Detailed program and plan of the full-time studies

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1 EHESP School of Public Health Master of Public Health Detailed program and plan of the full-time studies EUROPUBHEALTH Specialization: Advanced Biostatistics and Epidemiology ACADEMIC YEAR Master of Public Health Directory: Dr. Martine Bellanger MPH Course Director Dr. Moise Desvarieux Academic coordinator of the track Advanced Biostatistics and Epidemiology track

2 TEACHING PROGRAM ON HIGHER EDUCATION LEVEL The European Public Health Master (Europubhealth) Classes conducted in 2014/2015 academic year SPECIALIZATION: Advanced Epidemiology and Biostatistics Program of the second year in the Europubhealth programme for French and international students conducted by the EHESP School of Public Health (Rennes and Paris), France. For the first year of the Europubhealth program students basic acquisitions on public health being conducted at University of Sheffield (Sheffield, Great Britain) or in Andalusian School of Public Health, University of Granada (Granada, Spain). The MPH of EHESP is validated for a 4-year period ( to ) by the Agency for Public Health Education Accreditation (APHEA), 1st specific accreditation system for education in public health at the European level.

3 Study plan in Advanced Biostatistics and Epidemiology # COMPULSORY Modules titles ECTS Upgrading Biostatistics Not credited 203 Advanced Core curriculum Epidemiology Advanced Core curriculum Information sciences and biostatistics Advanced Core curriculum Environmental and occupational health sciences Cross-disciplinary Module: Global Health 3 Total Compulsory Modules (1) 12 MINORS 2 out of 3 minors EPI 6 electives with a minimum of 4 in EPI be chosen among minors and majors: ELECTIVE Modules titles ECTS EPI Minor 210 Infectious Disease Epidemiology 3 EPI Minor 211 Chronic Disease Epidemiology 3 EPI Minor 238 Perinatal and Pediatric Epidemiology Biostats Data Mining 3 MAJORS 3 EPI Major 223 Design, Concept and Methods in Epidemiology : compulsory 3 Major EPI EPI Major 224 Analysis in Epidemiology (II) 3 (224 or 225) EPI Major 225 Analysis in Epidemiology (I) SAS Software Biostats Major 230 Multi-level Analysis 3 TOTAL Elective modules 18 OVERALL COMPULSORY + ELECTIVE MODULES : (3) + (2) = (3) SUPRA 215 Biostats Intro to R: computing, graphics and statistics 229 Biostats Modelling of infectious diseases 231 Biostats Spatial statistical analysis OR ANY MINOR & Major of interest in other track 30 ECTS PASS/FAIL MINORS 2 Minors BIOSTATS 1 out of 3 EPI Minors MAJORS 2 OUT OF 3 Major Biostats 6 electives with a minimum of 4 in Biostats be chosen among minors and majors ELECTIVE Modules titles ECTS Biostats Data Mining 3 Biostats Intro to R: computing, graphics and statistics 3 EPI Minor 210 Infectious Disease Epidemiology 3 EPI Minor 211 Chronic Disease Epidemiology 3 EPI Minor 238 Perinatal and Pediatric Epidemiology 3 Biostats Modelling of infectious diseases 3 Biostats Multi-level Analysis 3 Biostats Spatial statistical analysis EPI Major 223 Design, Concept and Methods in Epidemiology 3 TOTAL Elective modules 18 OVERALL COMPULSORY + ELECTIVE MODULES : (3) + (2) = (3) SUPRA 224 EPI Major 224 Analysis in Epidemiology (II) 225 Major 225 Analysis in Epidemiology (I) SAS Software OR ANY MINOR in EPI not taken or any MInor & Major of interest in other track 30 ECTS PASS/FAIL EUROPUBHEALTH INTEGRATION MODULE RENNES 2 INTERNSHIP - THESIS 28 Total (4) 30 ECTS MPH Year 2 : (3) + (4) 60 ECTS

