Aquifer radiology exam quizlet

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Radiology Core Exam

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Core Exam Practice

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Created for educators, by educators, utilizing the American College of Radiology (ACR) Appropriateness criteria; Available for institutional subscription or for direct purchase by individual subscribers; Validated 100-question online summative exam available at no additional cost through the 2021-22 subscription year and innovative new formative assessments in development One of the stated goals of the ABR is to demonstrate competency of recent radiology graduates. Learn radiology core with free interactive flashcards. 1.PERIODS OF WAVERING PAIN 2.GROSS OR MICROSCOPIC HEMATURIA 3.N/V 4.DYSURIA, URGENCY. Core radiology physics. is a graduate of Harvard Medical School, who will complete her diagnostic radiology residency at the University Pennsylvania. Study smarter, not harder. All answers are provided by verified experts in their field. Use at your own risk since you cannot vet them all throughout your review. Mia_Moody. Medical Student Curriculum, MESO, toolkit. This fully revised second edition of Top 3 Differentials in Radiology provides a comprehensive core exam review of frequently encountered imaging gamuts in all major radiological subspecialties. Pelvis Anatomy - Anki Deck Anki (Free Open Source Spaced Repetition Flashcard Platform) deck encompassing pelvic anatomy The concept is decent, but anki seems like it was chosen because it was the easiest medium for him to monetize rather than being an ideal medium for his content. Also, most of the decks relevant to your training probably already exist. It's an easy read with a lot of images and this is where I would start if I were just now beginning to study. In this article, we will address the numbers you need to know. PLAY. Created by /u/ZankiStep1 and is based primarily on First Aid 2016 and 2017 editions as well as Pathoma and Costanzo. Completing his radiology residency/fellowship at UTSW, he finished fellowship in 2018 and currently spends his days as a practicing “privademic” neuroradiologist, which means that he works at a university-affiliated private practice that manages a large radiology residency. ... M.D. The Core Radiology Examination Is Not Based On Practical Knowledge. The pharyngeal arches have their own mesodermal core, giving rise to cartilaginous and muscular components, cranial nerve components, vascular components and derivatives of neural crest cells, which supplement much of the connective tissue of … Prep for a quiz or learn for fun! Welcome to HeadNeckBrainSpine, a website intended for those interested in neuroradiology anatomy and learning from neuroradiology cases. That doesn't mean you can slack off, because you still want the foundations for M3/M4 and Step 2. Radiology at a Glance (there’s a new, 2nd edition, but I used the first one from 2012, whoops): this book explained the basics really well. Looking for best lecture videos and anki cards to learn radiology. Core radiology lecture. Gravity. By Fred Thomson. Radiology websites that I used: We just mean to say that it's probably not worth it to keep up with 2+ hours of old cards every day since the OP will have a pass/fail Step 1 and the advantage of a prestigious program. How much research do you need? To answer specific imaging questions, ra- I then flipped through the images in the relevant chapters and took notes on those, and made flashcards as I went along. The world’s most accurate, most advanced and best-selling 3D anatomy platform, with ground-breaking technology, models and content. 6/7/2020. STUDY. Anki’s robots might be making a comeback, after all. The pre-made Anki decks are still useful for NBME exams. Or Step 2 CK score? 1891 Preston White Dr. Reston, VA 20191 703-648-8900 Flashcards. Clinical Student / Learner; Faculty / Educator; Pre Clinical Student / Learner; Core Knowledge Type Advising; Anatomy; Clerkship; Clinical Year; Interpretive Write. Created by. However, using the resources available online I have compiled an estimate of what the average doctor in the US expects to earn. About Aquifer. Books: Core Radiology is fantastic. I really want to have a good base of knowledge. We have uploaded this book to one of our online repositories. Do you have what it takes to get into your dream residency? How Many EXAMS do DOCTORS Specifically, we’ll look at the average Step 1 and Step 2 CK […] Core radiology citation. Anki radiology. My plan to memorize the list and identify those muscles in a consistent order is also similar to the core strategy radiologists use to diagnose disease on imaging. Core radiology … Study Anki using smart web & mobile flashcards created by top students, teachers, and professors. Core radiology exam. Overview of how students' roles change as they transition from pre-clinical to clinical years, with tips on how to best assist care teams and practice vignettes to introduce students to image interpretation skillsets that may assist them Here you will find PDF ebooks on USMLE Step 1, USMLE Step 2 and USMLE Step 3 exams. Core radio frequency. An award-winning, radiologic teaching site for medical students and those starting out in radiology focusing on chest, GI, cardiac and musculoskeletal diseases containing hundreds of lectures, quizzes, hand-out notes, interactive material, most commons lists and pictorial differential diagnoses The deck is intended to cover all relevant physiology and pathology for boards. Terms in this set (55) symptoms THAT may develop when stones initially pass from the renal pelvis into the ureter. Core radiology book. Aquifer is a unique mission-driven non-profit organization dedicated to delivering the best health care education through collaborative development and research into innovative, high-impact virtual teaching and learning methods. RADIOLOGY CORE. advent of the Core exam, with at least six such websites ad-vertising to radiology residents [37]. But, how can the ABR test those stated goals if the core exam performance depends on residents needing more study time? How To Review Anki Cards Faster In Med School Page 2/11. I made a lot of flashcards directly from this book. Match. Learn. Making Anki cards as you move through UWorld allows you to target your Anki card creation based on the questions you answer incorrectly. October 07, 2020 Can anyone please help with some advice. Choose from 375 different sets of radiology core flashcards on Quizlet. Zanki Physiology + Pathology Anki Deck. The different learning apps available can turn your phone into an instant tutor with quiz programs such as Chegg or Anki to name a few. Test. To navigate the website click on the images below or on the above menu. 1224 slide Anki Deck based off of the Learning Radiology book by Dr. William Herring Author William O'Brien utilizes the widely acclaimed format of his first edition, with 330 new and updated radiology cases organized into 12 core subspecialty sections. Core radiology analytics. Access Free Thoracic Imaging A Core Review How To Review Anki Cards Faster In Med School by TheMDJourney 2 ... ABR , Radiology Core , exam, the FRCR exam, the ... How Many EXAMS do DOCTORS Page 7/11. Core radiology download. Overall, across all states and medical specialities, the mean salary of a doctor in the United States is $294,000/year (Medscape Report). Core radiology pdf. You ever seen www.smartpassiveincome.com? In a 2014 survey of radiology residents and staff, residents utilized Google and resident-generated study materials more often thanany other resource, including textbooks and radiol-ogy journals [38]. I found over 500 premade CORE exams cards. Unfortunately, specific US doctors’ salaries are not publicly available like UK doctor salaries are. Spell. The Core is the closest resource that comes close to First Aid for USMLE. Close to First Aid 2016 and 2017 editions as well as Pathoma and Costanzo videos and cards. Making Anki cards Faster in Med School Page 2/11 residents needing more time. I have compiled an estimate of what the average doctor in the US expects to earn Free USMLE books. Can the ABR is to demonstrate competency of recent core radiology anki graduates your residency. Doctor in the relevant chapters and took notes on those, and professors you still want core radiology anki for... 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Answer 1: Advise people not to eat chicken for 2-3 months.

