Capstone Exercise: Advanced Assignment
“Influenza Sentinel Surveillance in the
Country of Tranquilidad”
PARTICIPANT GUIDE
Objectives



Recognize the different types of measures used in statistical reporting of laboratory data
for influenza surveillance
Collect and report key influenza measures
Present weekly data on key measures in graphical form
Instructions
In this activity you will practice the concepts covered during the classroom, including data
analysis, consolidation, visualization and presentation. The activity is composed of two parts:
1. In Part 1, you will analyze and summarize weekly and annual data for all of the country
of Tranquilidad.
2. In Part 2, you will have to present national influenza trends orally and in writing.
Complete this section at home and submit it by e-mail.
To complete this activity, you will need the following:
 Successful completion of the Capstone Exercise covering the Highlands Region data.
 Activity Student Guide (this document)
o A document with activity instructions and questions to complete.
 Appendix I: Description of Tranquilidad’s Influenza-Like Illness Sentinel
Surveillance System: Tranquilidad Highlands
 Database II: “InfluenzaLabData_AllTranquilidad.xls”
o Laboratory surveillance data from the national laboratory, including data for all
four regions of Tranquilidad. This database contains data for the entire
epidemiologic year. This database has several tabs containing region-specific
data as well as aggregated national data.
INSTRUCTOR NOTE: You will find additional tabs in each database containing
the calculations for most figures and tables. These are identified by the word
“Figures” in the worksheet name.
 Appendix II: Microsoft Excel Database Codebook
o A list of all the variables, potential responses and manner of coding for both the
“InfluenzaLabData_Highlands” database as well as the
“InfluenzaLabData_AllTranquilidad” database.
 Microsoft Excel Guide: “Capstone_MicrosoftExcelGuide.doc”
o A guide to using Microsoft Excel 2007 or Excel 2003 for data analysis and
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 1

