1. Which of the following is a condition which may occur during the incubationÂ
period?Â
a. Onset of clinical illness
b. Receipt of infection
c. Signs & symptoms of disease
d. Transmission of infection
e. Isolation of disease carrier through quarantineÂ
Rationale: The incubation period is defined as the interval from receipt ofÂ
infection to the time of onset of clinical illness. Accordingly, individuals mayÂ
transmit infectious agents during the incubation period as they show no signs ofÂ
disease that would enable the isolation of sick individuals by quarantine.
2. Chicken pox is a highly communicable disease. It may be transmitted by directÂ
contact with a person infected with the varicella-zoster virus (VZV). The typicalÂ
incubation time is between 10 to 20 days. A boy started school 2 weeks afterÂ
showing symptoms of chicken pox including mild fever, skin rash, & fluid-filledÂ
blisters. One month after the boy returned to school, none of his classmates hadÂ
been infected by VZV. The main reason was:Â
a. Herd immunity
b. All had been immunized prior to the school year
c. Contact was after infectious period
d. Subclinical infections were not yet detected
e. Disease was endemic in the class
Rationale: The disease is spread by contact with an infected individual who can
transmit the agent (VZV) to immunologically naive persons during theÂ
incubation period & for several days after onset of clinical illness. Since the boyÂ
started school 14 days after showing signs consistent with chicken pox, it isÂ
most likely that he was no longer infectious.
3. Which of the following is characteristic of a single-exposure, common-vehicleÂ
outbreak?Â
a. Long latency period before many illnesses developÂ
b. There is an exponential increase in secondary cases following initial exposuresÂ
c. Cases include only those who have been exposed to sick personsÂ
d. The epidemic curve has a normal distribution when plotted against the logarithm ofÂ
timeÂ
e. Wide range in incubation times for sick individuals
Rationale: Single-exposure, common-vehicle outbreaks involve a sudden, rapid
increase in cases of disease that are limited to persons who share a commonÂ
exposure. Additionally, few secondary cases develop among persons exposed to
primary cases. A histogram of the outbreak can plot the number of cases byÂ
time of disease onset. In single-exposure, common-vehicle outbreaks, a logÂ
transformation of the time of disease onset will often take on the characteristicÂ
shape of a normal distribution (i.e., a bell curve) with the median incubationÂ
time found at the peak of the curve.
4. What is the diarrhea attack rate in persons who ate both ice cream & pizza?Â
a. 39/52
b. 21/70
c. 39/67
d. 51/67
e. None of the above
Rationale:Â
The attack rate in this example is defined as the number of persons whoÂ
develop diarrhea divided by the total number of people at risk. In this example,Â
the at-risk group is those who have eaten both ice cream & pizza. Of these 52Â
persons, 39 developed diarrhea.
5. What is the overall attack rate in persons who did not eat ice cream?Â
a. 30%
b. 33%
c. 35%
d. 44%
e. 58%
Rationale:Â
The attack rate is the number of persons with diarrhea (14 + 9) divided by theÂ
total number of persons who did not eat ice cream (40 + 30).
6. Which of the food items (or combination of items) is most likely to be theÂ
infective item(s)?Â
a. Pizza only
b. Ice cream only
c. Neither pizza or ice cream
d. Both pizza & icecream
e. Cannot be assumed from the data shown
Among persons eating ice cream, over 70?veloped diarrhea regardless ofÂ
their pizza consumption (39/52 & 11/15). Among both groups of persons who did
not eat ice cream, each attack rate was equal to or less than 35% (14/40 &Â
9/30).