FEM-WIKI

Welcome to FEMWIKI

The Field Epidemiology Manual was originally developed in 2007 by the ECDC to support the European Programme for Intervention Epidemiology Training (EPIET). Trainers, supervisors, scientific coordinators, and facilitators created draft chapters using the lectures they delivered during the EPIET introductory course. The philosophy of sharing and building knowledge (in particular training materials) led to the creation of a collaborative information space for the epidemiological training community - The FEM Wiki.

Eventually, the ECDC decommissioned the FEM Wiki in 2022 and archived the last version as a PDF. Since FEM Wiki content was developed under Creative Commons, the Dutch Public Health Learning Support Company Transmissible decided to reinstall the Field Epidemiology manual as it was intended: a professional collaborative platform.

The aim of the FEM Wiki is to create a library of training materials for field epidemiology training programs.

FEM Wiki is an open information-sharing platform for all professionals and the lay public interested in public health. It is hosted and funded by ECDC. The content of FEM Wiki is provided by platform users and does not necessarily represent the official opinion of Transmissible BV. By contributing content to FEMWIKI, users agree to the conditions described under Creative Commons and FEM Wiki users’ code of conduct.

Article Portal

The FEMWIKI is organised into five main chapters. Below is a portal with links to each chapter's main pages.

• Assessing the burden of disease and risk assessment

• • Descriptive data analysis
    • Analysis by person characteristics
    • Analysis by place characteristics
      • Choosing an appropriate type of map
      • Which indicator to map?
    • Analysis by time characteristics
      • Methods for setting thresholds in time series analysis
      • Smoothing techniques for describing time series
    • Spatial Analysis (Geographical Information Systems)
  • Epidemic intelligence
    • Rapid Risk Assessment
      • Classifying and Measuring Risk
      • Identifying Risk
      • Stage 0: Preparation for rapid risk assessment
      • Stage 1: Collecting event information
      • Stage 2: Systematically collecting information
      • Stage 3: Extracting relevant evidence
      • Stage 4: Appraising evidence
      • Stage 5; Estimating the risk
    • Surveillance - Principles
      • Criteria for Surveillance
      • Event-based Surveillance
      • Indicator-based Surveillance
        • Establishing a Surveillance System
          • Analysis of Surveillance Data
            • Analysis, Interpretation and Dissemination
            • Quality checking
          • Common errors in surveillance data analysis
          • Evaluation of Surveillance Systems
            • 10 common errors in surveillance evaluations
            • Quality, Governance and Operating Procedures
            • Surveillance attributes for evaluation
              • capture-recapture
          • Sources and Types of Data
          • Types of Surveillance System (Active vs Passive)
            • Surveillance System Design and Operation
        • Uses of Surveillance Data
      • Objectives of Surveillance – Inputs and Outputs
      • Opportunities and Challenges
      • Surveillance or Research?
      • The Components of Surveillance
      • The Role of Surveillance
  • Field Epidemiology
    • Combining Studies: Meta-Analysis
    • Key definitions in infectious diseases epidemiology
    • Measurement in Field Epidemiology
      • Cluster Investigations
        • Statistical Methods for Cluster Investigation
        • Types of Cluster
      • Getting Measurement Right
      • Measures of association
      • Measures of Disease Impact
        • Impact numbers
        • Measures of disease impact - Further reading
        • Measures of impact among the exposed
        • Measures of impact in the population
        • Quantifying disease burden
      • Measures of Disease Occurrence
        • Attack rates and case fatality
        • Incidence rate
        • Odds
          • Probability
        • Prevalence
        • Relation between risk and incidence rate
        • Risks and Rates
      • Problems with Measurement
        • Bias
          • Detection Bias
          • Effect Modification and Confounding
            • [[Confounding in studies
            • Criteria for confounding
            • Dose Effect
            • Effect Modification
            • Interaction
            • Residual Confounding
          • Information (Measurement) Bias
            • Interviewer Bias
            • Recall Bias
