The Infectious Disease Epidemiology Game

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By: Lindsey Long

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The Infectious Disease Epidemiology Game

A fast-paced race through the context of Public Health acheivemennts and limitations over time

Roll the dice:

Choose and move your player:

Click for Instructions:

Open draw pile:

Start

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*Open this page on a second tab for best format. This is the "Draw Pile". You previously landing on a random "?" spot on the main board. Now, click on a "!" dot associated with the number that you landed on. Follow directions on each card. Pay attendtion to the time period mentioned in ( ). If it says "(Ongoing)" make sure to always complete the task on the card.

(If you are on a spot after 1900s) Political and cultural factors influence the allocation of resources for malaria control efforts and the acceptance of interventions like mass drug administration and vaccination campaigns. You are doing malaria research! TAKE 1 STEP FORWARD.

Welcome! Goal of the game: Get to "finish" before any other player, learn about infectious disease epidemiology and have fun! GOOD LUCK! 1.) Begin by choosing your player (A,B,C or D) game piece that you will move around the board. Place all players on the start. Roll the dice to see who will start first. 2.) On each turn, a player will roll the dice and move that many spots on the board. Touch the icon on each spot to learn about the Public Health milestone. 3.) On all spots with the "?" icon, you must click on the draw pile and follow the directions on the card that you draw. There are 8 spots without "?" icons, you do not have to draw a card when landing here. (***Open draw pile on a second tab for best format) 4.) Keep playing until someone reaches the finish! Players are allowed to occupy the same spot at the same time. Board game colors do not have significance. You've got this!

1946 (The United States) The Establishment of the United States Communicable Disease Center: Improved disease surveillance systems were introduced by the establishment of the U.S Communicable Disease Center in 1946. This included the systematic collection and analysis of morbidity and mortality data.

(Ongoing) Researchers in interdisciplinary fields: Engaged in robust research and sustained efforts in disease prevention, control, and potential eradication. You became part of the research study. TAKE 1 STEP FORWARD.

(If you are on a spot after 1790s) Vaccine developers: Contributed to the development of vaccinations to provide long-lasting protection against diseases. You worked on vaccine development. TAKE 1 STEP FORWARD.

(Ongoing) Education: Increased awareness of preventive measures and disease treatment, emphasizing the importance of community education. Your community does not have a health department. Unfortunately you lack access to health education. TAKE 2 STEPS BACK

(If you are on a spot during the 18th century - Late 19th century) Variolation and vaccination: Traditional practices like variolation in China, India, Africa, and England, and later vaccination, utilized to prepare the immune system and provide protection against diseases. You were not fortunate enough to know about this new technology. You tragically died from disease. GO BACK TO START.

Late 1800s – 1932 (The United States) Enhanced Quarantine Measures are Developed: Over 12 million immigrants coming to the United States entered through Ellis Island, between the late 1800s to the early 1900s. This area served as the largest ever medical screening facility where doctors would briefly test and question each individual for signs of physical ailments. This process helped reduce the spread of diseases and mitigate the risk for local citizens.

1948 (The United States and World Health Organizations) International Classification of Diseases System: The World Health Assembly adopted the International Classification of Diseases (ICD) in 1948. Proceeding the ICD was the ‘International List of Causes of Death” which was first used in 1893. Over time, the ICD progressed from a simple disease database used by 20 countries into a digital format of more informative health data that is now used globally. Health information can be gathered, documented, and analyzed across various countries through the ICD making it a more precise and powerful public health resource.

(Ongoing) Immune system: Innate and adaptive immune responses play crucial roles in defending against pathogens and providing long-lasting protection through vaccination. You had a compromised immune system before being exposed to disease. Unfortunantely, you did not survive. GO BACK TO START.

2011-present (Syria) Global Health Organizations: International assistance and targeted health promotion services are needed to address diverse communities. Specifically, the displacement of Syrians due to the civil war illustrates the challenge of innovatively creating necessary healthcare infrastructure in new environments. The Syrian civil war exemplifies the impact of conflict on healthcare infrastructure and disease spread. Global organizations like UNICEF and the World Health Organization are continually working towards responding to health needs in various regions of the world.

2020 Ongoing (Global) COVID-19 Pandemic and Immune Response: The study of immune response includes understanding the activation of both innate and adaptive immune systems. Amidst the COVID-19 pandemic, significant strides have been made in developing effective strategies to understand how Vaccinations trigger the activation of innate and adaptive immune systems, providing long-lasting protection.

1999 (Ongoing Global Studies) Research on Vaccine Safety and Efficacy: Continued research and advancements in understanding the safety and efficacy of vaccines was done and particularly addressed by Brent Taylor and co-workers. Their focus notably debunked the claims propagated by Andrew Wakefield and his associates in 1998 through the Lancet Journal, that falsely linked the MMR vaccine to autism.

