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Disease Detectives C - Disease Detectives Division C Exam - University of Chicago C - 01-22-2022

You will have 50 minutes to complete the test. If you have any questions, don't hesitate to reach out to [email protected] or [email protected]. Best of luck!

1. (1.00 pts) Concurrent outbreaks of the flu and COVID-19 would be an example of:

A) Pandemic

B) Epidemic

C) Syndemic

D) Cluster

2. (1.00 pts)
You have discovered a new pathogen that you believe may cause severe encephalitis in cows. Choose all of the following that must be true in order for this causation to be
established. (hint: use Koch’s Postulates)

A) All cases of the severe encephalitis in cows show appreciable amounts of this pathogen in the affected tissue.

B) All cows that do not present with this severe encephalitis do not contain this pathogen within them.

C) The pathogen, when isolated from diseased cows, can be grown in pure culture.

D) The pathogen, when grown in pure culture, causes the severe encephalitis when reintroduced into a healthy and susceptible cow.

E) The pathogen, when reisolated from this infected cow, is identical to when it was introduced to the cow.

3. (1.00 pts) Health events that are reported by health practitioners chosen to represent a certain geographic area is an example of what type of surveillance:

A) Symptomatic surveillance

B) Syndromic surveillance

C) Sentinel surveillance

D) Active surveillance

4. (1.00 pts) What kind of outbreak is this?

Source: CDC

A) Point source

B) Continuous common source

C) Intermittent source

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D) Propagated (progressive)

5. (1.00 pts) Malaria is caused by (circle all that apply):

A) Mosquitoes

B) A Plasmodia

C) A virus

D) A bacteria

6. (1.00 pts) A disease is most effective at spreading through a population when it has:

A) Low infectivity and low virulence

B) High infectivity and low virulence

C) Low infectivity and high virulence

D) High infectivity and high virulence

7. (1.00 pts) An individual spreads disease by sneezing. Which of the possible terms could apply to this form of spread? Circle all that apply.

(Mark ALL correct answers)

A) Direct transmission

B) Indirect transmission

C) Droplet transmission

D) Airborne transmission

8. (1.00 pts) Primary care advice as part of a routine consultation would be considered as part of:

A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

D) Quaternary prevention

9. (1.00 pts) What type of study is best for rare diseases?

A) Case control study

B) Ecological study

C) Cohort study

D) Cross sectional study

10. (1.00 pts) What type of study is best for rare exposures?

A) Case control study

B) Ecological study

C) Cohort study

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D) Cross sectional study

11. (1.00 pts) Which type of study is best for measurements of time relationship?

A) Case control study

B) Ecological study

C) Cohort study

D) Cross sectional study

12. (1.00 pts) Which type of study has the highest risk of confounding?

A) Case control study

B) Ecological study

C) Cohort study

D) Cross sectional study

13. (1.00 pts) Pathologic changes begin to take place in which stage of natural history?

A) Stage of susceptibility

B) Stage of subclinical disease

C) Stage of clinical disease

D) Stage of recovery, disability, or death

14. (1.00 pts) When deciding whether a higher specificity or a higher sensitivity of a test is important, we should consider the prevalence of the disease in the population.

True False

15. (1.00 pts) A preventative measure is put into place that addresses the clinical disease stage. This is:

A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

16. (1.00 pts) A preventative measure that addresses the subclinical disease stage is:

A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

17. (1.00 pts) A preventative measure that addresses the susceptibility stage is:

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A) Primary prevention

B) Secondary prevention

C) Tertiary prevention

18. (1.00 pts)

Ten probable cases of a disease characterized by fever, vomiting, and diarrhea visited the same buffet restaurant last week. Which mode of transmission is least likely?

A) Waterborne

B) Food-borne

C) Airborne

D) Vector-borne

19. (1.00 pts) A bacterium mutates and causes less severe disease than before. This represents a change in its:

A) Pathogenicity

B) Infectivity

C) Virulence

20. (1.00 pts) Of the person-place-time triad, this method of data organization is best for time:

A) Epidemic curve

B) Line listing

C) Cluster map

D) Subdivided table

21. (1.00 pts)

For the following 4 questions, refer to the figure below. This set of graphs is an (informal!) data visualization of scented candle reviews. It was produced after one Twitter user
suggested negative reviews complaining about lack of scent might align with COVID-19 case numbers (since, as you certainly know, lack of smell is a COVID symptom). U.S. COVID
numbers peaked in April, July/August, and November/December 2020.