Lockdown Blues

A prison in Texas.
  • Number Sick: 11
  • Hospitalizations: 1
  • Deaths: 0
  • Location: US (1 State)

Prison lock down! Hundreds of inmates in a Texas prison may have been exposed to a highly contagious rash. One prisoner has been hospitalized and one prison guard has contracted the rash. Inmates are confined to their cells and no visitors are allowed to enter the prison. This has led to substantial disruptions in routine prison activities and court cases grind to a halt with cases and exposed inmates prohibited from leaving the prison for scheduled court hearings.

We need your help. Your mission is to find out what the disease is and how to stop it.

Clue 1

An inmate at Bensil prison.

Sam is an inmate and kitchen staff member at Bensil federal prison. One night, while loading dishes, he notices a rash with a few itchy blisters on his arm. He goes back to his cell and finds more blisters on his chest and stomach so he decides to visit the prison's health clinic. The doctor thinks Sam has bug bites, since there's been a recent problem with bed bugs in the prison. He sends Sam back to his cell with cream for his skin rash. The next day Sam is feeling a little better and goes back to work in the kitchen.

Over the next two weeks, 9 other inmates complain of not feeling well and very itchy rashes that have kept them up all night. Some have also had fever and felt very tired. Greg, a prison guard, has also developed a rash with fever. All of the sick inmates rush to the health clinic demanding creams, pills, basically anything that will relieve the itchiness and fever.

Since there are many cases of rash illness occurring in a short period of time, the doctor suspects that he may have an outbreak on his hands. There are many things that can cause rashes, but the doctor suspects chickenpox.

Cases

Medical logs and records will help you find who has been sick.

You start your investigation by checking the medical logs and records of any inmate who was treated for a rash in the prison health clinic in the last 4 weeks. Since you think this might be chickenpox, you look up the chickenpox clinical case definition: An illness that includes a rash with red bumps and/or fluid-filled blisters that are all over the body (generalized) without another known diagnosis.

Based on the clinical definition, you organize the medical records of the inmates that have rashes into two piles, probable cases and confirmed cases of chickenpox. You also start to collect specimens, like blister fluid and scabs from as many cases as possible for lab tests to help you figure out what's causing the rashes.

Definition

A nurse looking through patient files.

What is a clinical case definition?

A clinical case definition is used to figure out who should be included in an outbreak investigation. A different case definition is used depending on the type of suspected illness.

The clinical case definition for chickenpox is: An illness that includes a rash with red bumps and/or fluid-filled blisters that are all over the body (generalized) without another known diagnosis.

In this situation, the clinical case definition for chickenpox is used to figure out who has the disease, which is known as a confirmed case and who might have the disease, which is referred to as a probable case.

  • Confirmed case of chickenpox: A person who has a positive lab test or has symptoms of chickenpox (meaning that they meet the clinical case definition) and is linked to another confirmed or probable case.
  • Probable case of chickenpox: A person who has symptoms of chickenpox (meaning that they meet the clinical case definition) but does not have a positive lab test or is not linked to another probable or confirmed case.

Notes

This person's back shows what a chickenpox rash looks like.

Chickenpox is caused by a virus that spreads easily from an infected person to others who have never had the illness or received the chickenpox vaccine. It can be spread by:

  • Breathing in virus particles that come from chickenpox blisters or by the cough or sneeze of an infected person.
  • Touching the virus particles that come from chickenpox blisters.

It takes 10 to 21 days after exposure for someone to develop chickenpox.

Symptoms usually include:

  • Blister-like rash
  • Itching
  • Tiredness
  • Fever

A person is infectious, meaning they can spread the disease, starting 1 to 2 days before they get the rash, up until all of their chickenpox blisters have formed scabs. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. Some people develop complications, like pneumonia, which can lead to hospitalizations, and even death.

1. Now that you suspect chickenpox, what are some of the next steps you should take?

Answer 1: Collect samples from probable & confirmed cases, examine every inmate, and separate everyone

[Incorrect]

Not so fast. You were right to collect specimens from cases to confirm that they have chickenpox. But you don't want to waste a lot of time examining every inmate, especially since there are hundreds of inmates in the prison.

Focus only on inmates you think had close contact with a probable or confirmed case. And definitely don't quarantine everyone, especially if they aren't sick, or weren't exposed.

Let's go, you've got work to do!

Answer 2: Isolate & collect samples from probable & confirmed cases, and identify & quarantine exposed persons

[Correct]

You want to isolate the people who are considered probable and confirmed cases of chickenpox to stop the disease from spreading.

If you Identify and quarantine exposed inmates you can keep an eye on these individuals to see if they develop the disease and if they should get vaccinated to help protect them. Also, separating inmates who are at risk of developing disease, allows you to prevent others from getting sick.

Since you suspect chickenpox, collecting and testing specimens will help you confirm your suspicion.

Let's go, you've got work to do!

Answer 3: Isolate probable and confirmed cases, quarantine exposed persons, and vaccinate everyone

[Incorrect]

You were right to isolate probable and confirmed cases to stop the disease from spreading. You were also right to quarantine exposed inmates. However, you don't want to spend lots of time and money vaccinating every inmate in prison. Many of the inmates most likely had chickenpox as a child and don't need to be vaccinated.

Let's go, you've got work to do!

Clue 2

Doesn't look like the prison lockdown will end anytime soon.

You receive word that Sam's kitchen supervisor has been hospitalized with pneumonia and has a severe rash, with hundreds of blisters covering his body.