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20 Syllabus Module Minor A: 210 Module 210 Infectious disease epidemiology UE coordinator Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA Dates 19 to 23 October 2015 Credits/ECTS Duration Module description 3 ECTS 5 days Infectious disease epidemiology studies the occurrence of infectious diseases; factors leading to infection by an organism; factors affecting transmission of an organism; and factors associated with clinically recognizable disease among those who are infected. It requires the use of traditional epidemiologic methods as well as methods unique to infectious disease epidemiology, such as mathematical modeling. In addition to knowing epidemiologic methods, infectious disease epidemiologists need to be familiar with the biological features and clinical manifestations of important pathogens as well as laboratory techniques for the identification and quantification of infectious organisms. This course is designed to provide an introduction to infectious disease epidemiology. It will focus on the tools and methods used in identifying, preventing, and controlling infectious diseases to improve public health. Case studies based on the literature and the work of faculty members will be used to illustrate the real-world application of these tools and methods to address public health problems. Prerequisites. Course learning objectives UE structure (details of sequences : title/speaker/date/duration ) Students who successfully complete this course will be able to: Discuss the key concepts of infectious disease transmission and control, and the differences with non-infectious diseases Apply biological principles to development and implementation of disease prevention, control or management programs Specify the role of the immune system in population health Apply epidemiologic tools and methodologies to understand the transmission dynamics and control of infectious diseases Critically appraise and interpret the findings of infectious disease epidemiology papers Specific leaning objectives are noted for each session. At the end of each session, students should know and be able to accomplish the session s learning objectives. Session 1. Introduction to Infectious Disease Epidemiology Session 2. & Evaluation of Diagnostic Tests and Treating Latent Infection as a Control Strategy: Tuberculosis Session 3. Causal Inference, Mathematical Modeling, and the Development of Public Health Policy: Voluntary Medical Male Circumcision to Prevent HIV Transmission Session 4. Epidemiology and Control of Malaria Session 5. Epidemiologic Methods for Measuring Transmission and Control of 1

21 Respiratory Infections: Influenza Session 6. Epidemiologic Methods in Vaccinology Session 7. Choosing Biologic Outcomes and Developing Immunization Policy: The Human Papillomavirus Vaccine to Prevent Cervical Cancer Session 8. Mathematical Modeling: Introduction to Concepts in Transmission and Dynamics Session 9. Epidemiologic Methods for Measuring Transmission and Control of Viral Hepatitis Session 10. Surveillance and control of healthcare-associated infections Course requirement Grading and assesment 100% Final written examination Location Columbia Global Centers\Europe, Reid Hall 4 rue de Chevreuse Paris Readings assigned journal articles 2

22 1 Session Title Introduction to Infectious Disease Epidemiology Speaker Session Outline Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA Overview of the Biological Basis of Infectious Disease Epidemiology, Immune Response, and Methods for Detection of Infectious Diseases Application of Fundamental Epidemiological Study Designs to Infectious Disease Learning Objectives Describe the host-pathogen-environment interaction and identify biologic factors influencing this interaction Summarize the epidemiologic classification of infectious diseases Explain the natural history of infectious diseases Demonstrate the role of transmission mechanisms in disease control and prevention Describe the branches of the immune system Explain the different immune responses to specific infectious diseases Describe laboratory testing methodologies used to monitor or detect infectious diseases and determine susceptibility to pathogens Apply traditional epidemiological study designs including cross-sectional, casecontrol, and cohort, for the purpose of investigating infectious disease transmission Compare the respective strengths and limitations of these traditional epidemiological study designs Explain the assumptions of traditional epidemiological study designs that limit their use in studying infectious disease transmission Duration Dates Training methods 3 hours Monday October 19, 9h-12h Face to Face Reading Validation Not applicable # 2 Session Title Evaluation of Diagnostic Tests and Treating Latent Infection as a Control Strategy: Tuberculosis Speaker Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA aah2138@columbia.edu Session Outline Learning Objectives Describe how knowledge of the epidemiology of an infectious disease can be used to choose a cut-point for a diagnostic test Calculate the sensitivity and specificity of a diagnostic test 3