1997 (Occurs in Jewish Populations, recently studied in France and The United States) Unique Population Immunity: Some populations develop immunity to diseases like smallpox and Bubonic Plague due to genetic mutations, such as the MEFV mutation in Jewish minority groups. Familial Mediterranean Fever (FMF) is most often caused by a mutation in this gene, and while it does have negative side effects, it is known to grant immunity to other diseases. Other social and environmental factors affect immunity. While prior FMF observations were made using Arab and Jewish populations, it was not until the late-1900s when the mutation was finally identified by positional cloning and was mapped to chromosome 16.

(Ongoing) Reservoirs: Environments in which infectious agents can live contribute to the complexity of studying and addressing infectious diseases. You live next to standing water making you susceptible to mosquito breading grounds that carry deadly diseases like Malaria. TAKE 1 STEP BACK

(Ongoing) Socioeconomic conditions: Influence the prevalence of diseases and access to healthcare resources, affecting disease burden within communities. You unfortunately were born in an area with low social mobility. TAKE 1 STEP BACK

(Ongoing) Waterborne illnesses are transmitted via viruses or bacteria through water. You are susceptible to waterborne illnesses and drink water from the local river source that may be polluted. You have no way to filter or mitigate your risk to waterborne illnesses. TAKE 1 STEP BACK

2002 (The United States) Establishment of The Office of Public Health Emergency Preparedness (OPHEP): This department was created to coordinate activities related to preparing against acts of bioterrorism and other public health related threats including that of infectious disease.

1921 (First developed in Paris, France) Tuberculosis Vaccine: The development of the Bacille Calmette-Guérin (BCG) vaccine against TB marked a significant milestone in Tuberculosis prevention efforts. This is the only TB vaccine that is available today. It has been successfully administered to millions of children and individuals for more than 100 years.

1946 (The United States) Alexander D. Langmuir: He was a renowned epidemiologist and helped in the catalyst of success for the now Centers for Disease Control and Prevention. In 1946, he aided in the establishment of the U.S Communicable Disease Center, setting initiatives for disease surveillance. Langmuir successfully championed the concept of the Epidemic Intelligence Service (EIS). This program would respond to disease outbreaks as a study of biologic warfare defense and more.

(If you are on a spot after 1980) Screening and preventive health strategies: Proactively conducted on "at risk" populations, driving current public health initiatives such as HIV/AIDS testing. You live in Pakistan where these types of initiatives are being put to the test. TAKE 1 STEP FORWARD.

1992 (The United States) Conference on Drug-Resistant Strains of Mycobacterium: In relation to several TB outbreaks due to multidrug-resistant strains of Mycobacterium tuberculosis, Therefore, a conference on "Meeting the Challenge of Multidrug-Resistant Tubercu- losis" (MDR-TB) was held at the CDC. Over 400 professionals from state health departments, federal agencies, and health organizations met to discuss plans in addressing drug resistance, laboratory research, epidemiology, disease surveillance, infection control, environmental public health, and more.

(Ongoing) You are a person over the age of 65 or part of the elderly population. You face higher risk to infectious disease as part of the vulnerable population. TAKE 1 STEP BACK.

1954 (The United States) Epidemiologic Genetics: Advancements in the field of genetic epidemiology were first made by Neel and Schull who coined the term “epidemiologic genetics”. Through this field, the role of genetics in determining risk to chronic diseases is observed. Also studied are nongenetic factors that influence disease risk. Continued growth through this filed can contribute greatly to our understanding of 1.) How and why diseases can be passed through lineage 2.) How and why diseases can alter the human genome i.e Gene Variance 3.) The comparison infectious and inherited disease.

2020 (Saudi Arabia) Refined Social Gathering Practices: The annual Hajj pilgrimage to Mecca, Saudi Arabia, exemplifies proactive planning and mitigation strategies to prevent disease spread. This included Vaccine requirements, food regulations, WaSH infrastructure, and the use of health education and communication to help reduce the spread of infectious disease among large groups of people. This was particularly used in lieu of COVID-19.

(Ongoing) Herd immunity strategies: Implemented to limit disease spread and protect vulnerable populations by elevating the percentage of immune individuals within a population. You thankfully live in herd immunity. TAKE 2 STEPS FORWARD.

1980s-1990s (The United States)Community Activism: Activists and community organizers played a crucial role in shaping treatment approaches during the HIV/AIDS epidemic in the United States. The empowerment and redirection of stigmas surrounding HIV/AIDS was important in creating successful prevention strategies and policy.