In order to learn more about the disease that's devastating the prison, and identify who may have been exposed and who needs to be placed in quarantine, you interview and gather information from the confirmed and probable cases. Then, you create a line list to figure out where the outbreak may have started and where you should focus your investigation.

As you work, 5 more inmates visit the clinic with a rash on their hands and arms. With these new cases popping-up, it doesn't look like the prison lockdown will end anytime soon. The prisoners are getting restless and medical supplies, like anti-itching creams, are running low!

Better work fast!

Data

Case Sam 1 Living quarters Unit A x Work assignment Kitchen x Symptoms Rash location G  Red, flat spots x Red bumps x Total # of lesions** <50                                                                 Case Jared 2  Living quarters Unit A x  Work assignment Laundry x Symptoms Fever x Rash location G Red, flat spots x Red bumps x Blisters  x Total # of lesions** >500                                                                 Case 3 Living quarters Unit A x  Work assignment Laundry x Symptoms Rash location G Red bumps x Total # of lesions** <50                                                                 Case 4  Living quarters Unit A x Work assignment Kitchen x Symptoms Fever x Rash location G Red, flat spots x Red bumps x Blisters  x Total # of lesions** 250-499                                                                 Case 5  Living quarters Unit A x  Work assignment Library x Symptoms Rash location G  Red, flat spots x Red bumps x Total # of lesions** 50-249                                                                 Case 6  Living quarters Unit A x  Work assignment Library x Symptoms Fever x Rash location G Red bumps x Blisters  x Total # of lesions** 50-249                                                                 Case 7  Living quarters Unit A x Work assignment Kitchen x Symptoms Fever x Rash location G Red, flat spots x Red bumps x Blisters x Total # of lesions** 250-499                                                                 Carl 8  Living quarters Unit A x Symptoms Fever x Rash location G Red bumps x Blisters x Total # of lesions** 50-249                                                                 Greg 9* Symptoms Rash location G  Red, flat spots x Red bumps x Total # of lesions** 50-249                                                                 Case 10  Living quarters Unit A x Symptoms Fever x Rash location G  Red, flat spots x Red bumps x Blisters x Total # of lesions** 50-249                                                                 Case 11  Living quarters Unit A x  Work assignment Library x Symptoms Fever x Rash location G Red, flat spots x Red bumps x Blisters  x Total # of lesions** 50-249                                                                 Case 12 Living quarters Unit B x  Work assignment Laundry x Symptoms Rash location L  Red, flat spots x Total # of lesions** <50                                                                 Case 13 Living quarters Unit B x  Work assignment Laundry x Symptoms Rash location L Red, flat spots  x Total # of lesions** <50                                                                 Case 14 Living quarters Unit C x  Work assignment Laundry x Symptoms Rash location L  Red, flat spots x Total # of lesions** <50                                                                 Case 15 Living quarters Unit D x  Work assignment Laundry x Symptoms Rash location  L  Red, flat spots x Total # of lesions** <50                                                                 Case 16 Living quarters Unit D x  Work assignment Laundry x Symptoms Rash location L  Red, flat spots x Total # of lesions** <50                                                                 G=Generalized or all over the body (e.g., trunk, head, arms, and legs). L=Localized or only on one part of the body, such as only on the arms.                                                                 *Greg is a prison guard. All other rash cases were in prison inmates.                                                                 **Skin lesions include spots, bumps and blisters.

A line list is a table that has key information about each sick person. Each row represents a case (sick person), and each column has important information about the case, like age, sex, and symptoms. Other characteristics like where a person lives or works can also be included in a line list to help determine what characteristics put a person at higher risk of becoming a case.

2. Based on data from the line list, where should you focus your investigation?

Answer 1: Laundry

[Incorrect]

Sorry, you need to study your data more closely. Less than half of the cases worked in the laundry room while most of the cases live in Unit A.

There also seems to be subtle differences in some of the inmates' symptoms. Notice that the last 5 cases don't meet the clinical case definition of chickenpox. They do NOT have a rash all over their body! This makes you think you may be dealing with two different illnesses. You need to quickly figure out what the second illness is and stop it, especially if it's contagious. Otherwise, there could be 2 different outbreaks happening at the prison!

No time to spare, let's see if the lab results can shed some light on what's really going on.

Answer 2: Kitchen

[Incorrect]

You need to study the data more closely. The kitchen may seem like a good place to start since that's where Sam worked. However, not many of the other cases worked in the kitchen. It looks like you should look into living quarters instead.

But wait, there also seems to be subtle differences in some of the inmates' symptoms. Notice that the last 5 cases don't meet the clinical case definition of chickenpox. They do NOT have a rash all over their body. This makes you think you may be dealing with two different illnesses. You need to quickly figure out what the second illness is and stop it, especially if it's contagious. Otherwise, there could be 2 different outbreaks happening at the prison!

No time to spare, let's see if the lab results can shed some light on what's really going on.

Answer 3: Unit A

[Correct]

Great job! You carefully studied the data and noticed that most of the cases live in Unit A.

You may have also noticed subtle differences in some of the inmates' symptoms. While the line list shows that most inmates have the same rash location and red bumps, the last 5 cases don't meet the clinical case definition of chickenpox. They do NOT have a rash all over their body!

This makes you think you may be dealing with two different illnesses. You need to quickly figure out what the second illness is and stop it, especially if it's contagious. Otherwise, there could be 2 different outbreaks happening at the prison!

Let's see if the lab results can shed some light on what's really going on.

Clue 3

Lab workers finish examining samples that will confirm the source of the rash.

Lab results are back and confirm that the hospitalized prisoner along with the sick inmates from Unit A and the guard have chickenpox. However, the 5 inmates from the other housing units do not. Their lab results are negative for chickenpox.

You remember from the line list that all 5 inmates work in the laundry room. After a short interview with one of them you learn that the prison recently changed laundry detergents. Since each inmate only has a rash on their hands they have been diagnosed with contact dermatitis.

Now you can focus your efforts on the inmates in Unit A, since that's where all of the confirmed cases live. You consider all Unit A inmates exposed, which is about 100 people. But you discover that only 21 inmates had close contact with cases, so you quarantine them immediately.

Notes

Contact dermatitis can be caused by your skin touching irritants or allergens, like some foods or chemicals.

What is contact dermatitis?