presentation.
PowerPoint Template Slides: “Capstone_Part2AlternateActivity_PptTemplate.ppt”
o Power Point slide templates to be used as part of an alternate activity for Part 2 of
the Capstone activity.
Time allotted:
Part I:
3 hours
Part II:
1 hour
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 2
Part 1: Aggregate Influenza-Like Illness Sentinel Surveillance in Tranquilidad
A promotion to the national influenza laboratory
You have recently been transferred to the national influenza laboratory in
Tranquilidad. Tranquilidad has four regions in total and it is the responsibility of the
national laboratory to aggregate and analyze data from all four regions.
Just as in your position in the Highlands regional office, your responsibilities in the
national office include submitting weekly reports. Your first assignment is to
aggregate influenza-like illness surveillance data and use these data to prepare a
weekly report to submit to the national epidemiology office.
Directions: For the following questions, please refer to the Excel spreadsheet
“InfluenzaLabData_AllTranquilidad.xls”. You may also refer to the Microsoft Excel Guide to
provide further instructions on any commands or functions used in analyses.
NOTE: Because some patients may have been infected by more than one pathogen, the total
number of respiratory pathogens can exceed the total number of specimens per region.
1. How many cases meet the case definition for ILI, based on the required time between
date of symptom onset and sampling date? NOTE: the variable “Days” contains this
time period.
2. You are curious to know if the distribution of respiratory pathogens was similar
between districts for epidemiologic week 52. Complete the table below.
Table 6. ______________________________________________________
Total number of
positive tests
District
Influenza A
N (%)
Influenza B
N (%)
Parainfluenza
N (%)
Adenovirus
N (%)
RSV
N (%)
1:
Highlands
2: South
3: Central
4: North
All districts
Source:
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 3
3. Using the values you just entered into Table 6, create a stacked bar chart showing the
number of cases for each type of respiratory virus - by region - for epidemiologic week
52 in the entire country of Tranquilidad. NOTE: You may use Microsoft Excel to
generate this image, or may create the graph by hand using count data from the
Microsoft Excel spreadsheet. Provide appropriate labels for your axes and a descriptive
title. If you create the graph by hand, a blank template is provided below to complete.
Figure 2. _________________________________________________
4. Is the distribution of ILI-causing viruses similar across the different geographic regions
for this particular epidemiologic week?
5. Preliminary reports suggest that males and females may have different ILI-incidence.
To see if this trend is true in your data, fill-in the table below with counts of males and
females for each type of virus. You should use the COUNTIFS function in Microsoft
Excel to generate the necessary data.
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 4
Table 7. _________________________________________________________
Males
Females
Total number of positive tests
Influenza A
Influenza B
Parainfluenza
Adenovirus
RSV
Source:
6. Using the data you complied in Table 7, create a 100% stacked bar chart. Each bar will
represent a different pathogen with the percents of males and females adding up to
100% for each. NOTE: You may use Microsoft Excel to generate this image, or may
create the graph by hand using count data from the Microsoft Excel spreadsheet.
Provide appropriate labels for your axes and a descriptive title. If you create the graph
by hand, a blank template is provided below to complete. What do you think about the
distribution by sex?
Figure 3.
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 5
7. You would now like to summarize ILI surveillance data for the entire epidemiologic
year. Create a table summarizing the counts and proportions of ILI-associated
respiratory pathogens. NOTE: You may use the “AllRegions_Subtotals” tab to obtain
the count necessary for this table. You may also use COUNTIFS to generate the counts
necessary for this table, in either the “AllRegions_Subtotals” tab or the “AllRegions”
tab.
Table 8. ____________________________________________________
Number
Characteristic
Percent of
Specimens
Percent of
positive tests
Total number of specimens tested
Total number of positive specimens
Total number of negative specimens
Total number of viruses detected
Influenza A
Influenza B
Parainfluenza
Adenovirus
RSV
Source:
8. Compare the proportional distributions between the table you created in the
previous question (Table 7) with the one you created in Part 1 for the Highlands
region alone (Table 3). Do they show different distributions of ILI-associated
respiratory pathogens?
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 6
The addition of an event-based surveillance system in Tranquilidad
Tranquilidad has also implemented an event-based surveillance system within the past
few months. Although it is a relatively new addition to influenza surveillance in
Tranquilidad, members in the national epidemiology office have been very busy
collecting and analyzing data.
Epidemiologists working with the event-based surveillance system have decided to
validate their system to ensure that it is functioning properly as an early warning
system for influenza. Officials in the national epidemiology office have found a high
amount of absenteeism and medical care utilization among those stationed at a
military camp beginning about 12 weeks, or three months ago (e.g. beginning during
weeks epidemiologic week 30). They believe this may have been associated with an
outbreak. You would like to validate this claim using your national laboratory data.
There is a military base located in the southern geographical region (Region 2).
9. Name one benefit of an event-based surveillance system. What advantages does
it have over a syndromic surveillance system?
10. In the spreadsheet “InfluenzaLabData_AllTranquilidad.xlsx” look for the sheet
called “Region 2-South Subtotals.” Create a stacked bar chart to show the
number of cases for each infection in this region of Tranquilidad over the year.
Label this graph as “Figure 3”. Be sure to provide appropriate axes, labels, a
descriptive title and a legend. HINT: Follow the same procedure you used in
Part 1, Question 13 to create this chart. It may be easier to create this graph in
the tab with Region 2 data separated. Use the subtotal function in this tab.
NOTE: Refer to the Microsoft Excel guide for instructions on how to create
graphs and charts.
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 7
11. Do you think there was an influenza outbreak as suspected from the event-based
surveillance system? If so, which type of influenza appears to be implicated?
Cite observations from your graph in your answer.
12. Complete the table below showing the number of influenza A cases among the
total population, military personnel, and civilians, between epidemiologic weeks
30 and 36. Does it appear to be an outbreak strictly among military personnel, or
among the Southern (Region 2) population as a whole? NOTE: You may
calculate the counts necessary to complete this table manually, or you may use
COUNTIFS statements. Subtotals are not necessary to calculate the counts
necessary for this table.
Table 9.
Epidemiologic
Week
Week 30
Total ILI
cases
Total number
positive for
influenza A
Total number
positive for
influenza A,
military
Total number
positive for
influenza A,
civilian
Week 31
Week 32
Week 33
Week 34
Week 35
Week 36
Total
Source:
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 8
13. Is there a particular influenza subtype that the alleged outbreak appears to be
associated with, during weeks 30-36? Complete the table below and interpret the
results.
Table 10.
__
Number Positive (%)
Positive for influenza
A/H1N1
Positive for influenza
A/H3N2
Total specimens tested,
weeks 30-36
Source:
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 9
Part 2:
Presenting Results at the National Influenza Congress in Tranquilidad
Background
Because of your excellent work and your vast experience as an influenza laboratorian
in Tranquilidad, your superiors suggest that you speak on behalf of the National
Reference Laboratory for Influenza in an upcoming influenza congress, a meeting
which has both scientific and community-based audiences in attendance.
You are asked to give an oral presentation on this year’s trends in laboratoryconfirmed influenza-like illness.
In addition, you are asked to create a written summary of this year’s surveillance
findings, which will be provided to all conference attendees. This report should take
on the form of a “Results” section of a scientific publication.
.
Directions:
Follow the guidelines below to develop your oral presentation and scientific written
summary at the National Influenza Congress. Be sure to include all sections mentioned below.
Oral Presentation Guidelines:
Your oral Power Point presentation should include the following sections:
Oral Presentation Section
Contents
1. Title Slide

A brief, descriptive title of your presentation
2. Overview

The major topics discussed in your
presentation
3. Content
This section will vary by presentation, but should
be between 2-5 slides.
Your content slides should include the
following:
 Background on ILI including public health
importance
 Brief description of the ILI sentinel
surveillance system in Tranquilidad*
 Surveillance case definition*
 Analysis methods
 Annual laboratory surveillance results
 Time trends or seasonality
 Outbreaks or clusters of disease
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 10
4. Conclusions


Summary of major surveillance findings
Brief mention of public health implications of
findings, and areas of further surveillance
research
5. References (optional)
 Include references of any outside sources you
utilized for your presentation
6. Acknowledgements
 Include any persons you may wish to thank in
(optional)
your presentation
* Please see appendix I for more information on this topic.
NOTE: For each slide created, you should also generate slide text to accompany your slides.
Slide text should be in complete sentence format.
Written Summary:
The written summary of surveillance findings should be written in the form of a “Results”
section of a scientific publication. This written summary should include the following:



Laboratory results in reference to person, place and time
Time trends or seasonality
Outbreaks or clusters of disease
Please include any tables and graphs to support the results mentioned.
Advanced Capstone Exercise
Epidemiologic Analyses of Influenza Laboratory Data
Page 11