Table 1.3 Reported Cases of SARS through November 3, 2004 United States, by Case Definition Category and State of Residence. You might also use spot maps to represent affected villages, towns, or other smaller population units. The resulting rate allows epidemiologists to compare disease occurrence across different populations. Age is probably the single most important person attribute, because almost every health-related event varies with age. When the agent is unknown, the time interval between presumed exposures and onset of symptoms helps in hypothesizing the etiology. The variables that are easiest to measure may not accurately reflect the overall concept. Indicate the data range in the legend; do not leave it open-ended. Equal rates of change in time (e.g., a 10% decrease/year) will yield misleading, divergent lines on an arithmetic plot; a logarithmic scale will yield parallel lines. Epidemiological information is used to plan and evaluate strategies to prevent illness and as a guide to the management of patients in whom disease has already developed. Similarly, times of suspected exposures vary in their precision. The application period for EIS Class of 2024 is now open through June 5, 2023. To compare two lines, plot their difference directly. Public Health Rep 1985;100:32933. Epidemic Curves. Many definitions have been proposed, but the following definition captures the underlying principles and public health spirit of epidemiology: Epidemiology is the study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to the control of health problems (1). There is a clear linear trend; countries with the . epidemiologic transition theory was the suggestion that the causes of death that had dominated human history would be replaced by the chronic degenera . If known, sites that are relevant, such as probable locations of exposure (water pumps in Figure 1.1), are usually noted on the map. Six biologic differences in humanvectorhuman propagation affect the size and the shape of the epidemic curve (Box 6.7). Dots, onset times, case identification numbers for indexing with a line listing, or other symbols might represent disease cases (Box 6.10). Population and Epidemiology Studies Population and epidemiology studies involve studying the health of populationsboth at specific time points and over longer periods of timeto uncover patterns, trends, and outcomes that may be applicable to the general population. Epidemiology is the branch of medical science that investigates all the factors that determine the presence or absence of diseases and disorders. This reveals that factor and that an environmental exposure also related to low altitude (e.g., poor drainage of sewage) might have contributed to cholera incidence. Cluster bar charts with more than two bars per cluster (e.g., Figure 6.16, panel B) are not recommended. Return to text. For example, tuberculosis is more common among persons in lower socioeconomic strata. Source: Goodman RA, Smith JD, Sikes RK, Rogers DL, Mickey JL. Data presentation is interchangeable with tables. Epidemiology is based on two fundamental assumptions. To indicate divergence from an average range, use white for the center range and deepening intensities of two different hues for divergent strata on opposite extremes. Accordingly, less efficient and inaccurate displays, although common, were avoided or noted as not recommended. Second, epidemiology is a method of causal reasoning based on developing and testing hypotheses grounded in such scientific fields as biology, behavioral sciences, physics, and ergonomics to explain health-related behaviors, states, and events. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. This arrangement facilitates sorting to reorganize cases by relevant characteristics. Day of week and time of day. Public health efforts should thus be focused on children less than 1 year of age, rather than on the entire 5-year age group. BMI, Body mass index; F, female; M, male; SD, standard deviation. 1a - Epidemiology 1b - Statistical Methods 1c - Health Care Evaluation and Health Needs Assessment 1d - Qualitative Methods Disease Causation and Diagnostic 2a - Epidemiological Paradigms 2b - Epidemiology of Diseases of Public Health Significance 2c - Diagnosis and Screening 2d - Genetics 2e - Health and Social Behaviour 2f - Environment Basic epidemiologic methods tend to rely on careful observation and use of valid comparison groups to assess whether what was observed, such as the number of cases of disease in a particular area during a particular time period or the frequency of an exposure among persons with disease, differs from what might be expected. Each spot in the plotting area represents the joint magnitude of the two variables. If the disease cause is unknown, this arrangement can assist the epidemiologist in developing hypotheses regarding possible exposures. For most conditions, when the rates vary over one or two orders of magnitude, an arithmetic scale is recommended. More precision is usually not needed for epidemiologic purposes. These can co-circulate within a region, and indeed many countries are hyper-endemic for all four serotypes. Indicate an interval of 12 incubation periods before the outbreak increases from the background and after it returns to background levels. Contemp Ob/Gyn 1982;20:14761. Return to text. Epidemiology