On March 21, a physician notified the Belfast Department of Human Resources (BDHR) of a dramatic increase in acute gastroenteritis among students at a college in Carrollton, Belfast. (Carrol

health & medical writing question

see attached file.
Requirements: Accordingly to questions
College of Health Sciences
PBH 405 Chronic and Infectious Disease Spring Semester 2023
Assessment Type: Case-Study
Weighting: 10%
Conditions of Assessment: Individual AssignmentOut of class preparation
Due Date: Wednesday, March 22nd, 2023
Project Description:
For this experiential assignment in Chronic and Infectious Disease, the following realistic case, based on an outbreak investigation undertaken in Belfast, Ireland is presented for your careful review and consideration.
Carefully read each section of the case and formulate a thoughtful, well-structured response to each question following the respective section. Your responses should be written in paragraph form.
Note: Certain aspects of the original outbreak and investigation have been modified for purposes of this assignment
Salmonellosis in Belfast A Case Study
PART I. OUTBREAK DETECTION
On March 21, a physician notified the Belfast Department of Human Resources (BDHR) of a dramatic increase in acute gastroenteritis among students at a college in Carrollton, Belfast. (Carrollton is a small town located in western Belfast [population estimate: 16,250] and is the county seat of Carroll County [population estimate: 64,900].)
The physician reported examining hundreds of students with a gastrointestinal illness at the colleges infirmary during the previous week. The majority of students reported having abdominal pain and watery diarrhea of several days duration.
Typically, approximately 100 students were examined at the infirmary each day, the majority of whom presented with upper-respiratory infections or injuries. On March 20 alone, over 200 students were examined at the infirmary for gastroenteritis.
Question 1: Do you think these cases of gastrointestinal illness represent an outbreak at the college? Why or why not? (2%)
The physician reported that stool specimens had been collected from selected ill students and had been submitted to the hospital laboratory for testing. Because the physician had an interest in parasitology, he had specifically requested that the stools also be examined for parasites. The physician reported that cultures for bacterial pathogens had been negative. On microscopic examination, four specimens were determined to be positive for salmonella. The earliest known onset of illness among the Salmonella -positive students was March 11.
Question 2: How is Salmonella transmitted? On what sources of infection should public health officials focus? (See Appendix A for additional information about Salmonella.) (2 %)
Staff from GDHR contacted the Carroll County Health Department about the outbreak. Because the majority of the ill students lived on campus and participated in the university meal plan, concerns were voiced regarding possible foodborne transmission of the infection at the college. Within a few hours of the initial report, an environmental health specialist from the Carroll County Health Department was dispatched to the college to interview food service staff and to inspect the kitchen at the main cafeteria for food safety problems. Meanwhile, staff from BDHR undertook steps to determine whether the salmonellosis problem extended beyond the college.
Question 3: What existing sources of information might help determine if others in the community have salmonellosis? (1%)
PART II. DESCRIPTIVE EPIDEMIOLOGY AND HYPOTHESIS GENERATION
To characterize the salmonellosis cases and to seek clues about the source of the Carroll County outbreak, investigators from BDHR examined medical records from patients with acute gastroenteritis examined at the local hospitals emergency department.
During January 14 through March 25, a total of 99 patients were examined at the emergency
department for acute gastroenteritis. The number of visits increased from 8??12 each week
through the first week of March to 22??28 each week during the last 2 weeks of March. Among the 65 patients with acute gastroenteritis examined at the emergency department
since March 11, when the first Salmonella-positive student had onset of illness, the following symptoms were reported: diarrhea (defined as three or more loose stools/day) (87%), stomach pain (80%), nausea (67%), vomiting (33%), fever (30%), and muscle aches (20%). Patients often reported that their diarrhea was watery. Approximately half of patients reported that their symptoms had been present 6 hours6 days after infection at the time they presented to the emergency department.
Patients ages ranged from younger than a year to 76 years (mean: 34 years); 63% of patients were female. The majority of the patients lived within Ulster city limits as opposed to other parts of the county outside the city. Cases did not appear to cluster by neighborhood of residence, child care center, or school but were widely distributed around the city. Information on specific exposures was unavailable. Stool specimens, available from 25 patients, were forwarded to the England Health Department for examination. Salmonella was identified in 11 (44%) of the 25 specimens. One stool from a child aged 2 years was also positive for Giardia.
Question 4: Interpret the descriptive epidemiology of the outbreak. Were symptoms among patients consistent with salmonellosis? Was clustering of cases by selected demographic characteristics apparent? What was the course of the outbreak and did it appear to be over? (2%)
Investigators contacted the directors of the four nursing homes in the Carrollton area. The three nursing homes connected to the public water supply reported substantial numbers of residents with acute gastroenteritis. The nursing home that used a well for their water supply reported no residents with acute gastroenteritis. On the basis of this information, the County Health Department issued a boil-water advisory on March 25.
Question 5: What is a boil-water advisory? How would you go about implementing one? What actions might improve the effectiveness of such an advisory? (2%)
Question 6: What studies or investigations might you undertake to confirm the hypothesis
that the public water supply was the source of Ulsters salmonellosis outbreak? (1%)
Appendix A
Salmonellosis information found at

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