Case Study 5: Outbreak in a School Setting Session Overview | Homework Solution

Case Study 5: Outbreak in a School Setting Session Overview

Instructions

For this exercise, you will be asked to work in groups to participate in an outbreak investigation in a school setting. Information regarding the scenario will be provided in parts, each of which will be followed by related discussion questions. Choose one group member to read each segment of information aloud to the rest of the group. After receiving the information, work as a team to answer each discussion question.

Intended Audience

All public health, medical, veterinary, pharmacy, emergency management, hospital, and other professionals interested in public health preparedness and field epidemiology.

Time Required (estimated)

90 minutes

Learning Objectives

• Describe the school nurse’s role in responding to and managing an infectious disease outbreak
• List the steps of outbreak investigation in a school setting Outbreak in a School Setting
• Discuss ways that schools can work with local public health authorities for effective outbreak response
• Create a case definition
• Write main points for a letter to parents about a school outbreak

Case Study 5: Outbreak in a School Setting Pre-Test

1. True or False: A school nurse is not required to report an outbreak to the local health

2. What data can be used to determine whether an outbreak is occurring in a school setting?
   1. Comparison of current rates of disease observed among the population with baseline rates in the same group Outbreak in a School Setting
   2. Comparisons of the current absenteeism rate with baseline rates
   3. Interviews with students and/or their parents on their condition and possible exposures
   4. All of the above
   5. A and C only

3. True or False: Once case definitions for probable and confirmed cases are developed, they cannot be

4. Which of the following information would NOT be included in a message to parents about a school outbreak?
   1. A summary of the outbreak to date Outbreak in a School Setting
   2. A list of control measures
   3. Signs and symptoms of the disease
   4. Instructions on proper hygiene practices
   5. Information about treatment
   6. Indicators of severe illness requiring hospitalization
   7. Contact information for the school nurse
   8. All of the above information should be provided

Case Study 5: Outbreak in a School Setting Student Guide

1. What control measures (if any) would you take at this point?
2. As a school nurse, are you required to report certain diseases or outbreaks to your local public health department? Should you report anything at this time? Who is the point of contact at your local health department?
3. What information should you gather to determine whether an outbreak is occurring?
4. Group Brainstorm: Have one member of the group write ideas on the flip chart. When you call the local health department to report the potential outbreak, what information should you be prepared to provide?
5. What are the steps of an outbreak investigation? Outbreak in a School Setting Are there additional considerations when the investigation is conducted in a school setting?
6. As a school nurse, would you be responsible for working with the local public authority to investigate and respond to this outbreak? If not, who would serve as the main liaison from the school to the health department? What are some of the responsibilities of the school liaison to the health department?

Table 1. Possible Cases as of January 13

* D = diarrhea; V = vomiting; F = fever; N = nausea; C = abdominal cramps; M = muscle aches

7. Based on the information provided, write case definitions for probable and confirmed (Hint: Case definitions determine who is counted as a “case” in an outbreak. They should always include criteria for person, place, time, and clinical features).
8. What types of environmental samples should be collected? Which laboratory tests will be conducted to determine if norovirus is present in the samples? Get Communication Trends Report Help!!
9. What is the difference between a cohort study and a case-control study? Which study design would be best in this situation?
10. Group Activity: Have one member of the group write ideas on a white board or flip chart. What do you communicate to parents at this point? As a group, draft 3-4 key points to include in a letter to parents (do not spend time on fine details, think about the major points you would cover).
11. Are student health records covered by HIPAA and/or FERPA? Are you Outbreak in a School Setting (as a school nurse) permitted to release personally identifiable information (PII) or protected health information (PHI) to the health department without written parental consent?
12. Based on these results, what control measures do you recommend? Does the lack of association with a specific food rule out the possibility that this was a foodborne outbreak?

References

Association of State and Territorial Health Officials. Comparison of FERPA and HIPAA privacy rule for accessing student health data. http://www.astho.org/programs/preparedness/public-health-emergency-law/public- health-and-schools-toolkit/comparison-of-ferpa-and-hipaa-privacy-rule/. Accessed April 6, 2016.

Centers for Disease Control and Prevention. Norovirus website. http://www.cdc.gov/norovirus/index.html. Updated December 30, 2014. Accessed April 6, 2016.

Centers for Disease Control and Prevention. Norovirus outbreak in an elementary school – District of Columbia, February 2007. Morb Mortal Wkly Rep.2008;56(51):1340-1343 Outbreak in a School Setting.

Centers for Disease Control and Prevention. Updated norovirus outbreak management and disease prevention guidelines. MMWR Rec Rep. 2011;60(RR03):1-15.

Minnesota Department of Health. Checklist for schools when outbreaks of gastroenteritis are suspected. http://www.health.state.mn.us/divs/idepc/dtopics/foodborne/outbreak/facility/checkl ist.html. Accessed April 6, 2016.

North Carolina Division of Public Health. Steps of an outbreak investigation. July 2012. http://epi.publichealth.nc.gov/cd/lhds/manuals/cd/conference/2012/2012_OB_invest igation_steps.pdf. Accessed April 6, 2016.

Schwab NC, Gelfman MHB. Legal issues in school health services a resource for school administrators, school attorneys, school nurses. New York: Authors Choice Press, p. 193; Outbreak in a School Setting 2005.

U.S. Department of Education. Family Educational Rights and Privacy Act (FERPA) and the disclosure of student information related to emergencies and disasters. June 2010. https://www2.ed.gov/policy/gen/guid/fpco/pdf/ferpa-disaster-guidance.pdf. Accessed April 6, 2016.