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The hospital uses municipal water and sewage services. There had been no work on water or  sewage lines in the past year nor recent roadwork or digging around the hospital. The hospital dining service included two cafeterias. The main cafeteria served as the primary arena for all food storage,  preparation, cooking and delivery to 100% of patients in the hospital. Visitors also ate at this main  cafeteria. The specific facilities within the main cafeteria served hot entrees, a grill, deli bar, and  salad bar. A second smaller cafeteria at the hospital offers menu selections with a per item cost and  predominantly is used by hospital staff. Under the advisement of your State epidemiologist, you begin interviewing the sick hospital patients  to better understand the likely source of the outbreak. Among the 20 patients interviewed (6 had  been discharged and were no longer at the hospital), 25 had eaten food from the deli bar; 9 had  eaten food from the salad bar, and 3 from the grill. Seven-day food histories revealed no particular  food item that was common to all or most of the patients. It was also noted in the labor and delivery  ward that none of the newborns were exhibiting symptoms. Given this information, what is your leading hypothesis on the mode of  transmission in this outbreak? What studies or other investigations would you  initiate to explore this hypothesis. Provide some descriptive epidemiology on the  nature of this outbreak and the likely culprit in terms of the epidemiological  triangle. As the health department epidemiologist, please list your next priorities  and discuss them in relation to the steps of this outbreak investigation. H1-The Mode of transmission for the outbreak of disease is through oral-fecal route. H2- The clients who have consumed water from the Main canteen are exposed to the contract of microorganism. A descriptive incidence study, would be appropriate to explore the hypothesis. The next priority would be to study the Agent Host environmental factors of epidemiological triad and to break the interaction among them to control and prevent the Outbreak. The basic triad of descriptive Epidemiology are: Agent In infectious disease models, the term "agent" originally referred to the entity or micro- organism (e.g. virus, bacterium) capable of causing the disease. As a general rule, the agent must be present for the disease to occur. However, the mere presence of the agent is not always sufficient for the disease to occur.
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