            • Reporting Bias
            • Response Bias
          • Preventing bias
          • Selection Bias
            • Selection bias and case-control studies
              • Ascertainment Bias
              • Diagnostic bias
              • Non-response bias
              • Referral bias
              • Survival bias
            • Selection bias and cohort studies
    • Testing the Tests
      • Diagnostic tests versus screening test
      • Glossary
      • Parallel versus Serial testing
      • Receiver operating curve
      • Test Precision
      • Test reliability
      • Test Reproducibility
      • Threshold setting
      • Validity and accuracy
    • Methods in Field Epidemiology
      • Scientific (evidence base for prevention)
        • Causal Inference
          • Causal mechanisms
          • Viewpoints for Causality (Bradford Hill)
      • Types of Study
        • Analytical Study Designs
        • Advantages and disadvantages of cohort and case control studies
        • Case-control studies
          • Case-cohort study
          • Density case control studies
          • Table measuring risk, rate and odds ratio
          • Traditional case-control studies
        • Choosing a Reference Group
          • Control Selection
          • Developing a control definition
          • Special Considerations in Control Selection
        • Cohort studies
          • Measuring incidence rates
          • Measuring risk
          • Reference group for cohort studies
        • Cross-sectional Studies
        • Matching
          • Advantages and disadvantages of matching
          • Principles of matching
          • Restriction
          • Table format and Analysis
        • Measures of effect in various study designs
        • [[Non-traditional designs
          • Case cross over studies
          • Case to case study design
      • Descriptive Studies
      • Experimental Studies
    • Outbreak Investigations
      • Case definitions for outbreak assessment
        • Case Definitions
          • Defining a Case
          • Sensitivity and Specificity of a case definition
          • Various Levels of Case Definition
      • Confirm the outbreak
        • Types of Outbreak
          • Continuing Source
          • Distinguishing Different Sources or Modes of Transmission during an outbreak
          • Identifying Multiple Possible Outbreak Sources
          • Person to Person
          • Point Source
          • Refining the estimated point in time of an outbreak source
            • Incubation period, Latent period and Generation time
          • Unmasking Outbreak Source through Segmentation
          • Vector Borne
      • Describe the outbreak
        • Construction of Epidemic Curves
          • Diagnostic Applications of the Epidemic Curve
          • Disentangling Complex Data
          • Use of Epidemic Curves for characterising Outbreak Sources
      • Informing Action / Improving Knowledge
        • Additional resources for presenting findings
        • Choosing a method of data display
        • Communication of findings
          • To professionals
            • Definition of an Outbreak Investigation Report
            • Frequent Problems with writing an Outbreak Investigation Report
            • Structure of an Outbreak Investigation Report
            • Writing an Outbreak Investigation Report
            • Writing style of an Outbreak Investigation Report
              • SOCO (single over-riding communications objective)
          • To Public and the Media
        • Graphs, charts, diagrams
          • Bar graphs
          • Frequency polygons
          • Histograms
          • Line graphs
          • Other types of data display
          • Pie charts
        • Interpreting Data
        • Maps
        • Presenting Data
        • Tables
        • Types of variables and line listing
        • Use of computers
      • Investigations in Special Circumstances
        • Disasters and Emergencies
        • Health care settings
        • Possible Terrorist / Deliberate Event
        • Prisons
        • Schools
      • Outbreak investigations: 10 steps, 10 pitfalls
      • Outbreak steps : additional points
      • Rationale for Outbreak Investigations
        • Public health response (informing control)
      • The outbreak management team
  • Formal Risk Assessment
  • Health Economics
    • Cost-effectiveness
    • Cost-minimisation
    • Cost-utility
    • Measuring the Quality of Healthcare
    • Sensitivity Analysis
  • Screening
    • Evaluation of Screening
    • Measures of Accuracy in Screening
    • Principles of Screening

