EXAMPLE: Calculating Secondary Attack RatesConsider an outbreak of shigellosis in which 18 persons in 18 different households all became ill. If the population of the community was 1,000, then the overall attack rate was 18 ⁄ 1,000 × 100% = 1.8%. One incubation period later, 17 persons in the same households as these "primary" cases developed shigellosis. If the 18 households included 86 persons, calculate the secondary attack rate.Secondary attack rate = (17 ⁄ (86 − 18)) × 100% = (17 ⁄ 68) × 100% = 25.0%
Incidence rate or person-time rateDefinition of incidence rateIncidence rate or person-time rate is a measure of incidence that incorporates time directly into the denominator. A person-time rate is generally calculated from a long-term cohort follow-up study, wherein enrollees are followed over time and the occurrence of new cases of disease is documented. Typically, each person is observed from an established starting time until one of four "end points" is reached: onset of disease, death, migration out of the study ("lost to follow-up"), or the end of the study. Similar to the incidence proportion, the numerator of the incidence rate is the number of new cases identified during the period of observation. However, the denominator differs. The denominator is the sum of the time each person was observed, totaled for all persons. This denominator represents the total time the population was at risk of and being watched for disease. Thus, the incidence rate is the ratio of the number of cases to the total time the population is at risk of disease.Method for calculating incidence rateNumber of new cases of disease or injury during specified period Time each person was observed,totaled for all personsIn a long-term follow-up study of morbidity, each study participant may be followed or observed for several years. One person followed for 5 years without developing disease is said to contribute 5 person-years of follow-up.What about a person followed for one year before being lost to follow-up at year 2? Many researchers assume that persons lost to follow-up were, on average, disease-free for half the year, and thus contribute ½ year to the denominator. Therefore, the person followed for one year before being lost to follow-up contributes 1.5 person-years. The same assumption is made for participants diagnosed with the disease at the year 2 examination — some may have developed illness in month 1, and others in months 2 through 12. So, on average, they developed illness halfway through the year. As a result, persons diagnosed with the disease contribute ½ year of follow-up during the year of diagnosis.The denominator of the person-time rate is the sum of all of the person-years for each study participant. So, someone lost to follow-up in year 3, and someone diagnosed with the disease in year 3, each contributes 2.5 years of disease-free follow-up to the denominator.
- Fall '18