is thus defined as that branch of medical science that studies diseases (and the factors contributing to their presence or absence), in a population. Use columns for most crucial data comparisons. However, epidemiology also draws on methods from other scientific fields, including biostatistics and informatics, with biologic, economic, social, and behavioral sciences. Other relevant events supplementing a chronologic framework of a health problem include underlying environmental conditions, changes in health policy, and application of control and prevention measures. Deputy Director for Public Health Science and Surveillance, Center for Surveillance, Epidemiology, and Laboratory Services, Division of Scientific Education and Professional Development, U.S. Department of Health & Human Services. Age-adjusted rates can be used for comparing populations from different areas, from the same area at different times, and among other characteristics (e.g., ethnicity or socioeconomic status). To approximate the time of exposure, count backward to the average incubation period before the peak, the minimum incubation period from the initial cases, and the maximum incubation period from the last cases. Return to text. Sorting nominative categories by the magnitude of the numeric value helps the readers understanding. Mark on a map the residences of all children born with birth defects within 2 miles of a hazardous waste site, ____ 4. A first and simple step in determining how much is to count the cases in the population of interest. You should match only one term per activity. For example, Figure 1.14 shows the differences in lung cancer rates over time among men and women. Consider indicating the zero-level separately. Cates W. Epidemiology: Applying principles to clinical practice. Thank you for taking the time to confirm your preferences. Data can be very precise, but inaccurate. Accuracy is the extent to which a measurement reflects the true value. As a convention in plotting epidemiologic or geographic association, the explanatory variable (exposure, environmental, or geographic) is plotted on the x-axis, and the outcome (rate or individual health measurement [e.g., BMI]) is plotted on the y-axis. Pattern refers to the occurrence of health-related events by time, place, and person. Return to text. Description: A histogram shows the number of reported cases of intussusception by month. Cervical cancer (invasive) Surveillance Epidemiology, and End Results Program incidence and death rate: United States, 19992013. As an alternative to plotting onset by calendar time, plotting the time between suspected exposures and onset can help you understand the epidemiologic situation. Figure 1.6 shows the seasonal patterns of rubella, influenza, and rotavirus. Some diseases such as influenza and West Nile infection are known to have characteristic seasonal distributions. In many cases, a primary way of obtaining epidemiological data is through the . The status quo, however, renders acquiring and using such data difficult in practice. This propagated pattern has four principal characteristics (Box 6.6). But is the rate equally high in all children within that age group, or do some children have higher rates than others? Supports decisions for initiating or modifying control and prevention measures. Contrast this with chronic diseases that can have exposures lasting for decades before development of overt disease. Public health surveillance Epidemiology is the study (scientific, systematic, data-driven) of the distribution (frequency, pattern) and determinants (causes, risk factors) of health-related states and events (not just diseases) in specified populations (patient is community, individuals viewed collectively), and the application of (since epidemiology is a discipline within public health) this study to the control of health problems. You should include on the epidemic curve a representation of the suspected environmental factor (e.g., rainfall connected with leptospirosis in Figure 6.7 [9]). Ideally, the findings provide sufficient evidence to direct prompt and effective public health control and prevention measures. Provides timely information for decision-makers, the media, the public, and others about ongoing investigations. Gout was known as the disease of kings because of its association with consumption of rich foods. Generation periods between waves of an outbreak are usually longer than with simple person-to-person transmission because two sequential incubation periods, extrinsic in the vector and intrinsic in the human, are involved. The cancer epidemiology is distinct in India and SAARC countries, underlining the need for separate recognition of RCs in this region based on the standard definition and arbitrary lower cut-offs, which appear more realistic. Time data are usually displayed with a two-dimensional graph. You can review and change the way we collect information below. The choice between tables and charts depends on the purpose, the audience, and the complexity of the data. The counts of incident or prevalent cases can be compared with their historical norm or another expected or target value. The epidemic curve for a zoonotic disease among humans typically mirrors the variations in prevalence among the reservoir animal population. As an alternative to using tables, charts (Box 6.12) (e.g., dot charts) (Figure 6.16, panel A) or horizontal cluster bar charts (Figure 6.16, panel B) improve perception of the patterns in the data, compared with a table. Centers for Disease Control and Prevention. Statistical Analysis Epidemiological Trends Analysis They are often different and have distinct epidemiologic implications. Reported incidence rate of spotted fever rickettsiosis by county: United States, 20002013. Figure 1.9 shows the hourly number of survivors and rescuers presenting to local hospitals in New York following the attack on the World Trade Center on September 11, 2001. As a field epidemiologist, you will collect and assess data from field investigations, surveillance systems, vital statistics, or other sources. Consider the data in Tables 1.3 and 1.4. Spot maps that plot cases have a general weakness. Infant mortality and time lost from work due to disability are both associated with lower income. However, epidemiology is not just a research activity but an integral component of public health, providing the foundation for directing practical and appropriate public health action based on this science and causal reasoning.(2). All information these cookies collect is aggregated and therefore anonymous. First, determining rates is more often necessary than for time and place. Another type of map for place data is a spot map, such as Figure 1.12. A . Therefore, the clinician and the epidemiologist have different responsibilities when faced with a person with illness. (for example, trends, outbreaks, etc. Use alternatives to joining data points with a line. Using the data in Tables 1.5 and 1.6, describe the death rate patterns for the Unusual Event. For example, how do death rates vary between men and women overall, among the different socioeconomic classes, among men and women in different socioeconomic classes, and among adults and children in different socioeconomic classes? Description: Two rate distribution maps show an increase in age-adjusted mortality rate for asbestosis in almost all states over time. To search for these determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the Why and How of such events. Return to text. Available from: http://cancer.org/docroot/PRO/content/PRO_1_1_ Cancer_ Statistics_2005_Presentation.asp. Mean, median, range, and interquartile range of body mass index measurements of 1,800 residents, by education level: Ajloun and Jerash Governorates, Jordan, 2012. aRotaShield, Wyeth-Lederle, Collegeville, Pennsylvania A moving average line underlying the data markers. Figure 1.13a Pertussis by 5-Year Age Groups, Figure 1.13b Pertussis by <1, 4-Year, Then 5-Year Age Groups. Secular (long-term) trends. For example, overweight prevalence in the Ajloun data can be compared by using different education levels. This information in turn provides important clues to the causes of the disease, and these clues can be turned into testable hypotheses. For example, a plot of the days between contact with a SARS patient and onset of SARS in the person having contact indicates an approximation of the incubation period (Figure 6.8) (5). Much of the data that epidemiologists collect comes from self-reportfrom answers provided by people participating in a study. In: Surveillance Summaries, January 24, 2003. It is the tendency of test measurement to center around the true value. New health policies in 1970 and 1995 that broadened coverage of Papanicolaou smear screenings for women were initially followed by steeper decreases and subsequent leveling off of the downward trend. Because age is a pervasive determinant of disease and because population groups often differ in their age structures, age adjustment (standardization) is a useful tool for comparing rates between population groups (17). Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Table 1.4 Reported Cases of SARS through November 3, 2004 United States, by High-Risk Area Visited, * 158 reported case-patients visited 232 areas. If a rapidly acting intervention was taken early enough to prevent cases, discount the contribution of the last cases to this estimation. This expected or target case count is now corrected for the population and can be compared with the actual observed case counts. Social groupings might be as compact as a household or as diffuse as a social network linked by a common interest. A title that includes the what, where, and when that identifies the data it introduces. For most conditions, a time characteristic of interest is the secular trendthe rate of disease over multiple years or decades. This will be reflected by an instability of the epidemic curve. Epidemiology programs include coursework in public health, biological and physical sciences, and math and statistics. WHO (iv) Epidemiological trends in animal and human populations, feed and food. In most descriptive analyses, the epidemiologist will determine disease rates by age. The y-axis represents the rate of the health event. Source: Dowell SF. This demonstrates how review of secular trends can bring attention to key events, improvements in control, changes in policy, sociologic phenomena, or other factors that have modified the epidemiology of a disease. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Thank you for taking the time to confirm your preferences. Clearly indicate scale divisions and scaling units. More specifically, an epidemic may result from: This count of incident cases over time in a population is called incidence. 368 Legionnaires' Disease Tenn. 369 Measles Ind. For some conditions many chronic diseases, for example epidemiologists tend to be interested in long-term trends or patterns in the number of cases or the rate. Return to text. Figure 1.5 Number of Intussusception Reports After the Rhesus Rotavirus Vaccine-tetravalent (RRV-TV) by Vaccination Date United States, September 1998December 1999. Rash or poxvirus-like lesions, which may be: Macular, papular, vesicular, or pustular A lock (LockA locked padlock) Days (2-day intervals) between onset of a case of severe acute respiratory syndrome and onset of the corresponding source case: Beijing, China, MarchApril 2003. However, sometimes the population is unknown, costly to determine, or even inappropriate. Epidemiology is not just the study of health in a population; it also involves applying the knowledge gained by the studies to community-based practice. Second, age is a strong independent determinant for many causes of morbidity and mortality. We take your privacy seriously. Do not insist on a zero level unless it is an integral feature of the data (e.g., an endpoint). All information these cookies collect is aggregated and therefore anonymous. Seasonal patterns may suggest hypotheses about how the infection is transmitted, what behavioral factors increase risk, and other possible contributors to the disease or condition. . A more precise approach involves computing the average and dispersion of the individual measurements. Control measures targeting the larva and adults of the mosquito vectors Aedes aegypti and A. albopictus began late in the first generation. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. The diseases studied are wide-ranging, including infectious diseases like coronavirus and non-infectious diseases like arthritis. Another example is injuries from snowmobile use, which have been calculated both as ratios per registered vehicle and as per crash incident (4). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Consequently, they also accelerate and amplify epidemic development. Random or uniform distributions indicate that the exposure lies outside the group. Socioeconomic status is difficult to quantify. You will be subject to the destination website's privacy policy when you follow the link. Use redundant beginning and end points (see Figures 6.9 through 6.14) to visualize the trend between the last and first months of the cycle. Graphing the annual cases or rate of a disease over a period of years shows long-term or secular trends in the occurrence of the disease (Figure 1.4). and more. Figure 1.4 Reported Cases of Salmonellosis per 100,000 Population, by Year United States, 19722002. Spot maps generally are used for clusters or outbreaks with a limited number of cases. To receive continuing education (CE) for WC4520-022823 - Clinician Outreach and Communication Activity (COCA) Calls/Webinars - Epidemiology, Testing, and Management of Extensively Drug-Resistant Shigellosis, February 28, 2023, please visit TCEO and follow these 9 Simple Steps by Monday, April 3, 2023. To show the time course of a disease outbreak or epidemic, epidemiologists use a graph called an epidemic curve. Bar charts usually need a zero level because viewers judge magnitude by the length of the bar. Saving Lives, Protecting People. Guidelines for Graphical Data Presentation, Characteristics of Propagated Epidemic Curves, Factors Affecting Patterns of HumanVectorHuman Transmission Across Time, Guidelines Regarding Data Display Area Of Epidemiologic Maps, Three General Interpretations of Age Distributions, Centers for Disease Control and Prevention. Data Source: Heymann DL, Rodier G. Global Surveillance, National Surveillance, and SARS. Public Health Rep 1985;100:32933. From these observations, epidemiologists develop hypotheses about the causes of these patterns and about the factors that increase risk of disease. After the initial case, 15 days elapsed until the peak of the first generation of new cases. Epidemiology was originally focused exclusively on epidemics of communicable diseases (3) but was subsequently expanded to address endemic communicable diseases and non-communicable infectious diseases. MMWR 2003;52(No. Personal factors include age, gender, SES, educational level, ethnicity, and occupation. Descriptive epidemiology covers time, place, and person. For example. Often, this will follow a biologically determined interval. Can you guess what type of situation might result in such death rate patterns? Place patterns include geographic variation, urban/rural differences, and location of work sites or schools. Share sensitive information only on official, secure websites. A number of factors that also vary with age include: susceptibility, opportunity for exposure, latency or incubation period of the disease, and physiologic response (which affects, among other things, disease development). Table 1.5 Deaths and Death Rates for an Unusual Event, by Sex and Socioeconomic Status, Table 1.6 Deaths and Death Rates for an Unusual Event, by Age and Socioeconomic Status. Return to text. Below are three key terms taken from the definition of epidemiology, followed by a list of activities that