POST GRADUATE PROGRAM IN PUBLIC HEALTH, FACULTY OF MEDICINE, UNIVERSITAS

GADJAH MADA, YOGYAKARTA

COURSE TITLE : Outbreak Investigation

KUI :
Credit : 3 credit semester
Course type : Field Epidemiology Concentration
Semester :I

CLASS SESSIONS
Monday - Saturday
[08.00 –17.00]
Small Class:

COURSE COORDINATOR(S)
Riris Andono Ahmad, dr, MPH, Ph.D
[Insert NIDN],
0274-552021; risandono.ahmad@gmail.com
Gedung IKM Lantai 1, Room-FETP: 12.00 – 13.00, by appointment

TEACHING ASSISTANT(S)
Citra Indriani, MD, MPH
[Insert NIDN]
0274-552021; citraindriani@gmail.com
Gedung IKM Lantai 1, Room-FETP: 12.00 – 13.00, by appointment

Bayu Satria Wiratama, S.Ked, MPH

[Insert NIDN]
0274-552021; satriawiratama@gmail.com
Gedung IKM Lantai 1, Room-FETP: 12.00 – 13.00, by appointment

Baning Rahayujati, drg, MPH

[Insert NIDN]
0274-552021; baningrahayu@gmail.com
Gedung IKM Lantai 1, Room-FETP: 12.00 – 13.00, by appointment

PREREQUISITES
Epidemiology I

COURSE DESCRIPTION
This course will introduce the students to disease outbreaks, particularly on infectious diseases.
Understanding how it was started, spread and detected and how epidemiologists investigate
and respond in order to control them. During the course, students will be guided to explore
outbreaks and the systems and processes that support outbreak detection, investigation and

Department of Epidemiology [Semester 1] [2015]

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response through a combination of lectures, case studies, discussions, popular media analyses
and a fictional in-class outbreak. A systematic approach in investigating a disease outbreak to
ensure that investigation proceeds without missing important steps along the way will be the
main focus within this course.

COURSE AIMS
After completion of this course, students are expected to be able list and apply steps of field
investigation of a potentially serious health problem that requires a timely response and
develop an intervention strategy for containing an outbreak.

COURSE LEARNING OUTCOME

Students who successfully complete this course will be able to:

 List the operational steps of an outbreak investigation

 Determine whether an epidemic exist
 Verifying the diagnosis
 Count cases and determine attack rate
 Develop biologically plausible hypothesis
 Describe the use of and present data in a line listing
 Construct and interpret an epidemic curve
 List the types of evidence that need to be collected in the field
 Identify the essential roles in the logistics of outbreak investigation and response
 Develop recommendation of strategies to control and prevent in response to an outbreak
 Prepare an in house outbreak report

COURSE COMPETENCIES
Based on the International Field Epidemiology Training Program Standard core curriculum,
students will obtain competency that needed to succeed in the workplace as a public health
professional as a field epidemiologist and the competency is responds to an outbreak.

READING MATERIALS
The textbook for this course is
 Gregg M, Epidemiologi Lapangan, Ed 3 rd : Terjemahan Bahasa Indonesia;
 Mark S.D, Outbreak Investigation Around the World,
 David L. Heyman, Ed 18th atau Edisi Terjemahan, Control of Communible Disease Manual,
Washington DC: APHA 2014
 Gordis L, Epidemology, 3rd Ed. Philadelphia, PA. Elsevier Saunders: 2004. Update edition is
preferable

Additional readings of published scientific studies will be assigned.

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ASSESSMENT AND GRADING POLICY

In addition to midterm and final examination, there is also home assignment due often. Please
do not putt off homework until the last minutes! Do the homework as soon as possible after
relevant material has been covered in lecture will make the task easier for you and will
maximally reinforce the material in your understanding. Late submission will not be accepted.
Assignment should be uploaded to GAMEL on the due date. Faxed and mailed submission will
not be accepted unless prior arrangements have been made. The answer for the assignment
will be discussed during the tutorial session.