Source: @kate_ptrv. “I couldn’t just walk past this Tweet, so here is some fun #dataviz Scented candles: An unexpected victim of the COVID-19 pandemic 1/n.” Twitter, Nov. 27 2020
19:59, https://twitter.com/kate_ptrv/status/1332398737604431874. (https://twitter.com/kate_ptrv/status/1332398737604431874.)

This graph shows:

A) Correlation

B) Causal inference

C) Causation

D) Covariance

22. (1.00 pts) If you wanted to superimpose a graph of COVID data to examine the association, you would most likely use:

A) Prevalence

B) Incidence

C) Attack rate

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D) Burden of disease

23. (1.00 pts) Imagine Yankee Candleland Health Department decides to monitor COVID case numbers by tracking scented candle reviews. This would be a type of:

A) Passive surveillance

B) Active surveillance

C) Active surveillance

D) Syndromic surveillance

E) None of the above

24. (3.00 pts) Suggest a possible confounding factor or bias that could have influenced these results.

Expected Answer: Lots of possibilities. Maybe more people are just buying scented candles for the holidays around october and november– these are the only 2 data points (oct and
nov) where there is a significant uptick in negative reviews (the error bars don’t overlap)

25. (5.00 pts) Complete the chain of infection diagram:

Expected Answer: 1. Reservoir 2. Portal of exit 3. Mode of transmission 4. Portal of entry 5. Susceptible host

26. (1.00 pts)

For the next five questions, match the pattern of disease to each case (outbreak, sporadic, endemic, pandemic, epidemic).

There were 80 cases of mononucleosis reported in Chicago in 2018 and 2019. In 2020, there were 150 cases reported from local hospitals. In 2021, there was an increase in cases
as well.

Epidemic

27. (1.00 pts) This year, there were 2 reported cases of tetanus in the Chicagoland area.

sporadic

28. (1.00 pts) Each year, there are roughly 200 to 500 million cases of malaria reported globally. In 2020, there were 300 million cases reported.

Endemic

29. (1.00 pts) On average, there are 25 reported cases of influenza a year at your high school. Last year, there were 50 reported cases.

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Outbreak

30. (1.00 pts) In 1968, a strain of the influenza A virus originated in Hong Kong and spread across Asia, North America, and Europe. The mortality rate was about .5%.

Pandemic

31. (4.00 pts) Identify the four main types of biological agents that can cause disease.

Expected Answer: 1. Bacteria 2. Virus 3. Fungi 4. Parasite Also prion could be an acceptable answer?

32. (3.00 pts) Identify the three types of disease caused by biological agents.

Expected Answer: Infection Allergy Toxicity

33. (1.00 pts)

For the next six questions, refer to this scenario. Give your answers to two decimal places.

Suppose the current prevalence of COVID-19 in the city of Chicago is 0.042%. Studies have shown that highly accessible testing is essential to the control of COVID-19. As such,
you are developing a new rapid test. In your clinical trial of the test, you compared your results against that of RT-PCR (the gold standard) to get this data:

What is the sensitivity of the rapid test as a percent? Do not include the % symbol in your answer.

71.19

34. (1.00 pts) What is the specficity of the rapid test?

98.96

35. (1.00 pts) What is the positive predictive value of the rapid test?

92.82

36. (1.00 pts) What is the negative predictive value of the rapid test?

94.81

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37. (5.00 pts)

RT-PCR has a 95% sensitivity and a 99% specificity. Knowing this, knowing the sensitivity and specific of the rapid test that you calculated above, and knowing that 0.042% of peopl
in Chicago actually have COVID-19, calculate the probability that an individual who has a positive rapid test but a negative RT-PCR actually has COVID-19. Give your answer as a
percent, but do not include the % symbol. Round to two decimal places.

0.15

38. (3.00 pts) What are some implications/consequences of having a low sensitivity but a high specificity?

Expected Answer: Is good at finding true negatives, but not super good at identifying true positives. This can lead to missing some people who are actually positive, which could lea
to increased disease spread.

39. (3.00 pts)

For the next six questions, please refer to this scenario:

50 people go to a party and 31 of them begin to feel ill. After partygoers are interviewed, eating peach ice cream is determined to be a risk factor. The following 2x2 table is produced
from the survey data:

What type of study is this? Circle all that apply:

(Mark ALL correct answers)

A) Retrospective

B) Prospective

C) Cohort

D) Case-control

E) Observational

F) Experimental

40. (1.00 pts) Calculate the relative risk. Give your answer to the third decimal place.