541 CE, 6th Century CE, into the 1600s (Global Spread from India to Europe) Early Pandemics: We begin by observing several critical plague epidemics. The Justinian Plague circa 541-542 CE spread from India to Constantinople. In procession came many more waves of the plague but none so quickly and infamously as the Black Death Bubonic plague that swept across Europe, nearly eradicating the area’s population. Those with immunity were left to bury the dead and face several more decades of uncertainty and fear; relying on religious and later, public health practices to save them from death. From the mid-1300s all the way until the 1600s, Black Death plague outbreaks increased the need for accurate and effective medical, technological, and sociological developments. Antonine Plague, Cyprian Plague, and Black Death altered social organization, political structures, and economic systems in various regions, impacting human populations and shaping historical events.

(Ongoing) Water, sanitation, and hygiene initiatives are implemented to mitigate the risk of infectious diseases related to poor water quality and hygiene practices. You have never heard about the importance of washing your hands and you can not dispose of waste in a sanitary way, contributing to water pollution and increasing your risk to waterborne illnesses. TAKE 1 STEP BACK.

Mid-1300s (Jewish populations in Europe) Disease discrimination and blame placed onto cultural groups: During the plague outbreak in Europe, Jewish minority groups were blamed for the disease due to their immunity, highlighting social and cultural factors influencing disease perception and response. Learn more about this as you travel down the board!

(Ongoing) Refugee camps and infectious disease risk: Political and socioeconomic factors contribute to infectious disease risk in refugee camps, highlighting the importance of public health strategies such as WaSH interventions in vulnerable populations. You unfortunately have spent time in a refugee camp. TAKE 2 STEPS BACK

Woo, that was close! You survived a disease outbreak in your area. TAKE 1 STEP FORWARD. Because life without friends is boring, choose another player who can also TAKE 1 STEP FORWARD.

1980s (The United States) Antiretroviral Therapy (ART): While there is no cure for HIV/AIDS, HIV treatment reduces the amount of HIV in the body and helps individuals stay healthy. The emergence of effective antiretroviral treatments for HIV/AIDS revolutionized disease management and treatment.

(Ongoing) Resource allocation: Prioritization of resources and access to preventive measures, influencing disease burden within communities. You unfortunately do not have access to health resources. TAKE 1 STEP BACK

Link to References

Game creation: March 2024

My name is Lindsey Long and I am a rising Senior undergraduate student at The Ohio State University studying Environmental Public Health.

Additional Resouces: Content in this game is based off of various peer reviewed research articles and marterials from PUBHEPI 5412 at The Ohio State University taught by Dr. Amie Hufton in the College of Public Health. Disclaimer: Infectious Disease Epidemiology is a continuously growing field. This game does not cover all milestones, historical accounts, or factors related to the field, however it aims to educate and promote public health while highlighting challenges faced by global health leaders and vulnerable populations.

Learn about the game creator:

(If you are on a spot after 1670s) Scientists studying pathogens: Investigated the role of microorganisms, including bacteria, fungi, parasites, and viruses, in infectious diseases. You are part of the research team! TAKE 1 STEP FORWARD.

1670s (Germany) Discovery of Pathogens: Pathogens are microorganisms, including bacteria, fungi, parasites, and viruses, which act as agents that carry disease to host individuals or species, were studied. Microorganisms carried diseases and were recorded in Bills of Mortality and other surveillance systems.

1932-1972 (The United States) New Legal and Ethical Considerations: Controversies over individual rights and ethical research practices, such as those highlighted in the Tuskegee Syphilis Study shed light on issues surrounding research practices and the advancement of scientific knowledge through the use of human subjects.

1300s (Europe and Asia) Increased Trade and Interactions between Countries: Heightened human and animal interactions facilitated the spread of diseases like the Bubonic Plague through the Silk Trade route. Since regions can grow political power and wealth from economic trade facilitations, we can only see an increase in this practice as time goes one – further contributing to the spread of disease.

Mid-1600s (Americas) European Colonization: The impact of infectious diseases on Indigenous populations in the Americas, led to devastating health consequences and loss of entire civilizations. European colonizers brought deadly diseases to populations in the Americas who had yet built immunity to said diseases. Increased movement of Europeans to other areas of the world such as Africa and Asia have also left populations vulnerable.

(Throughout history, with notable impacts during various pandemics and crises) Pandemics and other catastrophic events disrupt education services, alter workforce dynamics, impact economic trade, weaken countries' status, and decrease foreign investment, leading to significant economic losses. Unfortunantely you lived through a pandemic TAKE 2 STEPS BACK.

1718 (England) Lady Mary Wortley Montagu: She led a movement advocating for the popularization of and the practice of variolation in England in the early 18th century, acting as an influence to encourage the population to protect themselves and others from disease.

(Ongoing) You are pregnant and face higher risk to infectious disease as part of the vulnerable population. TAKE 1 STEP BACK.

