PUBH621 Epidemiology Report: Contact Tracing and Exposure Assessment

This report, focusing on PUBH621 Epidemiology, delves into the critical aspects of contact tracing and exposure assessment, primarily in the context of Tuberculosis. It begins by defining notifiable diseases and emphasizes the role of contact tracing in controlling the spread of infectious diseases. The report then contrasts the contact tracing guidelines of the Northern Territory and Victoria, highlighting jurisdictional differences and procedural variations. A detailed case study of Tuberculosis is presented, including the signs, symptoms, and burden of the disease in Australia. The report further explores the modes of infection and the degree of infectiousness, explaining how Tuberculosis is transmitted and the varying risk levels associated with different degrees of contact. Finally, it examines the risk groups involved in contact tracing and the prioritization methods used to identify and manage potential cases, offering insights into the practical application of epidemiological principles. This assignment provides a comprehensive understanding of the challenges and strategies in public health related to infectious disease control and prevention.

PUBH621 Epidemiology: Simulated Contact
Tracing and Exposure Assessment

Table of Contents
INTRODUCTION...........................................................................................................................3
MAIN BODY...................................................................................................................................3
Notifiable Disease........................................................................................................................3
Contact Tracing............................................................................................................................3
Differences between Northern Territory and Victoria Contact Tracing Guidelines....................4
Case Study...................................................................................................................................5
Ways of Infection and Degree of Infectiousness.........................................................................6
CONCLUSION ...............................................................................................................................8
REFERENCES................................................................................................................................9

INTRODUCTION
Epidemiology is known as branch of medicine that deals with incidents, possible control
of diseases and distribution of medicines. Apart from this other factors are explained which are
related to report. In this study different factors like distribution patterns and determinant of
health and disease conditions are included (Yang and et.al., 2017). This report is providing the
brief of Tuberculosis and where the information related to TB can be found. The methods of
tracing and relative measures are considered in the report. Various guidelines will be explained
for northern territory and Victoria. Jurisdictional and procedural differences will be identified in
the report. Case study related to TB will be analysed and evaluated to prepare a report on the
case study.
MAIN BODY
Notifiable Disease
Notifiable disease is consider as a disease that is required by the law to be reported to the
government authorities. This reporting help them to gather and monitor the disease and provide
early and initial warning of future possible outbreak. On the basis of this information and report
healthcare authorities and government can effective action to prevent them from spreading. This
informative action also can help government official to produce a policy to reduce the number of
cases and ensure the availability of vaccination to control the disease. For this report
Tuberculosis is taken as the Epidemiology disease (Walker and et.al., 2018). There are different
government sites which are run by health care organization can be taken as resources to collect
the information of disease. Other sites also can be considered to collect the particular information
of Tuberculosis and methods of tracing.
Contact Tracing
Contact of tracing is considered as the process of identification of person who may have
come in contact with a person who is infected with epidemiologic disease. This process includes
the process of collecting information that can be used to find the health status of individual
person. This is important to evaluate the health condition of person to prevent the disease to
spread. It is a preventive method that can be used by government and other health officials to
check status of epidemiology disease. It can help the government and health care organization to
prevent and interrupt infection and its spreading. This process includes different steps to
identification of health status of person who was possibly in contact with infected person or

patient. There are different goals of this process which are interrupt transmission of disease,
offering initial diagnosis, evaluate the level of infection and learn about epidemiology disease in
the particular population. Tracing process includes various steps which are- review of index case,
stratification of contact list and contact screening. There are also some sub parts these activities
have which can be used to trace TB in a suspect.
Differences between Northern Territory and Victoria Contact Tracing Guidelines
These are two different contact tracing guidelines that are used to identify the level of infection
in the person. The latest version of Northern Territory guidelines were released in year 2016.
There are different aims of these guidelines which are-identification of the latest case of
tuberculosis in patient and start the initial treatment with primary care, identifying the people
who were in contact with patient should be offering treatment of LTBI, identifying the source
case which is recently appeared (Lalor and et.al.,2017). Evaluate the source case where the other
pulmonary disease were detected. Identifying and evaluating the area and people who should be
part of screening. Provide the requisite and relevant information of Tb to target audience to make
them aware of disease. The particular steps that are included in the Northern Territory guideline
for TB are-
1. categorize the patient as per the degree of infection.
2. Identify the possible contacts and arrange them as per the risk level and this arrangement
can be made into low, medium and high risk level.
3. Examine all the cases that includes the high degree of risk and which are need to be
provided with medical services on the immediate basis.
4. After evaluating the people with high risk other categorise should be considered for the
evaluation to prevent the spreading of Tuberculosis. This evaluation should be based on
the out comes of examination of high risk contacts.
5. Sent the TB health care staff to visit the particular area that is suspected area and provide
them with information related to TB. This is important for the health care organization to
create awareness in people to prevent these type of diseases.
Victoria guidelines have other perspectives which are different to a certain level from the
Northern Guidelines (Behr, Edelstein and Ramakrishnan, 2018). The aims of Victoria guidelines
are- identify the persons who were might in contact with the person who is suffering from the
particular disease. Counselling the people who are detected with the TB and provide them with

