced by an infected person, these can then be acquired by others using the pool.

DNA fingerprinting is a critical tool in the identification of the source of an epidemic. The principle behind it is that fragments of DNA are extracted from the bacteria within the epidemic and compared with previous bacterium from other epidemics. In case there are similarities, it is safe to conclude that the two epidemics are related. In instances where there are no close semblances, it is assumed that the two outbreaks are distinct and independent of each other. DNA fingerprinting is necessary though cannot be used as the single source of truth (Reporting Timeline | Outbreaks | E.Coli | CDC, 2019). In this case above, the DNA fingerprint was necessary as it helped eliminate the possibility of a relationship between the two outbreaks. The isolates that appear similar are 2, 3, 4,6,and 7. They are different from the controls. The DNA fingerprinting did not yield any helpful conclusions are the comparisons were not leading to any beneficial direction. In case they would have been similar, the conclusion would have been easier and more logical.

A case definition is helpful in demarcation of the lines of focus during an investigation. While multiple microorganisms carry the innate ability to cause a bloody diarrhea, there is a given series of symptoms are likely to occur together in an E.coli outbreak. To help identify them, clinicians and the public are guided by the case definitions. Case definitions are helpful especially on public health surveillance for publicly notifiable illnesses (Surveillance Case Definitions | NNDSS, n.d.). However, the ideal definition of case definition may easily miss out on the atypically presenting illnesses. This can easily leave out infected persons who may not report their condition and hence end up spreading the illnesses. It is thus important to combine other surveillance protocols such as contact tracing fo those identified to be positive along with case definitions.

A significant difference is noted in the age distribution with a majority of those infected in the current case being of the ages of 20-29 while in the other 1997 case children of ages 1-9 accounted for the high number of infections. This clear difference would give direction to the nature of questions I would ask. I would be interested in the nature of games that this children engage in during their free time. I would ask concerning any pets that they may be spending time with. I would seek to establish whether the other children affected interacted with each other. I would want to know about their kindergarten and daycare center and whether there might be a link in the whole continuum resulting in the massive illnesses within that specific population age group.

The paper acknowledges that there has been a significant level of progress in the nature of data quality in the present times. However the paper goes into detail to elaborate the process of generation of predictive data, which while advantageous also carries without a number of shortcomings. Predictive data is able to save on a number of issues. Elements such as time are easily saved when a person is able to sit through and scientifically extrapolate information to draw more relevant and needed conclusions. Labor used to generate the primary data is also minimized. The quality of primary data and valued attached to it is significantly increased when that data is set to be used for other multiple extrapolations. This then implies that the parties involved are very likely to invest much more in collection and quality of the primary data since they will be using it for a longer while. This model serves best in the developed countries which in most cases have their systems used as the prototypes upon which the metrics and formula of extrapolation are based upon.

Developing countries are however sidelined through this model. This is basically because the methods used in extrapolation barely pay attention to the needs and structures in these nations. Data sets are arrived at for which the nations using them are not able to explain. One of the disadvantages is that policy makers have to make blind decisions based on vague data or alternatively commission more research. This compounds issues since a majority of donor partners, who are usually based in the developed world are usually unwilling to fund such researches (AbouZahr et al., 2017). The lack of funds and inaccurate data leaves these nations with no option but make decisions that they cannot validate. The ripple effect of the same is failed systems and cyclic blame games at the expense of the uncared for patients. A model that contextualizes the actual challenges and structures within developed countries will need to be pursued. The frameworks on which the data is extrapolated needs to be in such a way that it pays attention to what this nations need.

References

AbouZahr, C., Boerma, T., & Byass, P. (2017). Bridging the data gaps: do we have the right

balance between country data and global estimates? Global Health Action, 10(sup1), 1299978. https://doi.org/10.1080/16549716.2017.1299978

Coggon, D. (n.d.). Epidemiology for the uninitiated | The BMJ. Www.Bmj.Com.

https://www.bmj.com/about-bmj/resources-readers/publications/epidemiology-uninitiated

Martin, E. T. (n.d.). Genetic detectives: how scientists use DNA to track disease outbreaks. The

Conversation. Retrieved March 20, 2020, from https://theconversation.com/genetic-detectives-how-scientists-use-dna-to-track-disease-outbreaks-57462

Reporting Timeline | Outbreaks | E.coli | CDC. (2019, January 11). Www.Cdc.Gov.

https://www.cdc.gov/ecoli/reporting-timeline.html

Surveillance Case Definitions | NNDSS. (n.d.). Wwwn.Cdc.Gov. Retrieved September 29, 2020,

from https://wwwn.cdc.gov/nndss/case-definitions.html

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