Regular grades are awarded for this course (A, B, C, D, E)

Student grades will be based on:
A ≥ 90%
B ≥ 80%
C ≥ 70%
D ≥ 60%
E ≤ 60%
Homework assignment and quiz 30%
Final examination 40%

COURSE REQUIREMENTS
Prepare for class and study the material after class. Participation in class including lecture, and
exercise during tutorial. Complete homework assignments on your own and submit on the due
date. Take a midterm exam and a final exam as scheduled. Any plagiarism is not tolerated and E
grade will automatically assign. There are no extra credit tasks and no make up for a higher
grade. Grades are not a matter of negotiation. Regular attendance is expected. If you miss a
class, you should find a way to learn the material I taught. 75% class attendance is needed for
midterm exam and a final exam.

Please observe the following classroom etiquette:

 Smartphone, cell phone, and other personal electronic devices should not be used and
should be in the “off” position;
 Laptop should not be used during classroom discussion. If you wish to take notes during
lecture, you may do so. Please note that “web surfing” is not allowed during class at any
time during lecture session
 Avoid distracting others if you must eat or drink. Clean up after yourself!.

Late work
For every day after deadline of the take home exam, a half grade penalty will be applied to the
student’s grade. The class discussion questions and reflections will not be accepted after the
due date.

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Incomplete
There is no automatic “grade of incomplete”. Students are expected to complete all course
assignment and exams on schedule by the end of a semester. An incomplete may be given only
when a student has met the attendance requirement (minimal 80% of the class sessions) but
certain course assignment have not been completed for reason satisfactory to instructor (i.e.
sickness).
The student must contact the course instructor no later than one week before final
examination to remove incomplete.

Citation and Original Work

Citation should be included with any material in which the original research, ideas, or
interpretations are not your own. Citations should be in Harvard format. If you have any
questions about citations, please contact your teaching assistance.

Collaboration
The best ideas are not created in isolation, but are the results of interaction, discussion, debate
and revision. Therefore the collaborations in encouraged. However, when submitting written
work that is the product of collaboration, all work must be in your own words. You should be
aware the rule of plagiarism. Our GAMEL software is capable this rule as well.

COURSE STRUCTURE
Course activities cover lecture, tutorial, individual or group assignment and laboratory excercise
including work at BBTKL (Balai Besar Teknologi dan Kesehatan Lingkungan) Yogyakarta
Laboratory. The lecture will be delivered through face to face in class, including tutorial and
laboratory work. Students are required to attend directly in the class.

The course is scheduled on Wednesday and Friday from 13.00 am to 15.00 pm for 16 weeks
periods. Lectures will be given on Wednesday and tutorial session will be held by teaching
assistant on Friday. Individual assignment will be given at the end of the tutorial session and
should be submitted via website before the next tutorial session.

All of the lecture can be found under content on the GAMEL.

UGM POLICIES AND EXPECTATIONS

Students and faculty have a shared commitment to the UGM’s mission, values and oath.

Academic Integrity
Students are required to adhere to the UGM Code, available online at http://

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COURSE SCHEDULE
Please see the lecture section of Courseworks to download the readings, exams, and lecture
slides.

Lecture
Session 1 – Introduction on teaching methods: Overview of Outbreak Investigation
(Context and importance)
Session 2 – Steps in Outbreak Investigation
Session 3 – Case Definition and Case Finding
Session 4 - Descriptive Epidemiology and Hypothesis Development
Session 5 - Design and conducting follow up study: Environmental and Epidemiology
Session 6 - Data Analysis and Interpretation
Session 7 – Control measures and risk communication

Case Study - Class

Session 1 – Food born Outbreak : Oswego
Session 2 – Zoonosis : Leptospirosis
Session 3 – Vector born Disease : Dengue Hemorrhagic Fever
Session 4 - Role play : Foodborne