23 Determine the predictive value of a diagnostic test given the prevalence of disease in the population Outline limitations of the use of various tests for the diagnosis of latent tuberculosis infection and identify settings in which use of specific tests or cutpoints would be useful Evaluate strategies for TB control that target people with latent TB infection Duration Dates Training methods 3 hours Monday October 19, 14h-17h Face to Face, Group Work and Student Presentations Reading - Cailleaux-Cezar M, de A. Melo D, Xavier Gm, et al. Tuberculosis incidence among contacts of active pulmonary tuberculosis. Int J Tuberc Lung Dis 2009;13: Golub JE, Pronyk P, Mohapi L, et al. Isoniazid preventive therapy, HAART and tuberculosis risk in HIV-infected adults in South Africa: a prospective cohort. AIDS 2009;23: Assignement Come to class prepared to discuss the following: 1) Based on the data presented by Cailleaux-Cezar et al., do you think the Brazilian government should change its criteria for LTBI treatment? If so, how? What data support your answer? If not, what additional evidence would you require? 2) If clinical trials have shown that treatment of LTBI reduces TB incidence among HIVinfected individuals, why did Golub et al. conduct this study? Why did they use the chosen study design? How might the effect size change if TST-testing was not performed? # 3 Session Title Causal Inference, Mathematical Modeling, and the Development of Public Health Policy: Male Circumcision to Prevent HIV Transmission Speaker Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA aah2138@columbia.edu Session Outline Learning Objectives Describe the biological properties that appear to promote HIV acquisition in uncircumcised men compared to circumcised men Apply criteria for causality to determine whether a biomedical intervention prevents acquisition of an infectious disease Define risk compensation and explain how it can impact the effectiveness of a prevention intervention Interpret the results of mathematical modeling papers to determine whether a public health intervention will lead to reductions in infectious disease transmission and prevalence Duration 3 hours 4

24 Dates Tuesday October 20, 9h-12h Bailey RC et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial. Lancet 2007;369: Hallett TB et al. Understanding the impact of male circumcision interventions on the spread of HIV in southern Africa. PLoS One 2008;3:e2212. Londish GL, Murray JM. Significant reduction in HIV prevalence according to male circumcision intervention in sub-saharan Africa. Int J Epidemiol 2008;37: Assignement Come to class prepared to discuss the following: 1) Applying Hill s criteria for causality, what is the evidence that male circumcision prevents acquisition of HIV? 2) In deciding whether and how best to include voluntary medical male circumcision as part of a HIV prevention program, what are the key questions to be addressed? Which of these can be answered using the clinical trial data and which are best answered by mathematical modeling? # 4 Session Title Epidemiology & Control of Malaria Speaker Session Outline Dr. Jacques LeBras Institut de Médecine et d Epidémiologie Appliquée/Institut de rechercher pour le developpement (UMR 216 IRD) Paris Epidemiologic Methods for Measuring Transmission and Control of Vector-borne Infections: Malaria Learning Objectives Discuss the limitations of epidemiologic methods used to measure the burden of malaria in the population Describe the control strategies used for malaria Duration Dates Training methods 3 hours Tuesday October 20, 14h-17h Lecture Reading Validation NA for this session, final written exam on November # 5 Session Title Epidemiologic Methods for Measuring Transmission and Control of Respiratory Infections: Influenza Speaker Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA 5

25 Session Outline Learning Objectives Identify sources of surveillance data used to monitor influenza activity, and the ways in which these sources can be biased Describe available influenza mitigation strategies, and how they affect transmission Describe how complexity can be added to basic SIR models for evaluating pandemic policy strategies Describe how model assumptions can alter the interpretation of model output Discuss strengths and limitations of study designs used to assess the effect of herd immunity from influenza vaccination Duration Dates Readings 3 hours Wednesday October 21, 9h-12h Khazeni N, Hutton DW, Collins CIF et al. Health and economic benefits of early vaccination and nonpharmaceutical interventions for a human influenza A (H7N9) pandemic. Ann Intern Med 2014;160: Loeb M, Russell ML, Fonseca et al. Effect of influenza vaccination of children on infection rates in Hutterite communities: a randomized trial. JAMA 2010;303: Assignement Come to class prepared to discuss the following: 1) What kind of influenza mitigation strategies are available, and how might these interventions affect transmission (think of this in terms of the equation for R0)? 2) In the paper by Khazeni et al, what assumptions did the authors make? Do you think they were reasonable? 3) What are some of the strengths and limitations of the study design chosen by Loeb et al? # 6 Session Title Epidemiologic Methods in Vaccinology Speakers Judith Mueller Lecturer Departement EPI & Biostats EHESP Judith.Mueller@ehesp.fr Session Outline Learning Objectives Explain the principle epidemiological concepts around vaccine prevention Describe study designs for evaluation of vaccines and vaccination strategies Explain the role that vaccination can play in the occurrence and prevention of epidemics Describe a selection of immunization programs (polio, pneumococci) Duration Dates 3 hours Wednesday October 21, 14h-17h 6