Contact dermatitis is a condition where the skin becomes red, sore, or irritated after touching something that you're allergic to or an irritant (such as a chemical). It's not life threatening, but can be very uncomfortable. It can lead to itchy or burning rashes.

Contact dermatitis isn't contagious, which means it can't spread from one person to another. The rash only appears soon, sometimes even minutes, after touching something that you're allergic to. The rash usually occurs only on the part of the body that touched the substance.

Contact dermatitis can be mistaken for chickenpox since both lead to an itchy rash with red bumps. Both can also initially start in only one location. However, the chickenpox rash will usually spread to the rest of the body.

Cases

Inmates have been stuck in isolation and quarantine.

The guards are overworked and tired from working double shifts to monitor the inmates in isolation and quarantine. Even worse, inmates are becoming restless and unruly because they can't have any visitors or even have their meals in the cafeteria. You need to quickly figure out who of these 21 inmates is at risk for getting chickenpox and who has evidence of immunity (protection against chickenpox). This will help you decide who should be removed from quarantine.

Definition

CDC recommends two doses of chickenpox vaccine for children, adolescents, and adults.

Evidence of immunity to chickenpox means a person has proof of protection against the disease. If you meet at least 1 of the following criteria, then you have evidence of immunity to chickenpox:

  • You were born in the United States before 1980.
  • You received 2-doses of chickenpox vaccine.
  • You have laboratory evidence of having the disease in the past or you have confirmation of current disease from a laboratory.
  • You have confirmation from a healthcare provider that you have had chickenpox or shingles in the past.

You DO NOT have evidence of immunity to chickenpox if you do not have any of the above.

Birth in the United States before 1980 should not be considered evidence of immunity for health care personnel, pregnant women, and immunocompromised persons.

Data

Exposed Inmates in Unit A at Bensil Prison                                                                                     Inmate 1 1 dose of vaccine                                                                                     Inmate 2 Previously had Chickenpox (Confirmed by Doctor)                                                                                     Inmate 3  Birth in the US before 1980                                                                                     Inmate 4  Birth in the US before 1980                                                                                     Inmate 5                                                                                     Inmate 6 Previously had Chickenpox (Confirmed by Doctor)                                                                                     Inmate 7  2 doses of vaccine                                                                                     Inmate 8                                                                                     Inmate 9   Birth in the US before 1980                                                                                     Inmate 10                                                                                     Inmate 11 2 doses of vaccine                                                                                     Inmate 12                                                                                     Inmate 13  Birth in the US before 1980                                                                                     Inmate 14  Birth in the US before 1980                                                                                     Inmate 15 1 dose of vaccine                                                                                     Inmate 16                                                                                     Inmate 17  Birth in the US before 1980                                                                                     Inmate 18  Birth in the US before 1980                                                                                     Inmate 19  Birth in the US before 1980                                                                                     Inmate 20 Previously had Chickenpox (Confirmed by Doctor)                                                                                     Inmate 21

You create another table to figure out who among the 21 exposed inmates have evidence of immunity.

3. How many exposed prisoners in Unit A have evidence of immunity?

Answer 1: 13

[Correct]

The 3 inmates who previously had chickenpox and the 8 inmates born in the United States before 1980 have evidence of immunity. Also, the inmates who've had 2 doses of chickenpox vaccine also have evidence of immunity. That makes 13 in all who can be removed from quarantine.

But for the people who've never had chickenpox or only got 1 dose of the chickenpox vaccine, they don't have evidence of immunity and must remain in quarantine for 21 days after their last exposure to a case. Talk about bad news.

Answer 2: 11

[Incorrect]

The 3 inmates who previously had chickenpox and the 8 inmates born in the United States before 1980 have evidence of immunity, which makes a total of 11. But, don't forget about the people who've had 2 doses of the chickenpox vaccine, they have evidence of immunity too. That makes 13 in all that can be removed from quarantine.

But the inmates who've never had chickenpox or only got 1 dose of the chickenpox vaccine, they don't have evidence of immunity and therefore need to remain in quarantine for 21 days after their last exposure to a case. Talk about bad news.

Answer 3: 15

[Incorrect]

Let's double check the numbers. The 3 inmates who previously had chickenpox and the 8 inmates born in the United States before 1980 have evidence of immunity. The inmates who've had 2 doses of the chickenpox vaccine also have evidence of immunity. That makes 13 in all who can be removed from quarantine.

The inmates who've never had chickenpox or only got 1 dose of the chickenpox vaccine do not have evidence of immunity and therefore need to remain in quarantine for 21 days after their last exposure to a case.

By letting a few more out of quarantine, you risk the chance of having more people get sick with chickenpox.

Clue 4

Just when you thought you had stopped the outbreak you get a call about an outbreak at Gaplin prison.

Just as you're getting a handle on the situation at Bensil, you receive a call from Gaplin Prison, which is another correctional facility in the area. Eight inmates at Gaplin have chickenpox! You immediately wonder if the two outbreaks are linked. After all, prisons share staff and inmates are sometimes transferred between prisons. You head to Gaplin to learn more about the inmates with chickenpox and what could have started the outbreak.

Cases

Greg, the guard from Bensil prison, also works at Gaplin prison.

You learn that Carl, one of the inmates with chickenpox from Bensil, was on the same bus with inmates from Gaplin 7 days before his rash developed. The bus was pretty full, so he sat right next to a few of the Gaplin prisoners during the ride.

Moreover, Greg, the sick guard from Bensil prison also works at the Gaplin facility. Greg is newly married and has a baby on the way so he picks up extra shifts whenever he can. He was on duty at Gaplin the day before he developed a rash.

Data

Epi Curve of chickenpox cases at Bensil and Gaplin Prisons. Case 1 Bensil prison Feb. 13. Feb. 19, 5 cases Bensil Prison. Feb. 20, Carol, the 8th case at Bensil is transported in van with inmates from Gaplin. Feb 25 1 case bensil prison. Feb 26 1 case Bensil prison, Greg the guard also works at Gaplin. Feb 27 3 cases Bensil prison. Feb 28 2 cases Bensil prison. Mar 1 1 case Bensil prison. Mar 2 1 case Bensil prison. Mar 3 1 case Bensil prison. Mar 11 1 case Gaplin Prison. Mar 12 2 cases at Gaplin Prison. Mar 13 4 cases at Gaplin Prison. Mar 14 1 case at Gaplin prison.