1.625

41. (2.00 pts) Is there an association between peach ice cream and disease? Explain.

Expected Answer: This relative risk > 1 suggests an association between eating the peach ice cream at the party and getting sick.

42. (1.00 pts) Calculate the odds ratio. Give your answer to the third decimal place.

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3.88

43. (3.00 pts)

Generally speaking, is the odds ratio or the relative risk you calculated a better indication of the correlation between eating peach ice cream and falling ill? (Consider the relationship
between the two: what does the relative risk represent? What does the odds ratio represent?)

Expected Answer: Relative risk is generally a better indicator as it is more easily/intuitively interpreted

44. (3.00 pts)

Through a culture of the patients’ blood samples, the disease is determined to be typhoid fever! According to the rare disease assumption, will the odds ratio or the relative risk be a
better indicator of the correlation in this situation?

Expected Answer: The relative risk is still a better indicator: even though the disease is rare in the population, within the sample there is a very high incidence and the two stats will
differ.

45. (4.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577) (https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

What is the statistical method used by the authors when rates were compared between groups with similar characteristics? What statistical phenomenon does this control for?

Expected Answer: Blocking, confounding

46. (2.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

The use of a placebo guarded against what type of bias?

response bias

47. (2.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

What was the case definition of “Severe Covid-19”?

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Expected Answer: At least one of the following: Clinical signs at rest that are indicative of severe systemic illness; respiratory failure; evidence of shock; significant acute renal,
hepatic, or neurologic dysfunction; admission to an ICU; or death

48. (3.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

What type of study is this? Observational or experimental? How do you know? What subcategory of the chosen type is this study?

Expected Answer: Experimental, randomized controlled trial - participants were assigned to treatment groups by the researchers.

49. (5.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

Randomization of participants to treatment groups in this study allowed conclusions to be drawn regarding causation or generalizability to the human population as a whole? Why no
the other choice?

Expected Answer: Causation Not generalizability - can’t extrapolate to children younger than the study population or to pregnant women (needs follow-up study - see page 10)

50. (3.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

What side effects were shown to be statistically significantly more likely to occur in individuals who received the vaccine compared to those who received the placebo for people aged
16-55 years for Dose 2?

Expected Answer: Fever, Fatigue, Headache, Chills, Diarrhea, Muscle Pain, Joint Pain

51. (6.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

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A major part of public health is messaging and communicating with the population, which is part of both Steps 11 and 13 of the Steps to Control an Outbreak. What data from this
study would you use in vaccine messaging in order to build trust?

Expected Answer: Safety and efficacy data; analysis that included breakdown based on sex, race/ethnicity, age; huge number of participants; low number of adverse events…any
other reasonable answer that draws on the case study

52. (8.00 pts)

This question refers to the following case study: "Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine." https://www.nejm.org/doi/full/10.1056/nejmoa2034577
(https://www.nejm.org/doi/full/10.1056/nejmoa2034577)

A major roadblock in the effective control of the pandemic and vaccine rollout has been serious disparities in vaccine access and uptake among socioeconomically disadvantaged
populations and certain racial/ethnic groups. Propose 4 general or specific strategies to increase vaccine access to these populations.

Expected Answer: Language and culturally specific targeted messaging, community health workers, subsidized vaccine doses, messaging by trusted members of communities/role
models, diversity in media advocating for it, any other reasonable answer

53. (5.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

In your own words, name the steps involved in contact tracing and explain its value in the greater context of public health.

Expected Answer: Case-patients are identified, identify who needs to be notified, treat each case based on appropriate method, etc.

54. (2.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

What form of transmission is associated with the Ebola virus?

Expected Answer: zoonotic/vector note: NOT portal of exit/entry

55. (3.00 pts)

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This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

Refer to Figure 1A. What type of epi curve is depicted? Explain your reasoning.

Expected Answer: Propagated source

56. (3.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

What type of study is this? Observational or experimental? How do you know?

Expected Answer: Observational - nothing is controlled the study just reports on the contact tracing already in place

57. (3.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing) (https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

Define overdispersion. What are the two ways that overdispersion can be described (according to the study)?

Expected Answer: “we describe the extent of this phenomenon in 2 ways: first, by assessing the proportion of infectious persons linked to 80% of onward transmission using
methods described by Endo et al. (22); and second, by estimating the dispersion parameter (k)using methods described by Althaus (23)”

58. (2.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

What were the three methods used to determine case-patients in the study?