• General Communication

• • Aide memoire for oral presentations and visual aids
  • Health communication
    • Crisis communication
    • Health advocacy
    • Health education
    • Health literacy
    • Outbreak communication
    • Risk communication
    • Social marketing
  • Writing a Study Protocol
    • Analysing a public health problem
      • SMART definitions
    • Checklist for study protocols
    • Data collection instrument
    • Questionnaire Design
      • Advantages and Disadvantages of Questionnaires
      • Bias in Questionnaires
      • Hints to Design a Good Questionnaire
        • Questionnaire Layout and Coding
        • Seven Golden Rules to Design Questions
      • Piloting Questionnaires
      • Ten Steps to Design a Questionnaire
      • Types of Questionnaires
      • Types of Questions
        • Format of closed questions
      • Validated questionnaires
    • Writing for Publications
      • Checklist for posters
      • Scientific paper review form
    • Writing for Stakeholders

• Infection control and hospital hygiene

• Antimicrobial stewardship
• Healthcare-associated infection prevention and control as a part of patient safety programme
• Healthcare-associated infection prevention and control programme
• Cooperative learning as active learning in adult
• Education and training of staff
• Healthcare-associated infections and risk assessment
• Burden of HAIs
• Main pathogens and resistance
• Antimicrobial resistance
• Acquired resistance
• Mechanisms of antimicrobial resistance
• Multidrug-resistant organisms (MDRO)
• Types of HAIs
• CAUTI
• CLABSI
• SSI
• VAP
• [[Infection control interventions
• Cohorting patients and/or staff
• Contact precautions
• Developing infection control interventions: isolation
• Environment as a source of healthcare-associated infections
• Hand hygiene
• Gloves and hand hygiene
• Hand hygiene - principles
• Five moments for hand hygiene
• Hand hygiene before invasive procedures
• Hand hygiene for patients and visitors
• Indications for hand hygiene
• Hand hygiene education and promotion
• Hand hygiene methods
• Hand hygiene products selection and evaluation
• Aesthetic preferences
• Evaluation of the microbicidal activities of hand-rub and hand-wash agents
• Pilot testing
• Product accessibility and cost
• Selection and evaluation for specific products
• Microbial flora of the hands
• Nails, rings, watches, bracelets
• Skin care
• Hospital cleaning and decontamination
• Immunization of health care workers
• Isolation of patients with Clostridium difficile infection (CDI)
• Methods for assessing environmental cleanliness
• Microbial typing
• Molecular epidemiology
• Pre-emptive isolation
• Reprocessing of flexible endoscopes
• Standard precautions
• The role of the clinical microbiology laboratory in infection prevention and control
• Clinical role of the microbiology laboratory
• Epidemiological/public health role of the clinical microbiology laboratory
• Surveillance and investigation of healthcare-associated infections
• Case definitions of healthcare infections
• HAI case definitions for use in hospitals
• Bloodstream Infection
• Bone and Joint Infection
• Cardiovascular System Infection
• Catheter-Related Infection
• Central Nervous System Infection
• Eye, Ear, Nose or Mouth Infection
• Gastrointestinal System Infections
• Lower Respiratory Tract Infection other than pneumonia
• Pneumonia
• Reproductive Tract Infections
• Skin and Soft Tissue Infections
• Specific Neonatal Case definitions
• Surgical Site Infection
• Systemic Infections
• Urinary Tract Infection
• European surveillance of healthcare-associated infections
• ECDC PPS in acute care hospitals
• ECDC PPS in European acute care hospitals protocol
• ECDC PPS in European acute care hospitals, definition of HAI
• ECDC PPS - antimicrobial use definition
• ECDC PPS - inclusion/exclusion criteria
• ECDC point prevalence survey of healthcare-associated infections and antimicrobial use in long term care facilities
• ECDC surveillance of Surgical Site Infections
• HAI Surveillance at the EU level - importance of international networks
• ECDC Programme on antimicrobial resistance and healthcare-associated infections
• European Antimicrobial Resistance Surveillance Network (EARS-Net)
• European Surveillance of Antimicrobial Consumption Network (ESAC-Net)
• Healthcare-Associated Infections Network (HAI-Net)
• Surveillance of Clostridium difficile infections
• Surveillance of HAIs in intensive care units
• The European Surveillance System (TESSy)
• Surveillance of healthcare-associated infections - definition
• Surveillance methodologies for healthcare associated infections
• Surveillance of healthcare-associated infections - other approaches
• Surveillance for MV Patients in the ICU

• Introduction to Public Health and basic concepts

• Public Health Informatics
• Apps for epidemiologists
• Data Capture Systems
• Electronic Data Transfer
• Online Reporting
• Web-crawling Applications
• Health Informatics Standards – general introduction
• Health Informatics Standards - Health Information Systems and Processes
• Health Informatics Standards - Standard Content
• Software for epidemiologists
• Weblinks for epidemiologists
• Public Health Interventions
• Contact tracing
• Host
• Prevention
• Hygiene and Sanitation
• Primary prevention
• Vaccination
• Herd immunity
• Measuring protection
• Secondary prevention
• Tertiary prevention
• Reservoir for infectious agents
• Source of infection
• Transmission routes
• Public Health Law
• Brief history of International Communicable Disease Law
• EU Public Health Legislation
• Decision 1082/2013/EU: Serious cross border health threat
• Some key recitals under 1082
• EU Food Safety Legislation
• EU Legislation for Communicable Diseases Surveillance
• International Health Regulations 2005 edition
• Applying Epidemiology for the International Health Regulations.
• Public Health Microbiology
• Applied Immunology
• Antibodies
• Antigen presenting cells (APC)
• Antigens (Ag)
• How pathogens try to trick our defenses
• Helminthic mechanisms of immune evasion
• Mechanism of infectious disease
• What determines our susceptibility to infections?
• Practical Aspects of Specimen Collection and Shipment
• The Role of Microbiology
• Bioinformatics
• Expert Advice
• Laboratory Support
• Types of Microorganisms
• Public Health Programs

• Statistical Concepts

• Models
• Logistic Regression
• Estimating Odds Ratios in the presence of interaction
• Fitting logistic regression models
• Interpreting model coefficients
• Linear models
• Model building strategies
• The logistic model
• Stratified Analysis
• The Mantel Haenszel Method
• Power and Sample Size
• Presenting Statistics
• Sampling
• Concepts in sampling
• Statistical Tests
• Significance and Confidence
• Confidence Intervals
• Significant probability to be different from the expected
• The idea of Statistical Inference