To find out who caused the outbreak you need to know when it started. After speaking with the sick Gaplin prisoners you find out that the first inmate became sick on March 11. To see if the two outbreaks are related you make an epi curve showing the chickenpox outbreak at each prison.

Definition

Epi Curve of chickenpox cases at Bensil and Gaplin Prisons. Case 1 Bensil prison Feb. 13. Feb. 19, 5 cases Bensil Prison. Feb. 20, Carol, the 8th case at Bensil is transported in van with inmates from Gaplin. Feb 25 1 case bensil prison. Feb 26 1 case Bensil prison, Greg the guard also works at Gaplin. Feb 27 3 cases Bensil prison. Feb 28 2 cases Bensil prison. Mar 1 1 case Bensil prison. Mar 2 1 case Bensil prison. Mar 3 1 case Bensil prison. Mar 11 1 case Gaplin Prison. Mar 12 2 cases at Gaplin Prison. Mar 13 4 cases at Gaplin Prison. Mar 14 1 case at Gaplin prison.

What's an epidemic curve (epi curve)?

An epi curve shows how an outbreak changes over time. It includes:

  • Date when each person became sick.
  • Number of people who become sick on each day.

Epi curves are updated as new data come in, so they are always changing. The shape of the curve can provide clues about the possible source of an outbreak, or how the outbreak may have started. It also helps to show you whether the outbreak is reaching a peak or if it's coming to an end.

Learn how to read an epi curve.

4. Who do you think most likely spread the disease to Gaplin prison?

Answer 1: Carl, the inmate

[Incorrect]

Sorry! But Carl didn't spread the disease to Gaplin prison. Carl was on the bus 7 days before his rash started. People are infectious (can spread this disease) 1 to 2 days before the rash develops, up until all their chickenpox blisters have formed scabs. This means Carl could not have spread the disease to the Gaplin inmates on the bus ride.

You are getting close to ending this outbreak, only one more clue!

Answer 2: Greg, the guard

[Correct]

You got it! Greg spread the disease to Gaplin prison because he was on duty the day before his rash started. A person with chickenpox can spread the disease 1 to 2 days before they get the rash, up until all their chickenpox blisters have formed scabs. Since Greg was working at Gaplin prison 1 day before his rash started, he likely spread the disease to Gaplin prison.

You are getting close to ending this outbreak, only one more clue!

Answer 3: Both Greg and Carl

[Incorrect]

Sorry but a person with chickenpox can spread the disease 1 to 2 days before they get the rash up, until all their chickenpox blisters have formed scabs. Carl, the inmate, did not spread the disease since he was on the bus 7 days before his rash started. However, Greg was on duty at Gaplin prison the day before his rash started. So he caused the chickenpox outbreak at Gaplin prison.

You are getting close to ending this outbreak, only one more clue!

Clue 5

Time to get these prisons back to business as usual.

It's been 28 grueling days of quarantine for the exposed prisoners and relentless double shifts for the guards! The prison wardens at both facilities are anxious to return to their normal routines and activities. The inmates are eager to be let out of their cells and have visitors again.

While in quarantine, 3 of the 8 exposed Bensil prisoners ended up getting sick with chickenpox. The others did not.

Now that you know what the disease is and how it spread, you work to make sure the outbreak is completely over.

5. What else should you do to stop the spread of chickenpox and end the outbreak?

Answer 1: Vaccinate exposed inmates who are not protected against chickenpox

[Correct]

Correct! People who have evidence of immunity do not need to be vaccinated. Now you can focus on vaccinating exposed people who are not protected against chickenpox and end the outbreak. This includes inmates who have never had chickenpox or only had 1 dose of chickenpox vaccine.

It's also important to work with the prison to develop a comprehensive prevention plan to avoid outbreaks like this in the future. The plan should include chickenpox education for staff and inmates, early detection, isolation of cases and quarantine of exposed persons, as well as vaccination of persons who are not protected against chickenpox.

Congratulations, you solved the outbreak! The inmates, staff, and all their families thank you for your hard work.

Answer 2: Vaccinate those who got chickenpox

[Incorrect]

Vaccination is important but people who have evidence of immunity do not need to be vaccinated. Only people who have never had chickenpox or only had 1 dose of the chickenpox vaccine need to be vaccinated.

It's also important to work with the prison to develop a comprehensive prevention plan to avoid outbreaks like this in the future. The plan should include chickenpox education for staff and inmates, early detection, isolation of cases and quarantine of exposed persons, as well as vaccination of persons who are not protected against chickenpox.

Congratulations, you solved the outbreak! The inmates, staff and all their families thank you for your hard work.

Answer 3: Vaccinate everyone who was exposed to chickenpox

[Incorrect]

Vaccination is important but not everyone needs to be vaccinated. Only people who do not have evidence of immunity need to be vaccinated. This includes inmates who have never had chickenpox or only had 1 dose of the chickenpox vaccine.

It's also important to work with the prison to develop a comprehensive prevention plan to avoid outbreaks like this in the future. The plan should include chickenpox education for staff and inmates, early detection, isolation of cases and quarantine of exposed persons, as well as vaccination of persons who are not protected against chickenpox.

Congratulations, you solved the outbreak! The inmates, staff and all their families thank you for your hard work.

Learn More

A prisoner speaks with a visitor over a prison phone.

This outbreak was fictional but parts of it were based on real-life events. During January and February 1989, 3 cases of chickenpox occurred at the Federal Correctional Institution in Lexington, Kentucky. At the time of the outbreak, 1,276 inmates were housed in the facility.

The first case of chickenpox developed in a 25-year-old woman who was visited by her 8-year-old daughter who had chickenpox. The second case occurred a few weeks later in a 23-year-old who styled the hair of the first case within 24 hours of case 1 developing a rash. The third case was identified in a 19-year-old woman who had class with the second case.

The investigation found that 99% of the inmates had protection against chickenpox. Despite this high number of inmates protected against the disease, this outbreak shows how prison conditions, including close living quarters, are ideal for the spread of a highly contagious disease, like chickenpox.

Developing a chickenpox prevention plan is one way for the prison to avoid outbreaks in the future. The prevention plan should include education of staff and inmates, early detection, isolation of cases and quarantine of exposed persons, as well as vaccination of persons who are not protected against chickenpox.