Laboratory
Session 1 – Role of Laboratory and Existing Lab for Supporting Outbreak Investigation
Session 2 – Lab Case Study 1 :
Waterborn Case Study and Introduction to Microbiology Examination Methods
Session 3 – Lab Case Study 1 :
Introduction to Specimen Handling (Tools, Materials, Sampling, Collecting, Keep
and Transportation) and Practice : PPI (personal protection device) and Specimen
Handling
Session 4 - Lab Case Study 1 :
Continue on Salmonella Case Study and Discussion
Session 5 - Lab Tour 1 (divide into two group)
Visit virology, biology, chemistry, water laboratory, pengembangan tepat guna,
and rapid test lab
Session 6 - Lab Case Study 2:
Jaundice Case Study
Session 7 - Lab Case Study 2:
Introduction to Viral Culture. Rapid Diagnostic Test and PCR
Session 8 – Lab Case Study 2:
Continue on Jaundice Case Study and Discussion
Session 9 – Lab Tour 2 (divide into two group)
Visit virology, biology, chemistry, water laboratory, pengembangan tepat guna,
and rapid test lab

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Session 10 – Lab Case Study 3

High Fever Case Study
Session 11 – Lab Case Study 3
Basic Immunology
Session 12 – Lab Case Study 3
Continue on High Fever Case Study and Discussion
Session 13 – Summarize of all case study and discussion
Session 14 – Summarize of all case study and discussion
Session 15 - Tentament – Lab Exam

Week 1
Hours Monday Tuesday Wednesday Thursday Friday Saturday
08.00 - 09.40 Lecture 1 Case Study 1 Case Study 2 Lecture 4 Case Study 3 Role Play
10.00 – 11.40 Lecture 2 Case Study 1 Case Study 2 Lecture 5 Case Study 3 Role Play
12.00 – 13.00
13.00 – 14.40 Case Study 1 Lecture 3 Case Study 2 Case Study 3 Lecture 6 Role Play
15.00 – 16.40 Case Study 1 Lecture 4 Case Study 2 Case Study 3 Lecture 7 Role Play

Session 1 – Introduction on teaching methods

Overview of Outbreak Investigation I: Context and importance
[Date] Learning Objectives:
By the end of this session, students will be able to:
 Define and discuss outbreak definition
 Define and discuss the role of field epidemiologist within outbreak situation
 Define and discuss the importance of outbreak investigation
 Identify way to detect an outbreak or epidemic
 Identify the steps in an outbreak investigation
 Define and identify key agencies involved in outbreak investigation and their role
 Identify the key control measures that should undertake to contain the
outbreak

Activities
 During this session, a -100 minutes Contagion movie will be aired to introduce
the students to the outbreak situation and what will be their role as an
epidemiologist who works or assist the public health authority.

Reading
1. Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa
Indonesia; Bab 1: Definisi Epidemiologi Lapangan; Bab 4: Aspek
Operasional Dalam Epidemiologi Lapangan

Assignment:
Film summary focus on: how the disease is detected and monitored? Who will you
be? , What steps was undertaken to deal with the situation? What are the main
control measures? Who are the key agencies and what are their roles?

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Session 2 –Steps in Outbreak Investigation

[Date] Learning Objectives:
By the end of this session, students will be able to:
 Define and discuss outbreak definition
 Define and discuss the role of field epidemiologist within outbreak situation
 Define and discuss the importance of outbreak investigation
 Identify way to detect an outbreak or epidemic
 Identify the steps in an outbreak investigation (disease and food poisoning)
 Define and identify key agencies involved in outbreak investigation and their role
 Identify the key control measures that should undertake to contain the
outbreak

Activities
 Class Lecture and Discussion on Overview of Disease Outbreak and Outbreak
Investigation and relate it to the Contagion Movie

Reading
1. Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa
Indonesia; Bab 1: Definisi Epidemiologi Lapangan; Bab 4: Aspek
Operasional Dalam Epidemiologi Lapangan

Assignment: none

Session 3 – Outbreak Identification- Confirmation and Case Definition-Case Finding

[Date] Learning Objectives:
By the end of this session, students will be able to
 Define and identify methods of identifying outbreak
 Confirming that increases are real
 Verifying diagnosis
 Assessing risk and appropriate level of response/investigation triggers
 Determined the occurrence of disease outbreak
 Establish case definition by time, place and person
 Explain the possible, probable and confirmed case definition
 Select case definition that will be used, based on the sensitivity and specificity
of the case definition to detect the case
 Discuss and determined methods for finding cases
 Create line listing