respective as per the level of risk. Identify the further cases that are result of personal contact
with patient and recognise them for future plans. The tracing process suggested in the Victoria
Guidelines are-
1. Categorise the cases on the basis of the infectiousness and classified them in category like
low level infectiousness, medium infectiousness and high level infectiousness. For high
infectiousness the sputum smear is positive and for medium level and low level it is
consider negative.
2. In the period of three months the groups are classified in the different stages. On the basis
of risk they are provided with tests and medication to prevent further cases of Tb. The
priority cases are analysed first and then other medium and low priority cases are
considered for examinations.
Case Study
1). Signs and symptoms of Tuberculosis
Tuberculosis is a infectious disease which is characterized as bacterial disease that mainly
affect the lungs. Most people are affected by the tuberculosis bacteria but there are no symptoms
of it but when they appear in person includes continuous coughing, weight loss, night sweats,
loss of appetite, chills, chest pain and fever (Streicher and et.al., 2015). On the different level of
infection the symptoms are different.
1. Patient can face spinal pain and joint destruction.
2. Brain can lead to Meningitis.
3. TB can affect the waste filtration process and it can lead to blood in urine.
4. It reduce the function of heart which can result as cardiac tamponade which is a fetal
condition.
These are some symptoms that are visible in the patient of Tuberculosis. These signs can be used
to identify the disease in the person.
Burden of TB in Australia
If people of country are facing the issues like TB and other infectious disease that it can
cause major trouble to country and it is a burden for them to handle. Australia is the country
which is considered in the groups of countries that have lowest rate of Tb in all over world. In
year 2017, 1425 cases identified as the tuberculosis. Most of the cases of Tb were originated in
the abroad and sources of this infection is normal contact between the human beings. In the

women the cases were identified in between the age of 14 to 91 years. Tb is mostly visible in
men which is around 53.8 %. the main reason of infectiousness is the foreign trips of people and
consumption of foreign products.
Ways of Infection and Degree of Infectiousness
TB is a disease that is caused by pulmonary Bactria which is named as Micro bacterium
Tuberculosis. This is highly infectious disease which can spread quickly with heal of air. The
intent cure is not possible in the case of Tb and it takes time to get cured.
Ways of Infection
In the Tb the medium of the transmission is air and personal contact. Because the
medium of transmission is too common, it makes TB highly transmissible. It can be spread by
different ways so of them are sharing tooth brush, kissing, cough, sneeze, shout, or sing. The
transmission also depends on the environment because it is major factor that can lead the bacteria
micro bacterium tuberculosis to the host body. The transmission occurs when the person inhales
the bacteria through air (Keller and et.al., 2015). The bacteria of TB do not stick to cloths or
skin, they only travel through air so it is hysteria that Tb can spread through shaking Hand,
sharing food or Drink, Touching bed linens and touching toilet sit, so the people are need to be
aware of this so this disease can be treated effectively. There are two types of TB which are
active and other one is non active. In the non active Tb the human immune system do not allow
the bacteria to spread but in the active TB the Bactria of TB spread through air. As the person
sneeze, cough, shout or sing the Bactria infect the surrounding air and later these Bactria are
inhaled by the host and they get infected by the TB.
This is how TB transmits from one patient to other healthy person. The Tb is classified in
the different categories which are high level, medium level and the last one in low level. The
infectiousness in each stage is different for people who are in contact with patient. The people
who are continuously in contact with patient have higher chances to get infected with the Bactria
of TB. The people who are in regular contact with patient but the contact is formal and not
intense then the chances of infection are medium (Galli and et.al., 2016). People who do not in
contact or only minor contact with patient have very less chance to get infected with the micro
Bacterium Tuberculosis. This is how pulmonary disease Tb transmitted through air and rate of
infectiousness is different for various intensity of infection level. Also the risk infection is
depends on people who are in contact with patient. Level and degree of contact can increase the