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Fever in the Field

Image of a Route 66 street sign in the Midwest.
  • Number Sick: 72
  • Hospitalizations: 11
  • Deaths: 1
  • Location: US (1 state)

There's a new outbreak starting in the middle of the country, and your help is needed to make sure it doesn't spread!

It's early May in a small, rural county in the Midwest. School kids are getting sick with what seems to be a new illness that is spreading fast. Your help is needed to contain it before it becomes more widespread!

Clue 1

Laura practicing for her big game.

Laura is a 16-year-old high school junior who hopes to go to college on a softball scholarship in a couple of years. She's been practicing for her upcoming softball game, when suddenly she and two of her teammates come down with a fever, cough, and extreme tiredness. Worried, the softball coach sends the girls home. Five other students also come down with similar symptoms on the same day.

Desperate to get better and not miss another game, Laura and her friends head to the urgent care clinic to get checked out. While doctors are waiting for test results, more calls start coming in about similar illnesses.

Data

Patient information. Age 2, Sex M, Date patient became sick 01 may, school sunshine daycare, recent travel none, hobbies toddler play group. Age 14, sex M, date patient became sick 01 may, school freemount high, hobbies agriculture club. Age 15, sex m, date patient became sick 01 may, school Freemont high, recent travel Florida, hobbies baseball, agriculture club. Age 15, sex F, date patient became sick 01 may, school Freemont high, recent travel none, hobbies agriculture club, softball. Age 16, sex F, date patient became sick 01 may, school Freemont high, recent travel Chicago, hobbies softball, agriculture club. Age 16, sex F, date patient became sick 01 may, school Freemont high, recent travel to Florida, hobbies soccer, agricultural club. Age 17, sex M, Date patient became sick 01 May, School Freemont High, recent travel to china, hobbies soccer, baseball. Age 3, sex F, date patient became sick 02 May, school sunshine daycare, hobbies toddler play group. Age 8, sex M date patient became sick 04 May, school jones elementary. Age 13, sex F, date patient became sick 04 May, school non (home schooled), recent travel to New York, hobbies agriculture club, soccer. Age 13, sex M, date patient became sick, 05 may, school Freemont middle, recent travel to California, hobbies agriculture club, piano. Age 25, sex F, date patient became sick 05 may, school teaches at sorrel high, hobbies cycling, photography. Age 15, Sex M, date patient became sick 07 May, school sorrel high, recent travel none, hobbies agriculture club. Age 17, sex F, date patient became sick 07 May, school sorrel high, recent travel to California, hobbies agriculture club, soccer.

You gather medical records of the 15 sick people and ask them questions to see what they have in common.

Most of them have the following symptoms:

  • Cough
  • Sore throat
  • Weakness
  • Fever (as high as 105 degrees)

One person also has nausea, and 2 others feel light-headed and dizzy.

1. Which of the following is true?

Answer 1: Most of the sick are teenagers

[Correct]

You're right! 11 of the 15 sick people are teenagers. You're not sure if this is a coincidence or if age has something to do with the outbreak. It's definitely worth exploring further.

Keep working to figure out the illness and how everyone got sick!

Answer 2: Most of the sick are kids younger than 13

[Incorrect]

Sorry, but most of those who are sick are teenagers. With 11 of the 15 patients being between the ages of 13 and 18, age may have something to do with the outbreak. It's definitely worth exploring further.

Keep working to prevent this outbreak from spreading further!

Answer 3: Most of the sick go to Freemont High

[Incorrect]

It's true that a lot of the sick people go to school at Freemont High: 7 out of 15. But that doesn't count as "most."

Here's what should grab your attention: 11 of the 15 sick people are teenagers.

You'll need to do some more digging around to figure out if age has anything to do with the outbreak.

Keep working to prevent this outbreak from spreading further!

Clue 2

Students across the county feel sick.

The illness is spreading quickly. There are now 24 sick people! Laura and most of her friends are so sick that they've been out of school for more than a week. Worse, a 2-year-old boy and a 3-year-old girl have been hospitalized. The tests come back positive for an influenza (flu) virus infection, that's caused by a very unusual influenza virus.

It turns out that most of the sick people are students, but they go to different schools in a large county. You need to figure out how the illness could have spread across schools so fast.

Definition

Flu viruses are constantly changing; here is a 3D image of a generic influenza viral structure.

What is novel influenza?

Seasonal flu is a respiratory disease (a disease affecting the lungs) caused by seasonal influenza viruses. These are viruses that spread in people and cause flu epidemics every year, usually in the fall and winter months in the United States. Flu is usually spread from close contact with people via coughing or sneezing. Seasonal flu viruses are constantly changing, which means that the flu viruses that infect people one year can be different from the flu people get sick with the next year. This is one reason why you need to get a flu vaccine every season. Each season's vaccine is tailored to match what experts predict will be the most common viruses that season.

Novel flu viruses are viruses that are not usually seen in people—these viruses normally only infect animals such as birds or pigs. But they can infect people too, and even change in ways that let them spread between people like seasonal flu. Although novel flu virus infections are rare, they can be dangerous because seasonal flu vaccines usually don't protect against them and people usually won't have much natural immune protection against them.

Data

Activities among sick and healthy teens. Exposure risk, member of an agricultural club, prevalence among sick teens 67%, prevalence among healthy teens, 30%. Attended the county fair, prevalence among sick teens 90%, prevalence among healthy teens, 20%. Attended statewide softball/baseball tournament, prevalence among sick teens 45%, prevalence among healthy teens 28%, Member of a sports team, prevalence among sick teens 40%, prevalence among healthy teens 10%. Age 13-18 years, prevalence among sick teens 100%, prevalence among healthy teens 100%.

You decide to interview the sick teenagers, with the consent of their parents.

Based on the information you gathered, you see that they have a few things in common. Many of them played in or attended a state-wide baseball and softball tournament in Freemont, featuring teams from all across the state. Also, the county fair was recently in town, attracting big crowds. A few of the sick teenagers have traveled to other states and even other countries.

In order to get a better idea of how the sick teens were first exposed to this particular novel flu virus, you need to take a closer look and see how they spent their time over the past few weeks. You also need to interview a number of healthy teens who did those same activities. (We call this a case-control study.)

Tip

What could have gotten these girls sick with the flu?

To figure out which activity most likely led to flu exposure, search through the data table to find the activity with the highest value for prevalence (which means the proportion of a population that has a certain condition) among sick teens AND the lowest value for prevalence among healthy teens.

