Chapter 36

The most common types of health care-associated infections are _________.

urinary tract infections

Over the past 100 years, the decrease in deaths due to infectious disease has been somewhat offset by an increase in death due to metabolic diseases.

true

Brian lives in a town where 98% of the population is immunized against measles. Brian is unlikely to get measles, despite the fact that he has never been immunized. This situation demonstrates the concept of _______.

herd immunity

The Public Health Security and Bioterrorism Preparedness and Response Act identifies select agents and identifies a Tier 1 subset of particularly hazardous microorganisms.

true

The Centers for Disease Control estimate that _______ of all hospital patients acquire some type of health care-associated infection.

between 5 and 10 percent

eliminate source

chemotherapy: antibiotics administered to end infectivitiy; disinfection: UV irradiation of a hospital room

Chlorination of water supplies represents an epidemiological technique directed at ________.

eliminating sources of infection

The Public Health Security and Bioterrorism Preparedness and Response Act governs the ________ of select agents.

all of the answers are correct

Check all of the parameters that are monitored by public health practitioners to identify population health issues.

Genetic background, Environmental conditions, Behaviors/lifestyle choices, Emerging infectious agents, Antimicrobial resistance

Morbidity rate is an important parameter used by epidemiologists to measure disease. If there are 10 new cases of measles per 10,000 individuals in a population in a two-month period, the morbidity rate is ________.

0.1%

Which of the following is a mechanism by which new susceptible individuals enter a population?

Birth of new individuals and migration of individuals into the population

What has been the greatest change on public health over the past century as a result of public health surveillance?

Cases of pneumonia and tuberculosis went up due to antimicrobial resistance as new drugs were developed.

Which of the following terms refers to a sudden increase in the occurrence of a disease above the expected level?

Epidemic

Which of the following statements is false regarding the efforts made by the U.S. government to prepare for a potential bioterrorism attack?

FBI screening of all laboratory workers who have access to potential agents of bioterrorism

The first epidemiologist was _________.

John Snow

Public health surveillance is the proactive evaluation of _________.

all of the choices are correct

Which of the following is a major cause of health care-associated infections in the United States?

Staphylcoccus aureus

Consider the links in the chain of infection. Which of the links is broken when the susceptible members of the population are immunized?

Susceptibility

Increasing global population, overcrowding, and international travel have contributed to many changes in epidemiological trends of infectious disease. Which of the following would have been just as likely to occur a century ago as today?

The incidence of bubonic plague in humans, transmitted via the rat flea, is gradually increasing in the United States with most of the cases reported in the west.

Consider the following hypothetical situation. Researchers doing influenza surveillance involving molecular analysis of recent isolates of the virus notice a major change in the H and N antigens. What is a likely outcome?

The number of cases of influenza will increase significantly.

Healthcare-associated infection (HAI)

a patient's own fecal microbes end up in their urinary tract catheter, inhalation of fungal spores from flowers delivered to the hospital room after surgery, a bloodstream infection from a nurse's injection with a contaminated needle

A _______ epidemic is characterized by a sharp rise to a peak then a rapid, but not as pronounced, decline in the number of individuals infected.

common source

Which of the following terms refers to a disease that maintains a relatively steady, low-level frequency at a moderately regular interval?

endemic

Alternatively, if such increases occur only within a given population, this may indicate that there is an epidemic_________ at hand.

epidemic

Consider the links in the chain of infection. Which of the links is broken when hands are thoroughly washed?

exposure

break connections

sanitation: pasteurization of milk and juices; sanitation: regular restaurant inspections

Eight 10-year-olds in the community became sick within a 24-hour period with vomiting and diarrhea. Personnel from the health department interviewed the children and their families, attempting to determine the source of the illness. Which piece of information below is most suggestive of the common source?

All eight children attended the same birthday party two days prior to becoming ill.

Which type of epidemic usually results from the introduction of a single infected individual into a susceptible population?

Propagated

A group of scientists that are studying the spread of Lyme disease suspect that it is spreading north due to movement of the tick vector brought about by climate change. What application(s) below would assist with this study?

Remote sensing and geographic information systems

Healthcare-associated infections are of huge concern to healthcare personnel, causing 88,000 deaths annually. What measures would be recommended for prevention and control of healthcare-associated infections? (Check all that apply.)

Routine hand washing, Wearing gloves when contacting bodily fluids like blood or saliva, Use of aseptic technique by hospital personnel

The public health measures implemented in the 1900s have greatly changed the quality of life in the United States today, either directly or indirectly. How? (Check all that apply.)

Implementation of strict sanitation guidelines, Widespread use of vaccines, Increased life expectancy

Infectious diseases can emerge or reemerge for a variety of reasons. What sort of data could reveal changes that are likely to lead to the emergence or reemergence of an infectious disease? (Check all that apply.)

Increasing drug resistance to a commonly used antibiotic, Decrease in immunization use against the disease, Climate changes leading to an increased range of a vector,

Using the fictitious epidemiological data, complete the following sentences.

It appears that pathogen A peaks in April and then becomes minimally detectable in the population by the month of July. Should hygiene play a role in the spread of pathogen A, then national awareness and education activities should peak in January and February. If crowds are to be avoided at all costs, then people should avoid crowds between the months of March and June.