Reading:
 Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa Indonesia;
Bab 3: Surveilans dan Bab 5: Melaksanakan Sebuah Penyelidikan Lapangan
 ESR, 2012. Guidelines for Investigating and Control of Disease Outbreak;

Assignment:
to be delivered during the course work on developing a case definition

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Session 4–Descriptive Epidemiology in Outbreak Investigation and Develop Hypothesis

[Date] Learning Objectives:
By the end of this session, students will be able to:
 Create frequency distribution
 Describe data by person, place and time and interpret it
 Plot epidemic curves
 Interpret epidemic curve for determining the mode of transmission, exposure
and incubation period
 Identify and discuss common mistakes in the preparation and analysis of
epidemic curve
 Develop hypothesis based on descriptive finding and observational study

Reading:
1. Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa Indonesia;
Bab 9: Mendeskripsikan Temuan dan Bab 10: Menganalisis dan
Mengintepretasi Data
2. Dicker, R., Coronado F., Koo D., Parrish, R G, 3rd Ed, An Introduction to Applied
Epidemiology and Biostatistics, Public Health Service US CDC; Lesson 4:
Organizing Epidemiological Data and Lesson 5: Investigating an Outbreak

Assignment: online quiz will be delivered in the GAMEL

Session 5 – Design Appropriate Follow up Study to Test Hypothesis

Environmental and Epidemiology Study
[Date] Learning Objectives:
By the end of this session, students will be able to:
 Select the appropriate study design for hypothesis testing
 Explain main steps involved in carrying out a retrospective cohort study and
case control study
 Identify pluses and minuses of various ways of collecting study data

Reading:
1. Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa Indonesia;
Bab 9: Mendeskripsikan Temuan dan Bab 10: Menganalisis dan
Mengintepretasi Data
2. Dicker, R., Coronado F., Koo D., Parrish, R G, 3 rd Ed, An Introduction to Applied
Epidemiology and Biostatistics, Public Health Service US CDC; Lesson 4:
Organizing Epidemiological Data and Lesson 5: Investigating an Outbreak

Assignment: none

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Session 6 – Analytical Epidemiology: Analyzing and Interpreting Data

[Date] Learning Objectives:
By the end of this session, students will be able to:
 Plan the data analysis
 Calculating attack rates and risk ratio
 Identify the strength association and confounding (is the associations real?)
 Interpret the statistical significance and confidence interval
 Describe challenges in conducting analytical epidemiology during outbreak
investigation: no association, multiple associated exposures, few explained
cases

Reading:
1. Gregg M, Epidemiologi Lapangan, Edisi Ketiga : Terjemahan Bahasa Indonesia;
Bab 9: Mendeskripsikan Temuan dan Bab 10: Menganalisis dan
Mengintepretasi Data
2. Dicker, R., Coronado F., Koo D., Parrish, R G, 3 rd Ed, An Introduction to Applied
Epidemiology and Biostatistics, Public Health Service US CDC; Lesson 4:
Organizing Epidemiological Data and Lesson 5: Investigating an Outbreak

Assignment: none

Session 7 –Principle of Control Measures and Risk Communication - Outbreak

[Date] Learning Objectives:
By the end of this session, students will be able to:
 Explain the principle in controlling an outbreak
 Develop general control measures for outbreak
 Develop specific control measures for outbreak
 Develop a plan for communicating warning and recommendation for the public
 Create an oral and written communication for media about acute health event
 Create a briefing documents for specific audience (public, politician,leader, etc)
 Use SOCO (single overriding communication objective) to prepare and deliver a
presentation for a specific target audience

Reading:
1. James Chin, Control of Communicable Disease Manual
2. WHO, 2004, Outbreak Communication: Best practices for communicating with
the public during outbreak;
3. WHO, 2008, Outbreak Communication Planning Guide, Geneva;