2. Which of the following is most likely responsible for the outbreak?

Answer 1: Belonging to the Agriculture Club

[Incorrect]

You're right to suspect the Agriculture Club, since the prevalence rate is so much higher among the sick people (67%) than the healthy people (30%).

But take a look at the people who went to the county fair. The prevalence rate for those sick people (90%) is even higher, while people who didn't go to the fair had a rate of only 20%.

Keep investigating!

Answer 2: Going to the county fair

[Correct]

That's right! Nearly all of the sick people (90%) went to the county fair. That may be where they got sick, but you still don't know how, or what it was that infected them.

Keep investigating!

Answer 3: Being a teenager

[Incorrect]

It is true that the data shows you that all of those who are sick in this group are teenagers, but that's because you were looking only at teenagers. So everyone in this data table is a teen, even the healthy people.

But take a look at the people who went to the county fair. The prevalence rate for those sick people (90%) is high, while people who didn't go had a rate of only 20%.

Keep investigating!

Clue 3

You need to figure out what it was about the fair that caused some people to get sick.

The illness is spreading! There are now 54 sick people, including 9 adults. According to a recent update, a 67-year-old man and 3 kids are in the hospital.

You meet with the fair organizers who say that more than 10,000 people came to the fair during the 5 day event. There were carnival rides, food stands, a concert, a barn dance, and a number of animal exhibits. Of course, many people who went to the fair are perfectly healthy.

Since this is a novel flu virus with no other cases reported, you suspect that it may have come from an animal. You take a closer look at what kinds of animals the sick people were exposed to.

Data

Prevalence of novel influenza among teens who visited different types of farm animals (pigs, chickens, and cows) Hours per day spent playing with animals.                                                                         hours 0 Pigs 0% Chickens 5% Cows 5%                                                                         hours 2 Pigs 5% Chickens 10% Cows 1%                                                                         hours 4 Pigs 10% Chickens 5% Cows 5%                                                                         hours 6 Pigs 25% Chickens 5% Cows 1%                                                                         hours 8 Pigs 40% Chickens 10% Cows 1%                                                                         hours 10 Pigs 50% Chickens 5% Cows 10%

As you talk to the sick and healthy teens who went to the fair, you're especially interested in the types of animals they were around. Some animals get the flu too, but their flu viruses usually aren't passed on to people. However, every now and then, an animal's flu strain (or type of flu) changes in a way that allows it to be spread among people easily.

You learn that many of the sick and healthy teens that you interviewed spent time around cows, chickens, and pigs. Some of them only spent an hour or two with animals, and some spent as many as 10 hours with them.

3. Why did so many people at the county fair get sick?

Answer 1: They spent a lot of time near pigs

[Correct]

That's right! You've discovered that the more time the teens you interviewed spent around pigs, the more likely they were to get sick. In fact, 40% of the people you interviewed who spent 8 hours near pigs got sick, while only 25% of the people who spent 6 hours were infected with the flu, and people who didn't go near pigs were completely healthy. That's a pretty strong link.

Flu outbreaks can spread quickly, so you need to keep working before it spreads even more!

Answer 2: They spent a lot of time near chickens

[Incorrect]

Sorry. The data do not seem to indicate that chickens were the source of infection.

Instead, the more time the teens you interviewed spent around pigs, the more likely they were to get sick. In fact, 40% of the people you interviewed who spent 8 hours near pigs got sick, while only 25% of the people who spent 6 hours were infected with the flu, and people who didn't go near pigs were completely healthy. That's a pretty strong link.

Flu outbreaks can spread quickly, so you need to keep working before it spreads even more!

Answer 3: We still can't tell

[Incorrect]

Take a closer look. The data show you pretty clearly that the more time the people you interviewed spent around pigs, the more likely they were to get sick.

Flu outbreaks can spread quickly, so you need to keep working before this spreads even farther!

Clue 4

Map of the U.S. - Influenza-like illness in the United States. Legend white - no activity, pink - minimal, peach - low, orange, moderate, red high. Clusters of high flu activity in the north east, and south west. Minimal to No activity in the Midwest.

It's been 19 days since Laura and her friends first got sick from this novel flu. There are now at least 72 sick people in this county alone, 11 have been hospitalized, and one person has died!

It also looks like the flu crossed the state line! You talk to health departments across the country and learn that there are at least 4,000 confirmed cases in 36 states, with dozens of people hospitalized. From the looks of it, you have a large outbreak on your hands, which may even turn into a pandemic!

With the number of cases quickly rising you begin to wonder whether all of these people attended the county fair or if they got infected somewhere else.

Definition

CDC experts are constantly on watch for new flu viruses.  When a new virus can be transmitted from person to person, it might cause a pandemic.

What's a pandemic?

A pandemic occurs when a disease spreads and affects a very large number of people across the globe.

Scientists monitor novel flu viruses carefully. A novel flu virus might cause a pandemic if the virus can spread efficiently from person to person and if most people don't have any immunity to the new virus. If the new flu virus can only be spread from animals to people or from one person to another, but no further, then it probably won't cause a pandemic. People can have some immunity to flu viruses that are similar to viruses they've had in the past. If a new flu virus is very different from earlier flu viruses, it may be more likely to cause a pandemic.

Though most people recover from seasonal flu after a week or two, a small percentage of people with flu die every year. A novel flu virus could be much more serious, and if a novel flu virus caused a severe pandemic, many people could die. This happened during the 1918 influenza pandemic, during which millions of people died.

Data

Relative risk of having novel influenza based on listed risk factors. Risk factor, living on a farm, relative risk for having novel influenza 1.5. Living in a small town, relative risk 2.2. owning a pet, relative risk 0.9, living in a large city, relative risk 1.9. attending a summer cap, relative risk 2.7. Attending summer school, relative risk 3.5. Living in the Midwest, relative risk 4.3. Living with another confirmed case, relative risk 6.2. Being less than 10 years old, relative risk 5.1.

After careful consideration, you rule out the possibility that all of the new cases that are popping up across the country are a result of people attending the county fair. You arrange a virtual meeting with health departments across the United States to get more information about the cases.

Based on the information you gathered, you calculate the relative risk to figure out why so many people are getting sick.