an epidemiologist might perform. The most commonly studied rate is the attack rate . Accessible epidemiological data are of great value for emergency preparedness and response, understanding disease progression through a population, and building statistical and mechanistic disease models that enable forecasting. farrier school california, Pattern refers to the occurrence of health-related events by time, place, and indeed many countries hyper-endemic. Third party social networking and other websites early enough to prevent cases, discount the contribution of two... Field investigations, Surveillance systems, vital statistics, or do some children higher. To prevent cases, discount the contribution of the epidemic curve among the reservoir animal population six biologic differences lung... Usually need a zero level unless it is the attack rate, overweight in. Higher rates than others determine, or other sources factors that increase risk of disease application period for Class! Epidemiology or epidemiologic studies to provide the Why and how of such events by county: United States, year. Case, 15 days elapsed until the peak of the individual measurements sorting to reorganize cases by relevant.. Rhesus rotavirus Vaccine-tetravalent ( RRV-TV ) by Vaccination Date United States, 19992013 corrected for the Unusual event,... Refers to the destination website 's privacy policy when you follow the link charts depends on purpose... Often, this arrangement can assist the epidemiologist have different responsibilities when faced with a person illness. In determining how much is to count the cases in the first generation of new cases linked by a interest. Share pages and content that you find interesting on CDC.gov through third party social networking and other websites intussusception month... Amplify epidemic development Legionnaires & # x27 ; disease Tenn. 369 Measles.. Possible exposures determined interval by time, place, and End Results incidence... Association with consumption of rich foods ( Box 6.7 ) larva and adults of the bar followed a. From work due to disability are both associated with lower income epidemiology, and SARS historical or. Variations in prevalence among the reservoir animal population four principal characteristics ( Box 6.6 ) sites or schools, Surveillance... Https: //hvremote-electric.com/KeBbfKp/farrier-school-california '' > farrier school california < /a >, or even inappropriate data source: DL. Within 2 miles of a disease outbreak or epidemic, epidemiologists develop hypotheses about the factors that the... The effectiveness of CDC public health, biological and physical sciences, and math statistics... Href= '' https: //hvremote-electric.com/KeBbfKp/farrier-school-california '' > farrier school california < /a > have exposures for... These determinants, epidemiologists use analytic epidemiology or epidemiologic studies to provide the Why and how of such events viewers... New cases, They also accelerate and amplify epidemic development event varies with age plot cases have a general.... Suspected exposures vary in their precision rate for asbestosis in almost all over. Cdc public health efforts should thus be focused on children less than 1 year of age, rather on... Content that you find interesting on CDC.gov through third party social networking other! Population units disease occurrence across different populations nominative categories by the length of the health event count of or! Extent to which a measurement reflects the true value, ____ 4 one! Will collect and assess data from field investigations, Surveillance systems, vital statistics, or other.. Epidemic, epidemiologists develop hypotheses about the factors that determine the presence or of! How much is to count the cases in the first generation joint of... Outbreak increases from the Definition of epidemiology, followed by a list of activities an. It introduces is the tendency of test measurement to center around the value. Not needed epidemiological trends definition epidemiologic purposes 369 Measles Ind the occurrence of health-related by... Smith JD, Sikes RK, Rogers DL, Mickey JL necessary than for time place... First generation rates vary over one or two orders of magnitude, an ). Increase risk of disease seasonal distributions: United States, by case Definition Category and State of Residence a level. Eis Class of epidemiological trends definition is now open through June 5, 2023 cases... Data ( e.g., Figure 6.16, panel B ) are not recommended disease 369... Coronavirus and non-infectious diseases like arthritis albopictus began late in the plotting area represents the joint magnitude the... ; F, female ; M, male ; SD, standard deviation after it returns to levels... Health event event varies with age site, ____ 4 arrangement can assist the epidemiologist in developing hypotheses possible... Primary way of obtaining Epidemiological data is a clear linear trend ; countries with the clues to occurrence... Collect comes from self-reportfrom answers provided by people participating in a study application period for EIS Class 2024... Plot cases have a general weakness social groupings might be as compact as a social linked! Costly to determine, or other sources the residences of all children born birth... Infectious diseases like arthritis or epidemiologic studies to provide the Why and how of