Expected Answer: 3 identification mechanisms: passive detection at healthcare facilities from persons manifesting symptoms consistent with EVD, house-to-house active case-
finding by community health workers, and tracing the contacts of EVD case-patients.

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59. (8.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

Contact tracing works to determine susceptible hosts (in the Chain of Infection diagram). Propose a strategy that could work in tandem with contact tracing to mitigate EVD
prevalence and identify which component of the Chain of Infection it targets.

Expected Answer: Answers will vary; depends on what component they choose but there should be a very clear connection between the two

60. (6.00 pts)

This question refers to the following case study: "Novel Use of Capture-Recapture Methods to Estimate Completeness of Contact Tracing during an Ebola Outbreak, Democratic
Republic of the Congo, 2018-2020.” https://drive.google.com/file/d/1VrK-v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing (https://drive.google.com/file/d/1VrK-
v8ZtpZak4oZXxJObFBuOE-kEU5iJ/view?usp=sharing)

The journal states that “[the] findings suggest that contract tracing efforts were very successful at identifying case-patients with >1 contact but much less successful at identifying
case-patients with contacts who later had EVD symptoms.” Suggest two improvements to the experiment that will target contacts who develop symptoms later on.

Expected Answer: something about longevity and follow-up of program, prolonged interaction with case patients, etc

Here is some background information about dengue fever that may be useful for the following questions:

The incubation period of dengue is 5-7 days. There are four dengue serotypes, or four different viruses that can cause dengue fever disease. About 25% of infected patients show
symptoms. Fever, body aches, nausea, and rash are common symptoms.
Source: “Dengue for Healthcare Providers: Clinical Presentation.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 13 Sept. 2021,
https://www.cdc.gov/dengue/healthcare-providers/clinical-presentation.html.

61. (3.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf)
The epidemic curve in figure 2 suggests which type of outbreak?

Expected Answer: Propagated– increasingly large peaks 1 incubation period apart. Even though this is a vector-borne disease it is spread from person-vector-person and can follow
person-person direct transmission trend

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62. (2.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf) (https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)
(https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)

What is the agent in this outbreak?

Expected Answer: DENV and mosquito vectors

63. (3.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf) (https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)
(https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)

What is the host in this outbreak? Name 3 specific risk factors addressed in the study that relate to the host.

Expected Answer: host: Susceptible population in Sundia Possible risk factor answers: sex, age, literacy, marital status

64. (3.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf) (https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)

What is the environment in this outbreak? Name 3 specific risk factors addressed in the study that relate to the environment.

Expected Answer: Lots of water, damaged sanitation infrastructure from earthquake (2nd to last pp of intro), season of year (just after monsoon season.) Lots of possibilities, accept
a reasonable answer; risk factors: Many possible answers (table 2, some of table 3; season/time of year)

65. (10.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf) (https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)

Which level of prevention (primordial/primary/secondary/tertiary) does each of the suggested dengue interventions constitute? Which step(s) in the chain of transmission does it
attempt to break?

a. Bed nets
b. Fogging/spray machine
c. Health education program
d. Dengue rapid diagnostic test kits
e. Cyclopoid copepods

Expected Answer: a. primary prevention - portal of entry b. primary prevention - mode of transmission c. primordial prevention - portal of entry d. secondary prevention - reservoir e.
primary prevention - mode of transmission

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66. (5.00 pts)

This question refers to the following case study: “Outbreak Investigation of Dengue Fever in Sundia, Chakaiser, Shangla, Pakistan–2008.” https://www.ayubmed.edu.pk/JAMC/26-
4/Nighat.pdf (https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf) (https://doi.org/https://www.ayubmed.edu.pk/JAMC/26-4/Nighat.pdf.)

This study suggests the implementation of a “strong surveillance system” for controlling Dengue in Pakistan. Dengue is endemic and fairly common in Pakistan, especially in urban
areas. Pakistan’s healthcare system is not very robust with limited funding for diagnostic testing. Consider these factors and the characteristics of dengue disease. Which type of
surveillance (passive/active, sentinel, symptomatic) would be the best in this scenario? Why?

Expected Answer: Passive sentinel– symptomatic and active surveillance are best for outbreak scenarios (not when it is endemic and not readily diagnosable by symptoms alone).
General passive surveillance requires a relatively robust system where diagnosis and communication can occur at every hospital location

Congratulations for finishing the test and best of luck for your other events!

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