Authorities have established an integrated system of laboratories so that a rapid and coordinated response to bioterrorism is in place. This conglomerate of laboratories is maintained by the ________.

Laboratory Response Network (LRN)

The single most effective and practical way to prevent the spread of infection among patients is _________.

attentiveness of health care providers and patients to hand washing

A disease is considered _____________ if it is constantly present at low levels within a population.

endemic

The best measure for preventing health care-associated infections is to prohibit visitors from bringing flowers and balloons to patients.

false

While recovering in the hospital from heart-bypass surgery, Gerald was infected with rotavirus from his 3-year-old granddaughter when she came to visit him and used the bathroom in his hospital room. This is an example of a nosocomial infection.

false

Active immunization of a population will raise the general level of herd immunity.

true

After an infectious disease has been identified in a population, the next step is to correlate the disease outbreak with a specific organism.

true

Health care-associated infections may develop within any health care facility.

true

Healthcare-acquired infections (HAIs) increase the length of hospital stays, escalate healthcare costs and are responsible for thousands of deaths annually. Hospitals respond by forming infection control committees that allocate resources to control and prevent HAIs.

true

The burgeoning human population, extensive global travel and past overuse of antibiotics all contribute to the development and spread of microorganisms.

true

Vaccines using inactivated pathogens do not stimulate cell-mediated immunity as effectively as vaccines using attenuated pathogens.

true

not a likely bioterrorism agent

tuberculosis, leprosy, sleeping sickness, malaria, common cold, mumps

______ immunity is an epidemiological concept that explains the resistance of a population to infection and the spread of an infectious organism due to the immunity of a high percentage of the population.

Herd

Measles reached an all time low in the United States when the CDC declared it eliminated in 2000. In 2014, 667 cases were reported and cases continue to occur in clusters throughout the country. Which of the following provides the most plausible explanation for this reemergence?

Parents, worried that vaccines may cause harm to their child, decide not to vaccinate, effectively reducing the herd immunity for any given disease.

An influenza virus from a chicken and an influenza virus from a human both end up in a pig, resulting in influenza viruses containing mixed genetics and mixed H and N surface receptors. This is an example of antigenic shift. What are the likely results of this event? (Check all that apply.)

This influenza virus is no longer recognized by the immune system of the human. The population of susceptible individuals will increase. Morbidity rates will increase. The level or protection provided by herd immunity will decrease.

Which of the following is an example of a noncommunicable infectious disease?

Urinary bladder infection

What is the number one type of healthcare-associated infections in the United States?

Urinary tract infections

Community- acquired

an oral-fecal infection acquired from work as a nursing home assistant, A heptitis A infection from eating at a local restaurant, influenza inhaled after someone sneezes on you in the grocery store parking lot

Potential bioterrorism agents

anthrax, smallpox, plague, hantavirus

A patient infected with HIV by a partner in 1997 responds well to treatment and exhibits a viral load of 0 in 2007. Shortly thereafter, the individual reconnects with the partner that infected them with HIV a decade earlier and after embarking on a sexual relationship, the patient's viral load climbed to 24,000/ml. This is an example of __________.

antigenic drift

To understand the nature of these epidemics and how they occur, one must understand how the effects of major genetic change to the pathogen, called ___________, differs from the effects of minor genetic change to the pathogen, called __________________.

antigenic shift, antigenic drift

_______ are the leading cause of health care-associated diseases.

bacteria

Healthcare-associated infections are commonly caused by ___________.

bacteria of the microbiota

The intentional or threatened use of viruses, bacteria, fungi, or toxins from living organisms to produce death or disease in humans, animals, and plants is known as _________.

bioterrorism

An infected individual who is a potential source of infection for others and plays an important role in the epidemiology of the disease is a(n) _________.

carrier

decrease susceptibility

chemotherapy: prophylactic medicines when traveling

In contrast, if an epidemic arises from a noncommunicable disease, then it is considered a ____________ epidemic and there is a _______ rise in the number of cases.

common-source, rapid

Epidemiologists are interested in how infectious diseases spread within populations, especially those diseases that are _______________, meaning spread easily from person to person.

communicable

The impact of public health measures in the United States has resulted in a(n) ________ in infectious disease-related deaths over the past 100 years.

decrease

The U.S. government has invested national effort into creating a biological weapons defense. The initiatives include ______. (Check all that apply.)

development of improved detection and diagnostic systems, preparation of clinical microbiologists and their laboratories as first-responder teams, a stockpile of specialized vaccines and medicines for civilian protection

A disease will be ________ likely to circulate in a community with a high percentage of individuals who are immune to the disease.

less

A ______ rate measures the number of individuals who become ill as a result of a specific disease within a susceptible population during a specific time period.

morbidity

The ______ rate is the relationship of the number of deaths from a given disease to the total number of cases of the disease.

mortality

The organism that causes plague, Yersinia pestis, is transmitted from rodents to humans via the rat flea and causes bubonic plague. Left untreated, it can progress to pneumonic plague and spread from human to human in respiratory droplets. In this scenario, bubonic plague is _________ and pneumonic plague is _________.