Assignment: will be delivered during the course in developing of risk

communication plan

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TUTORIAL
Case Study 1 – Oswego
[Date] Learning Objectives:
After this session, students were expected to better able to:
 Define the terms “cluster”, “outbreak” and epidemic
 List the steps in the investigation of an outbreak
 Draw interpret and describe the value of an epidemic curve
 Calculate and compare food-specific attack rate to identify possible vehicle
 List reason for investigating an outbreak that has apparently ended

Materials:
Oswego-Case Study (attached)

Case Study 2 - Leptospirosis

[Date] Learning Objectives:
By the end of this session, students will be able to:

Materials:

Case Study 3 – Hemorrhagic Fever Outbreak

[Date]

Case Study 4 – Role Play

[Date] Learning Objectives:
By the end of this session, students will be able to

Materials:

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LABORATORY
Please see the web to download the readings, data, computer program and lecture slides.
Session 1 – Role of Laboratory and Existing Lab for Supporting Outbreak Investigation
[Date] Learning Objectives:
 Introduce value of lab data and its impact on public health decisions
 Describe the similarities and differences between clinical (individual-focused)
laboratories and public health laboratories (population-focused).
 Describe current interaction and networks between clinical, lab and public
health (including regulatory and academic labs).

Reading:

Assignment:
Identify labs, their expertise for specimen testing & their contact persons.

Session 2/4 – Lab Case Study 1 :

[Date] Learning Objectives:
After this session, students were expected to better able to:
 Summarize the value of lab data and its impact on public health decisions.
 Understand how key laboratory (e.g. microbiological, chemical dll) methods
work and their public health utility
 Understand the pro/cons of key lab methods.
 Explain the advantages/disadvantages of different diagnostic tests for the
most common etiologic agents (bacteria).
 Consult with labs before a field investigation begins for sample collection,
storage, transportation, test/parameter selection.
 Coordinate the needs and objectives of different stakeholders (clinicians, lab,
veterinary and environmental) during collaborations.
 Understand what the laboratory does with samples that arrive
 Have an understanding of the range of test methods used to analyse samples
 Incorporate lab findings in both progress and final reports
 Develop write a structured report for public health action, including for media
purposes
Reading:
Assignment: to be delivered in class session

Session 5 &9 - Lab Tour 1 (divide into two group)

[Date] Learning Objectives:
After this session, students were expected to better able to:
 Describe laboratory capability and capacity
 Explain process of laboratory methodology

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Reading: SOP available in the lab

Assignment: List of SOP and explain regarding laboratory procedure which might
influence the test result.

Session 6/8 – Lab Case Study 2:

[Date] Learning Objectives:
After working through this session, students were expected to be able to:
 Summarize the value of lab data and its impact on public health decisions
 Explain the advantages/disadvantages of different diagnostic tests for the
most common etiologic agents (virus)
 Coordinate the needs and objectives of different stakeholders (clinicians, lab,
veterinary and environmental) during collaborations.
 Interpret Laboratory data in proper context (etiology, specimen factors,
disease specific epidemiological factors, test factors, frequency of disease)
 Review diagnostic tests available at the local level and recognize design
characteristics may affect specimen collection, transportation and storage.
 Communicate with lab staff about timing of lab results
Reading:
Assignment: Role play

Session 10/12 – Lab Case Study 3

[Date] Learning Objectives:
After working through this session, students were expected to be able to:
 Explain the advantages/disadvantages of different diagnostic tests for the
most common etiologic agents (virus)
 Analyze laboratory data for public health activities.
 Apply as appropriate the ethical, bio risk and legal aspects of specimen
collection, storage, transportation, testing and reporting.
 Review diagnostic tests available at the local level and recognize design
characteristics may affect specimen collection, transportation and storage.
 Understand advantages/disadvantages/limitations of screening/rapid tests and
confirmatory tests in different epidemiological contexts , and for different
types of specimens (e.g. human, environmental, food)
 Communicate with lab staff about timing of lab results including specimen
collection and handling
 Jointly write a structured report for public health action, including for media
purposes
Reading: none