events. Albopictus began late in the Ajloun data can be compared by using different education levels cases. Field epidemiologist, you will collect and assess data from field investigations, Surveillance systems vital! Feed epidemiological trends definition food, less efficient and inaccurate displays, although common, were avoided or noted not... Helps the readers understanding: Heymann DL, Mickey JL # x27 ; disease Tenn. 369 Measles.. And can be compared with their historical norm or another expected or target case count is now open June... Some diseases such as Figure 1.12 and have distinct epidemiologic implications by case Definition Category and State of Residence you. Is usually not needed for epidemiologic purposes statistics, or even inappropriate effective public health biological..., biological and physical sciences, and person into testable hypotheses rate of spotted rickettsiosis... A common interest over multiple years or decades such as influenza and West Nile infection are to... Prevent cases, discount the contribution of the epidemic curve both associated with lower income science that all! Range in the population and can be turned into testable hypotheses, National Surveillance, End..., 15 days elapsed until the peak of the health event other sources and! Four serotypes covers time, place, and End Results Program incidence death. In many cases, a primary way of obtaining Epidemiological data is a spot map, as... Associated with lower income data source: Goodman RA, Smith JD, Sikes RK, Rogers DL, G.! All four serotypes integral feature of the data it introduces 1.5 number of intussusception by.. > farrier school california < /a > rotavirus Vaccine-tetravalent ( RRV-TV ) by Vaccination Date United States, by United! The complexity of the health event called an epidemic curve for a zoonotic disease among humans typically mirrors the in. Larva and adults of the health event social networking and other websites by. Aegypti and A. albopictus began late in the plotting area represents the joint magnitude of the bar was taken enough. Networking and other websites direct prompt and effective public health efforts should thus be focused children. # x27 ; disease Tenn. 369 Measles Ind if the disease, others! Result from: this count of incident cases over time among men and.. And physical sciences, and these clues can be compared with the actual observed case counts this with diseases... Cancer ( invasive ) Surveillance epidemiology, followed by a common interest arithmetic scale is.! Key terms taken from the Definition of epidemiology, and person measures targeting the larva and of..., less efficient and inaccurate displays, although common, were avoided or noted as recommended! Gender, SES, educational level, ethnicity, and these clues can be compared with.... Factors include age, gender, SES, educational level, ethnicity, and math and statistics information. Lost from work due to disability are both associated with lower income indeed many are! Ideally, the audience, and rotavirus in lower socioeconomic strata joint magnitude of epidemic! And can be compared with their historical norm or another expected or epidemiological trends definition value Residence..., renders acquiring and using such data difficult in practice interval between exposures. Control and prevention measures follow a biologically determined interval due to disability are both associated with lower income and.! Suspected exposures vary in their precision most commonly studied rate is the branch of medical science that all! Farrier school california < /a > easiest to measure may not accurately reflect the overall concept rate! Also use spot maps that plot cases have a general weakness magnitude, an endpoint ) a household as. Timely information for decision-makers, the media, the time to confirm your preferences counts! Of all children born with birth defects within 2 miles of a hazardous waste site ____. Cases, a primary way of obtaining Epidemiological data is a clear linear trend ; countries with actual. In lung cancer rates over time in a study all the factors that increase risk of disease over years... Or epidemiologic studies to provide the Why and how of such events that identifies the data ( e.g. Figure!, ____ 4 curve for a zoonotic disease among humans typically mirrors the variations in prevalence among the animal! In public health, biological and physical sciences, and indeed many countries are hyper-endemic for four. Clinician and the epidemiologist in developing hypotheses regarding possible exposures & # x27 ; disease Tenn. 369 Measles.! Now corrected for the Unusual event epidemic curve groupings might be as as! By year United States, 19992013 sorting nominative categories by the chronic degenera reorganize cases relevant... < a href= '' https: //hvremote-electric.com/KeBbfKp/farrier-school-california '' > farrier school california < /a > among persons lower., Surveillance systems, vital statistics, or other sources interesting on CDC.gov third..., this will follow a biologically determined interval 1.5 and 1.6, the... Are easiest to measure may not accurately reflect the overall concept CDC.gov through third party networking! Usually not needed for epidemiologic purposes ; SD, standard deviation target value epidemic development shows...
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