1890 (Germany) Robert Koch: Robert Koch was a physician and microbiologist. His discovery of the TB bacterium revolutionized approaches to combating infectious diseases. Robert Koch's four postulates are a set of criteria that establish whether a particular organism is the cause of a particular disease. 1.) The microorganism must be found in the diseased animal, and not found in healthy animals. 2.) The microorganism must be extracted and isolated from the diseased animal and subsequently grown in culture. 3.) The microorganism must cause disease when introduced to a healthy experimental animal. 4.) The microorganism must be extracted from the diseased experimental animal and demonstrated to be the same microorganism that was originally isolated from the first diseased animal.

Mid-1500s (Italy) Magistracies in Italy: Groups of magistracies in Italy were utilized to implement surveillance systems and public health measures during outbreaks in Europe. Magistracies were tasked to track the spread of plague by implementing control measures. They would separate the sick from the healthy and restrict individuals suspected of carrying the disease while ensuring prosperous trade of goods and services at boarders.

(If you are on a spot after 1976) Vaccine hesitancy and misinformation: Criticism and hesitancy surrounding vaccines due to questionable research, side-effects, and mandate policies, leading to decreased trust in public health officials. You unfortunately do not have access to health education on vaccine importance or the resources to access vaccines. TAKE 2 STEPS BACK

(Ongoing) Global, especially in regions with high population densities like sub-Saharan Africa, Southeast Asia, and parts of Latin America. Environmental factors such as climate change and global warming leading to increased breeding grounds for mosquitoes, exacerbating malaria transmission. You live in one of these areas. TAKE 3 STEPS BACK.

1796 (England) Vaccinations: Edward Jenner's invention of the smallpox vaccine led to the eradication of smallpox. The WHO declared the eradication of active smallpox in 1980 and the last case was in Somalia.

1300s (Italian coasts)Isolation techniques: The utilization of cordon sanitaire and other methods to isolate infected individuals and prevent the spread of disease were used. The French describe it as "sanitary cordon," originally in reference to a line of military posts or other barriers which were used to protect and separate a community afflicted with an infectious disease.

1847 (Hungary) Ignaz Semmelweis: Was the pioneer of hand hygiene practices in the mid-19th century, linking handwashing to the prevention of puerperal fever. Ignaz Semmelweis's observations on hand hygiene practices were introduced in healthcare settings, marking a significant contribution to public health intervention.

(Ongoing) Stigma surrounding TB and historical factors such as European colonization have influenced the prevalence and management of TB globally. Generations ago, your ancestors were affected by the spread of disease through colonization. You were never born. GO BACK TO THE START

(Ongoing) Oh no, your cousin is sick and needs you to take care of them. You must refrain from other tasks and duties and tend to their needs. They got sick because they didn’t have access to a public health intervention that would have saved their life. TAKE 2 STEPS BACK.

(Ongoing) Despite advancements in treatment, HIV/AIDS continues to be a major health concern in sub-Saharan Africa. You have challenges accessing to life-saving medications. Addressing the HIV epidemic demands renewed commitment and innovative approaches. You live in Sub-Saharan Africa. TAKE 2 STEPS BACK.

Ongoing (Global) Bioterrorism Concerns: Bioterrorism is the intentional release of natural biologic agents such as viruses, bacteria or fungi into a population to cause disease, terrorize, or manipulate the government. Modern communities face the threat of bioterrorism. This reflects the importance of political, social, and scientific factors that can influence infectious disease control.

1662 (England) John Graunt: Made considerable observations on the Bills of Mortality, reorganizing and quantifying data to recognize important patterns related to infectious disease epidemiology and advancing public health.

(If you are on a spot after the 1950s) Research funding allocation: Unequal distribution of funding and lack of attention contribute to the ongoing neglect of diseases such as Chagas disease, dengue, and chikungunya. Thankfully you are part of the Neglected Tropical Disease movement started in the mid-1950s. TAKE 2 STEPS FORWARD

1974 (North America) The Lalonde Report: This report recognized that determinants of health go beyond traditional medical care. He argued for the importance in studying and observing socioeconomic factors and social inequalities in relation to health within communities. This report was led by the Canadian Institute for Advanced Research in the 1980s, which advocated for policy efforts related to this new Public Health approach.

1974 (World Health Organization partners) World Health Organization's Expanded Program on Immunization (WHO-EPI): This program was designed for the implementation of strategies that eliminate disease transmission and promote routine childhood immunization.

2002 (Global) The Global Fund to Fight AIDS, Tuberculosis, and Malaria: This fund was established to combat the rising prevalence of HIV/AIDS and other diseases. Specifically, the integration of new prevention techniques, medical treatments, and education led to a significant decline in AIDS presence, especially in the United States.

1894 (Hong Kong) Research on Yersinia Pestis: Alexandre Yersin identified, described, and cultured “Yersinia pestis”, the bacterium responsible for bubonic plague. This led to a better understanding of and control of the disease.