Assignment: none

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LABORATORY SCHEDULE

Week 2
Hours Monday Tuesday Wednesday Thursday Friday Saturday
08.00 - 09.40 Introduction Lab Tour Lab Tour Summary
10.00 – 11.40 Lab Case Study 1 Lab Case Study 2 Lab Case Study 3 Summary
12.00 – 13.00
13.00 – 14.40 Lab Case Study 1 Lab Case Study 2 Lab Case Study 3 Lab Exam Final Exam
15.00 – 16.40 Lab Case Study 1 Lab Case Study 2 Lab Case Study 3

Investigasi Kejadian Luar Biasa 1

Lecture
Session 1 Introduction on teaching dr. Citra Indriani, MPH Jumat, 21 Oktober 2016 13.00 - 14.40
methods : Overview of
Outbreak Investigation
(Context and importance)
Session 2 Steps in Outbreak dr. Citra Indriani, MPH Rabu, 26 Oktober 2016 08.00 - 09.40
Investigation
Session 3 Case Definition and Case dr. Citra Indriani, MPH Kamis, 27 Oktober 2016 13.00 - 14.40
Finding
Session 4 Descriptive Epidemiology and drg. Th. Baning Rahayujati, Kamis, 27 Oktober 2016 15.00 - 16.40
Hypothesis Development MKes
Session 5 Design and conducting follow dr. Citra Indriani, MPH Senin, 31 Oktober 2016 08.00 - 09.400
up study: Environmental and
Epidemiology
Session 6 Data Analysis and Trisno Agung Nugroho, SKM,
Interpretation Mkes
Session 7 Control measures and risk drg. Th. Baning Rahayujati,
communication MKes

Case Study - Class

Session 1 Food born Outbreak : Oswego dr. Citra Indriani, MPH Jumat, 28 Oktober 2016 13.00 - 20.00
Session 2 Zoonosis : Leptospirosis Evi Susanti Sinaga, SKM,
MPH Selasa, 1 November 2016 08.00 - 16.40
Session 3 Vector born Disease : Dengue Evi Susanti Sinaga, SKM,
Hemorrhagic Fever MPH Kamis, 3 November 2016 08.00 - 16.40
Session 4 Role play : Foodborne Evi Susanti Sinaga, SKM,
MPH Sabtu, 5 November 2016 08.00 - 16.40

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Laboratory
Session 1 Role of Laboratory and BBTKL
Existing Lab for Supporting
Outbreak Investigation
Session 2 Lab Case Study 1 : Waterborn BBTKL
Case Study and Introduction
to Microbiology Examination
Methods
Session 3 Lab Case Study 1 Introduction BBTKL
to Specimen Handling (Tools,
Materials, Sampling,
Collecting, Keep and
Transportation) and Practice :
PPI (personal protection
device) and Specimen
Handling
Session 4 Lab Case Study 1 : Continue on BBTKL
Salmonella Case Study and

15-18 November 2016

Discussion
Session 5 - Lab Tour 1 (divide into two BBTKL
group) Visit virology, biology,
chemistry, water laboratory,
pengembangan tepat guna,
and rapid test lab
Session 6 Lab Case Study 2: Jaundice BBTKL
Case Study
Session 7 Lab Case Study 2: BBTKL
Introduction to Viral Culture.
Rapid Diagnostic Test and PCR
Session 8 Lab Case Study 2: Continue on BBTKL
Jaundice Case Study and
Discussion
Session 9 Lab Tour 2 (divide into two BBTKL
group) Visit virology, biology,
chemistry, water laboratory,
pengembangan tepat guna,
and rapid test lab
Session 10 Lab Case Study 3 High Fever BBTKL
Case Study
Session 11 Lab Case Study 3 Basic BBTKL
Immunology
Session 12 Lab Case Study 3 Continue on BBTKL
High Fever Case Study and
Discussion
Session 13 Summarize of all case study BBTKL
and discussion
Session 14 Summarize of all case study BBTKL
and discussion
Session 15 Tentament – Lab Exam BBTKL

Department Epidemiology [Semester 1] [2015]