26 Training methods Lecture Reading Validation NA for this session, final written exam on November # 7 Session Title Choosing Biologic Outcomes and Developing Immunization Policy: The Human Papillomavirus Vaccine to Prevent Cervical Cancer Speakers Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA aah2138@columbia.edu Session Outline Learning Objectives Explain human papillomavirus (HPV) natural history and its link to cervical cancer Discuss how the diversity of HPV types necessitates development of broad spectrum immunologic vaccines Discuss the strengths and weaknesses of various biologic outcomes used to evaluate efficacy and effectiveness of HPV vaccination Design studies to assess the impact of HPV vaccination programs Duration Dates 3 hours Thursday October 22, 9h-12h Reading Joura EA, Giuliano AR, Iversen OE, et al. for the Broad Spectrum HPV Vaccine Study. A 9- valent HPV vaccine against infection and intraepithelial neoplasia in women. N Engl J Med 2015;372: Markowitz LE, Hariri S, Lin C, et al. Reduction in human papillomavirus (HPV) prevalence among young women following HPV vaccine introduction in the United States, National Health and Nutrition Examination Surveys, JID 2013;208: Assignement Come to class prepared to discuss the following: 1) In the papers by Joura and Markowitz, what were the endpoints? What was the rationale for choosing each endpoint, and what are the limitations? 2) Why weren t Markowitz et al. able to assert that there was evidence of herd immunity in their study? 3) What are some of the other studies that could be conducted to assess the impact of HPV vaccine on HPV infection and disease outcomes? # 8 Session Title Mathematical Modeling: Introduction to Concepts in Transmission and Dynamics Speaker Session Outline Pascal Crépey, PhD, Lecturer Departement EPI & Biostats EHESP Pascal.crepey@ehesp.fr Introduction to concepts in transmission & dynamics based upon mathematical modeling 7

27 Learning Objectives Describe in words, by diagram, and by differential equations a basic compartmental model (like the susceptible-infectious-recovered [SIR] model) Identify the parameters to calculate the basic reproductive number (R0) Explain the concept of and calculate the epidemic threshold Describe in words and mathematically the effect of vaccination on the spreading of a disease in a population Provide examples of control strategies for the transmission of infectious diseases, and what transmission parameters are targeted by these strategies Identify how and why epidemics behave differently in closed versus open populations Identify the limitations of deterministic models, and characteristics of infectious disease transmission that may limit their use. Duration Dates Training methods 3 hours Thursday October 22, 14h-17h Lecture Reading Validation NA for this session, final written exam on November 26 or 27, 2015 # 9 Session Title Epidemiologic Methods for Measuring Transmission and Control of Viral Hepatitis Speakers Andrea A. Howard, MD, MS Associate Professor of Epidemiology Mailman School of Public Health, Columbia University New York, NY, USA aah2138@columbia.edu Session Outline Learning Objectives Identify appropriate prevention strategies for viral hepatitis based upon the epidemiology of the disease in the targeted population Evaluate the impact of Hepatitis B vaccination strategies in the US and globally Assess the impact of risk behaviors and preventive measures on HBV and HCV prevalence Duration Dates Reading 2 hours Friday October 23, 9h-11h Burt RD, Hagan H, Garfein RS, Sabin K, Weinbaum C, Thiede H. Trends in hepatitis B virus, hepatitis C virus, and human immunodeficiency virus prevalence, risk behaviors, and preventive measures among Seattle injection drug users aged years, J Urban Health 2007;84: Liang X, Bi S, Yang W et al. Evaluation of the impact of hepatitis B vaccination among children born during in China. J Infect Dis 2009;200: Assignement Come to class prepared to discuss the following: 1) What were the outcomes used to determine the effectiveness of Hepatitis B vaccination programs in the paper by Liang et al? What are the pros and cons of each approach? 2) What risk behaviors and preventive measures were assessed in the paper by Burt et al? How could differences in study design among the included studies have influenced the findings? 8

28 #10 Session Title Surveillance and control of healthcare-associated infections Speaker Pascal Astagneau, Departement EPI & Biostats EHESP Session Outline Method of health care associated infection control programs and surveillance will be presented. Comparative analysis of interventions regarding human and economic resources required for data collection and patient follow up will be discussed in terms of cost effectiveness. Learning Objectives Identify different programs for controlling health care associated infections worlwide Compare different surveillance systems in terms of cost effectiveness Describe the limitations of surveillance systems that rely on routine data collection, for instance in hospital settings Duration Dates Training methods 4 hours Friday October 23, 13h-17h Lecture Reading Assignement NA for this session, final written exam on November

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