chances of infection. For this case the family members are at high risk and other people like
neighbours are at low level risk.
Risk Groups of Contact Tracing
As explained above the risk of infection is classified in the different categories. These
level of risk is classified in the three different category. As per the contact tracing process, the
people who were in contact with patient need to be examined to prevent the further spreading of
disease. In this process people are categorized as per degree of contact. The examination process
in the contact tracing is based on the prioritizing method where the people with high risk are
examined on early basis to reduce the rate and span of infection (Prado and et.al., 2017). For the
people like family members and close people are categorize in the high risk because they are too
close to the patient, and they are at maximum risk of infection do they are treated on high
priority by the action team that is designed by the government and health officials. By this team
reduce the chances of moire infections. As the primary targets are examined by the team on the
basis of their outcomes other categories are treated by the team. If the results are detected
positive then the chances of infection in the medium level and low level risk people is also high.
In this case they need to be assesses on high priority. For the particular case study the parents of
boy and other people are not detected with TB so it is not required to trace the people who are at
low and medium risk
There are different circumstances are possible their when the action team need to take the
people as target for contact tracing. For example, the patient in the case study is a student who
went to school every day. This is important for Team to consider the teachers and other student
as the target to trace and screen to examine them. By this process they can ensure the safety and
health of other students apart from this they also need to consider other people who were might
in contact of patient (Yates and et.al., 2016). The patient is small child and as per their mental
level he is not aware of the transmission process of TB so this is important for task force to
identify the other possible people who are at high risk. These are some circumstances which can
force the medical team to consider others for tracing.
Methods of Examinations
There are different methods can be used by the medical team to evaluate and analyse the
health condition of people.

Medical Evaluation- This is the process where the medical history, travel history and contact
history of individual person. This data can be use as research data which can be used to evaluate
the level of risk for individual person (Doroshenko and et.al., 2018). This process also includes
the other physical examinations which are important to know the health condition of person.
Tuberculin Skin Testing- This is a process that is used to analyse any physical contact with
patient to categorise the individual on the criteria of risk. This is used to find the presence of the
tuberculosis Bactria on the skin of person. This is preferred with in the 3 weeks to obtain the
baseline for measurements.
TST Conversion- If the contacts shows the negative result and second test shows the result as
positive then person should be considered as the possibly infected. This is important for medical
team to conduct proper examination to measure the further risk level.
Ensure the Safety of Other People After Returning
As the person is completely cured and already have recovered from the disease other can
ensure their safety by different measures (Hatherell and et.al., 2016). These measures are visible
in the patient. If the student is not sneezing, coughing and not showing sign of weakness can be
considered as completely cured. This is important for people and parents of child to closely
evaluate the condition to get better analysis of their health. This is how they can get ensure their
health and safety.
CONCLUSION
It can be concluded that epidemiological measures and knowledge is highly crucial for
managing public health. These strategies are mandatory for promoting awareness and well being
of individuals. It has been analysed from the above discussion that epidemiological information
can provide a great support to surveillance activities and to outbreak disease investigations. It
can bring a significant difference in morbidity and mortality rates. The study has also evaluated
that higher mortality rates in tuberculosis requires extensive programs for creating awareness
regarding health issue. The strategies and epidemiological policies will also assist health
professionals in formulating effective health care policies and treatment interventions. Thus it
can be concluded and suggested that contact tracing for vulnerable groups must be performed as
an essential measure for managing such contagious diseases.

REFERENCES
Books and Journal
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sciences. 17(6). p.960.
Hatherell, H.A. and et.al., 2016. Interpreting whole genome sequencing for investigating
tuberculosis transmission: a systematic review. BMC medicine. 14(1). p.21.
Keller, P.M. and et.al., 2015. Determination of MIC distribution and epidemiological cutoff
values for bedaquiline and delamanid in Mycobacterium tuberculosis using the MGIT
960 system equipped with TB eXiST. Antimicrobial agents and chemotherapy. 59(7).
pp.4352-4355.
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2012: retrospective national cohort study combining epidemiological and molecular
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Prado, T.N.D. and et.al., 2017. Clinical and epidemiological characteristics associated with
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Walker, T.M. and et.al., 2018. A cluster of multidrug-resistant Mycobacterium tuberculosis
among patients arriving in Europe from the Horn of Africa: a molecular epidemiological
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Shanghai, China: a retrospective observational study using whole-genome sequencing
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Yates, T.A. and et.al., 2016. The transmission of Mycobacterium tuberculosis in high burden
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