Membership of the Faculty of Public Health (MFPH) Health Protection and Communicable Disease Control Syllabus

Health Protection and Communicable Disease Control syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Health Protection and Communicable Disease Control in Membership of the Faculty of Public Health (MFPH), not a summary of it.

1. 1

   Communicable Disease Epidemiology

   4 topics

   • Chain of infection and modes of transmission
   • Reproduction number and epidemic dynamics
     • Basic and effective reproduction number
     • Serial interval and incubation period
   • Surveillance systems
     • Notifiable diseases and statutory notification
     • Sentinel and syndromic surveillance
     • Laboratory surveillance
   • Endemic, epidemic and pandemic patterns
2. 2

   Outbreak Investigation and Management

   5 topics

   • Steps of an outbreak investigation
   • Case definition and epidemic curves
   • Analytical outbreak studies
     • Case-control in outbreaks
     • Retrospective cohort in outbreaks
   • Outbreak control teams and roles
   • Control measures and communication
3. 3

   Environmental Public Health

   5 topics

   • Air quality and pollution
     • Particulate matter and health effects
     • Indoor air quality
   • Water, sanitation and food safety
   • Chemical incidents and toxicology principles
   • Radiation protection (ionising and non-ionising)
   • Climate change and health
4. 4

   Emergency Preparedness, Resilience and Response

   5 topics

   • Civil Contingencies Act and emergency planning
   • Major incident management and command structures
   • Pandemic preparedness planning
   • Risk assessment and business continuity
   • Mass prophylaxis and countermeasures
5. 5

   Antimicrobial Resistance and Healthcare-Associated Infection

   4 topics

   • Antimicrobial stewardship principles
   • Mechanisms and surveillance of resistance
   • Healthcare-associated infections
     • C. difficile and MRSA
     • Infection prevention and control measures
   • One Health approach

Health Protection and Communicable Disease Control flashcards for Membership of the Faculty of Public Health (MFPH)

18 of 51 cards from the Health Protection and Communicable Disease Control deck — real questions with worked answers.

1. Define the "chain of infection" and name its six links in order.

   A model of how infection spreads, requiring six sequential links: (1) infectious agent, (2) reservoir, (3) portal of exit, (4) mode of transmission, (5) portal of entry, (6) susceptible host. Breaking any link interrupts transmission.

2. Distinguish the main modes of transmission of communicable disease.

   Direct (contact, droplet spread, vertical) and indirect: vehicle-borne (food, water, fomites), vector-borne (mechanical or biological, e.g. mosquito), and airborne (droplet nuclei/aerosols suspended over distance, e.g. TB, measles).

3. Define the basic reproduction number $R_{0}$.

   The average number of secondary cases generated by one infectious case introduced into a wholly susceptible population. If $R_{0}>1$ the infection can spread; if $R_{0}<1$ it dies out.

4. How do the effective reproduction number $R_{t}$ and $R_{0}$ differ?

   $R_{0}$ assumes a fully susceptible population; the effective (net) reproduction number $R_{t}$ accounts for existing immunity/control measures: $R_{t}=R_{0}\times s$, where $s$ is the proportion still susceptible. An epidemic is controlled when $R_{t}<1$.

5. State the herd immunity threshold formula and its relationship to $R_{0}$.

   The critical proportion that must be immune to halt spread is $$H_{c}=1-\frac{1}{R_{0}}.$$ Higher $R_{0}$ requires higher immunity (e.g. measles $R_{0}\approx 15$ gives $H_{c}\approx 93\%$).

6. Compare active versus passive surveillance.

   Passive surveillance: routine, provider-initiated reporting to public health (cheaper, timely but under-reports). Active surveillance: public health actively seeks cases (e.g. contacting labs/clinicians); more complete and accurate but resource-intensive.

7. What is sentinel surveillance and when is it used?

   Surveillance using a selected, representative sample of reporting sites (e.g. sentinel GP practices for influenza-like illness) to monitor trends and estimate burden when whole-population reporting is impractical.

8. List the key attributes used to evaluate a surveillance system (CDC criteria).

   Simplicity, flexibility, data quality, acceptability, sensitivity, positive predictive value, representativeness, timeliness, and stability.

9. Define syndromic surveillance and give an example.

   Real-time monitoring of pre-diagnostic health indicators (symptoms/syndromes) rather than confirmed diagnoses to detect outbreaks early, e.g. NHS 111 calls, emergency department attendances, over-the-counter medication sales.

10. Differentiate endemic, epidemic, and pandemic.

    Endemic: the usual, constant baseline level of a disease in a population/area. Epidemic (outbreak): occurrence clearly in excess of the expected level. Pandemic: an epidemic spread over several countries or continents, usually affecting many people.

11. What does the term "hyperendemic" mean, and what is a "sporadic" pattern?

    Hyperendemic: persistently high disease levels, often above neighbouring areas. Sporadic: irregular, infrequent cases occurring without a clear pattern of spread.

12. List the ten standard steps of an outbreak investigation.

    (1) Confirm the outbreak/diagnosis, (2) establish a case definition, (3) find/count cases, (4) descriptive epidemiology (time, place, person), (5) develop hypotheses, (6) evaluate hypotheses, (7) reconsider/refine, (8) analytical studies, (9) implement control measures, (10) communicate findings. Note: control measures are implemented as soon as needed, not only at the end.

13. What are the components of a case definition?

    Clinical criteria (signs/symptoms or lab confirmation) plus restrictions by time, place, and person. Often graded as confirmed, probable, and possible/suspected cases.

14. Distinguish a point-source from a propagated (person-to-person) epidemic curve.

    Point-source: cases rise and fall sharply, clustered within one incubation period, single exposure. Propagated: successive taller peaks separated roughly by one incubation period as transmission passes between people. Continuous common-source curves show a plateau over the exposure period.

15. How can an epidemic curve be used to estimate the time of exposure?

    For a point source, count back from the peak (or median case) by the mean incubation period, and from the earliest and latest cases by the minimum and maximum incubation periods, to bracket the likely exposure window.

16. When is a cohort study versus a case-control study preferred in an outbreak?

    Cohort study: when the population at risk is well-defined and enumerable (e.g. wedding guests) — calculate attack rates and relative risk. Case-control study: when the population is large or undefined (e.g. community outbreak) — calculate odds ratios.

17. Give the formula for the attack rate in an outbreak cohort.

    $$\text{Attack rate}=\frac{\text{number of new cases in a period}}{\text{population at risk}}\times 100\%.$$ Compare food-specific attack rates among exposed and unexposed to find the source.

18. Define relative risk and odds ratio as used in outbreak analytical studies.

    Relative risk $$RR=\frac{\text{attack rate in exposed}}{\text{attack rate in unexposed}}.$$ Odds ratio $$OR=\frac{a\,d}{b\,c}$$ from a $2\times 2$ table. Values $>1$ suggest the exposure is associated with disease.

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