noncommunicable; communicable

The sudden, unexpected occurrence of a disease in a limited segment of a population is called a(n) _________.

outbreak

A(n) _______ is an increase in disease occurrence within a large population over a very wide region (usually the world).

pandemic

If sudden increases in disease occurrence occur worldwide, this may indicate the development of a _________________.

pandemic

Infectious disease outbreaks often follow certain patterns, with specific terms used to designate each pattern. Match the term with the recognized pattern of disease associated with that term.

pandemic- increase in disease around the world common-source epidemic- peak level reached in short period of time, followed by rapid decline propagated epidemic- slow rise, followed by gradual decline in cases

The ______ rate refers to the total number of individuals infected at any one time regardless of when the disease began.

prevalence

If an epidemic arises from a communicable disease, then it is considered a ________ epidemic where there is a _______ rise in the number of cases.

propagated, slow

The natural site or environmental location in which the causative organism is normally found is called the _________.

reservoir

A new pathogen infects a person at time zero in the graph. Infected people spread the disease to others over the next 30 days but thankfully, everyone recovers in a few days after getting sick. Which of the following describes why the "susceptibles curve" in red goes downward over time?

the susceptibles curve goes down because many of the infected people become well and therefore they are now immunized against repeated illness

An infection that is incubating in a patient at the time of admission and which develops clinical symptoms during the patient's stay in a healthcare facility is not considered to be a health care-associated infection.

true

Antigens in vaccines are mixed with an adjuvant to enhance the rate and degree of immunization.

true

Precautions that can be taken by individuals to prevent travel-related infectious diseases include _________.

wash hands with soap and water frequently and get or update vaccinations appropriate for specific destinations

To determine the frequency of an infectious disease event, epidemiologists calculate which of the following?

all of the choices are correct

Which of the following contributes to the emergence of new diseases?

all of the choices are correct

Which of the following is used to reduce or eliminate the source of an infection?

all of the choices are correct

Which agency is specifically responsible for the monitoring of disease and the implementation of prevention and control strategies in the United States?

Centers for Disease Control and Prevention

In response to the events of September and October 2001, the U.S. government created a number of agencies and committees to counteract terrorism under the auspices of the __________.

Department of Homeland Security

A geographic information system (GIS) is a data management system that helps to chart infectious disease data. For what type of situation would this system be most effective?

Determining if a tick living at high elevation is associated with an outbreak of the vector-borne Lyme disease

A graduate student is researching the spread of mosquito vectors and dengue fever into the southern United States. She has collected a substantial amount of data regarding the locations where the vector has been detected as well as the incidence of the dengue fever virus in both the vector population and in humans. What application would enable her to effectively illustrate patterns of vector and disease spread?

Geographic information systems

Infectious diseases can either fall in the category of communicable or noncommunicable. Communicable diseases are represented by diseases such as ________.

Gonorrhea, acquired through sexual contact with a partner infected with the bacterium Neisseria, Influenza, acquired by inhaling respiratory droplets laden with the influenza virus, Hepatitis A, acquired through the fecal-oral route from exposure to the hepatitis A virus

Which of the following is NOT a Tier 1 agent?

Hantavirus

Prevention and control information is particularly useful to determine the public health threat of a specific infectious agent. If one were to make a table of this information, what would the table contain? (Check all that apply.)

Whether or not a vaccine is available, What type of chemotherapy is effective, How is the agent disseminated or transmitted, What diagnostic test is available

During 2007, there were 3.6 new cases of pertussis per 100,000 susceptible individuals in the United States, part of a steady increase that has been occurring since the 1980s. (http://www.cdc.gov/pertussis/clinical/index.html). This statistic illustrates the term ______.

incidence

The first case in an epidemic is called the _________ case.

index

Which of the following is the major focus of epidemiologists?

Both the discovery of factors essential to disease occurrence and the development of methods for disease prevention

Check all of the measures that are employed by epidemiologists to control a chain of infection.

Breaking the connection between the source of the infection and susceptible individuals, Reducing or eliminating the source of infectio,Reducing the number of susceptible individuals

Considering well-known bioterrorism attacks in the United States, how were the Rajneeshees able to infect so many people with Salmonella enterica serovar Typhimurium?

By contaminating local restaurant salad bars with the agent

Outbreaks of food-borne illnesses, such as hepatitis A, occasionally arise in chain restaurants necessitating a flurry of activity by epidemiologists to characterize the risk factors and likelihood of an epidemic. Factors they must monitor are __________.

disease frequency over time, which involves the number of affected people, the population exposed and total population

There are many things that people can do to help prevent the spread of infectious disease. Match each term with the action that it represents.

disinfection-use of bleach on kitchen countertops sanitation-routine treatment of drinking water chemotherapy-use of antibiotics for a bacterial infection

Ebola Fever would be classified as a communicable noninfectious disease.

false

Most organisms that cause health care-associated infections come rom endogenous sources.

false

Surveillance of health issues is typically accomplished by two methods: population surveys and antibiotic treatment.

false

The Department of Health and Human Services maintains the system for monitoring bioterrorism events.

false