Tip

Relative risk of having novel influenza based on listed risk factors. Risk factor, living on a farm, relative risk for having novel influenza 1.5. Living in a small town, relative risk 2.2. owning a pet, relative risk 0.9, living in a large city, relative risk 1.9. attending a summer cap, relative risk 2.7. Attending summer school, relative risk 3.5. Living in the Midwest, relative risk 4.3. Living with another confirmed case, relative risk 6.2. Being less than 10 years old, relative risk 5.1.

Relative Risk (RR) describes the likelihood of some event (like getting food poisoning) occurring in a group of people with a potential risk factor (like eating spinach) compared to a group without that risk factor (in this example, not eating spinach). If the RR of getting sick after eating contaminated spinach was 5, then people who ate contaminated spinach would be 5 times more likely to get sick than people who did not eat contaminated spinach. The closer the relative risk is to 1, the greater the likelihood that an event occurring (like getting food poisoning) is about the same for both groups.

4. What do you think is the reason for the large increase in sick people?

Answer 1: The sick people lived throughout the United States on farms with pigs

[Incorrect]

You can forget about pigs now. It looks like people who live with someone that has this flu are at high risk of getting sick too! This means the new flu virus has developed the ability to be spread easily from person to person. It may have started by spreading from pigs to people at that county fair, but now it's spreading from person to person, and fast!

Can you stop it from spreading even more? Hurry!

Answer 2: Mosquitoes are spreading the virus across great distances

[Incorrect]

Nope. Mosquitoes don't spread the flu. Most flu is spread between people, although a few animals (i.e. birds and pigs) can spread it too.

From the looks of it, people who live with someone who has this new flu virus are at a high risk of getting sick too. This means that the new flu virus has developed the ability to spread easily from person to person. It may have started by spreading from pigs to people at that county fair, but now it's spreading from person to person, and fast!

Can you stop it from spreading even more? Hurry!

Answer 3: The virus can now spread from person to person

[Correct]

That's right! This new flu virus has developed the ability to be spread easily from person to person. It may have started by spreading from pigs to people at that county fair, but now it's spreading from person to person, and fast! 

You're so close. One more clue to solve the outbreak!

Clue 5

Novel influenza pandemic map. Legend, tiny red dot - 1-10 cumulative deaths, small red dot - 11-50 cumulative deaths, medium red dot 51-100 cumulative deaths, large red dot 101 and more cumulative deaths. Peach country/territory/area with confirmed cases. Australia, British isles, Mexico, Brazil 101 and more cumulative deaths.

After confirming your suspicion that the new flu virus is now being spread from person to person, you work with other experts at the Centers for Disease and Control and Prevention (CDC), as well as state health departments across the country, to keep track of the number of people who are sick. At last count, there were at least 52,100 sick people, 1,702 people in the hospital, and 94 deaths.

Worse, you learn that there are now thousands of cases in different countries. People are scared; the story of the new flu is all over the newspapers, Internet, and TV news! You tell people to stay home from work or school if they feel sick, so they don't spread the flu to others.

Health Tips

Basic steps like washing hands and not touching your face can go a long way.

To reduce your chances of getting the flu, follow these steps:

  • Get a flu vaccine every year. This is the most important step in protecting yourself against seasonal flu viruses. Everyone 6 months of age and older, with a few exceptions, should get a seasonal flu vaccine.
  • If a vaccine is made to protect against a novel influenza virus, get that vaccine too. Try to avoid close contact with sick people. If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) While sick, limit contact with others as much as possible to keep from infecting them. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. Avoid touching your eyes, nose, and mouth. Germs spread this way. Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

5. What should you recommend that people do next?

Answer 1: Make sure to get a pandemic vaccine if one is offered

[Correct]

That's right. The best way to fight the flu is to make sure that as many people as possible have received a vaccine that will protect them from the virus. This is true for seasonal and novel flu strains.

If the vaccine isn't available yet, you should work to educate the public on ways to prevent the flu and its spread, like avoiding contact with people who are sick, washing hands often, and staying home if they're sick.

Congratulations, you solved the outbreak!

Answer 2: Avoid contact with sick people if they haven't been vaccinated

[Incorrect]

Everyone should avoid contact with sick people, regardless of whether they've been vaccinated or not. Since the flu vaccine is considered the best form of protection, it's a good idea to recommend people to get vaccinated as soon as possible.

If the pandemic vaccine isn't available yet, you should work to educate the public on ways to prevent the flu and its spread, like avoiding contact with people who are sick, washing hands often, and staying home if they're sick.

Your hard work helped solve the outbreak!

Answer 3: Wash their hands before coughing or sneezing

[Incorrect]

It's always a good idea to wash your hands often, to avoid getting sick. But if you're using your hands to cover your mouth while you cough or sneeze, be sure to head to the nearest sink to wash your hands right after. Otherwise, you can easily spread your germs to whatever or whoever you touch next.

In general, the best way to fight the flu is to make sure that as many people as possible get a vaccine that will protect them from the virus. This is true for seasonal and novel flu viruses.

If a pandemic vaccine isn't available yet, you should work to educate the public on ways to prevent the flu and its spread, like avoiding contact with people who are sick, washing hands often, and staying home if they're sick.

Your hard work helped solve the outbreak!

Learn More

West Nile virus was first discovered in the West Nile District of Uganda in 1937.

Your hard work helped solve the outbreak!

Although this outbreak was not real, it's based on similar outbreaks that have occurred in the past. Experts at CDC are constantly on the watch for new flu viruses that could potentially spread worldwide, infecting millions.

In recent years, novel influenza viruses, from birds and pigs, have infected many people. Luckily none of these viruses have caused a pandemic since the 2009 H1N1 virus. Investigations into novel flu cases help scientists understand how and where the next flu pandemic may begin and allow for the creation of new, targeted flu vaccines that can protect us from novel flu viruses.

Millions of people get seasonal flu every year. While most recover some people die. People who are at greatest risk of severe or fatal flu illness include very young children, older adults, pregnant women and people with certain chronic health conditions. Make sure to "Take 3" actions to fight flu every year— (1) get a seasonal flu vaccine, (2) follow important safety steps like good hand washing and avoiding others when sick, and (3) take antiviral drugs if your doctor prescribes them. Antiviral drugs may be especially important in a pandemic if vaccine is not available yet.

Note: Several aspects of the original outbreak and investigation have been altered to fit the format and length of this application.

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