Epidemiological

exercise

Dr. Pranay Jadav

Assistant professor
Department of Community Medicine
GMERS, Gandhinagar
 objectives
• Measures of association
• Screening test
• Mortality indicators
• Morbidity indicators
• RCH indicators
• Fertility indicators
• Tuberculosis indicators
• Filarial indicators
• Aedes egypti indicators
• Malarial indicators
• Vaccine requirement
• Vaccine efficacy
• Caculations for water disinfection
 2 by 2 table (four fold table)

Diseased Not diseased

Exposed a b a+b

Not exposed c d c+d

a+c b+d a+b+c+d

 Strength of association
In case control study – it is measured by odds ratio

Odds ratio Odds of having disease

(OR) odds of not having disease
𝑎 𝑎𝑑
𝑐
𝑏 =
𝑑 𝑏𝑐

Interpretation Disease cases have ……….times more chances to report

history of exposure as compared to control

OR =1 No association
OR > 1 Positive association
OR < 1 Negative association
 Strength of association
In cohort study – it is measured by RR, AR, PAR
Risk ratio (RR) Incidence among exposed 𝐼𝑒
=
Relative risk incidence among unexposed 𝐼𝑢
𝑎
𝑎 + 𝑏 × 1000
𝑐 × 1000
𝑐+𝑑
Interpretation Exposed have ………. Times risk of developing disease
as compared to unexoposed
RR =1 𝐼𝑒 = 𝐼𝑢 No association
RR > 1 𝐼𝑒 > 𝐼𝑢 Positive association
RR < 1 𝐼𝑒 < 𝐼𝑢 Negative association
Attributable risk(AR) or risk difference (RD)

AR=Incidence of disease among exposed − incidence of disease among unexposed

𝐴𝑅 = 𝐼𝑒 − 𝐼𝑢
𝑎 𝑐
AR= − × 1000
𝑎+𝑏 𝑐+𝑑
Interpretation of AR:
• Mathematical difference of incidence of the disease between two groups
• It is an indicator of public health problem caused by exposure
Attributable fraction or attributable proportion

𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑒𝑥𝑝𝑜𝑠𝑒𝑑 −𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑛𝑜𝑛−𝑒𝑥𝑝𝑜𝑠𝑒𝑑
ARP = × 100
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑒𝑥𝑝𝑜𝑠𝑒𝑑
𝑅𝐷 𝐼𝑒 −𝐼𝑢
ARP= =
𝐼𝑒 𝐼𝑒
𝑎 𝑐
−
𝑎+𝑏 𝑐+𝑑
ARP= 𝑎 × 100
𝑎+𝑏
Interpretation of ARP:
• ………..% of disease is attributed to exposure among exposure group
• …… % of disease can be prevented in exposure group if exposure is modified or
eliminated
 Population Attributable risk (pAR)

PAR=Incidence of disease among total population − incidence of disease among unexposed

𝑃𝐴𝑅 = 𝐼𝑝 − 𝐼𝑢
Incidence of disease among total population 𝐼𝑝 is equal to absolute risk
𝑎+c 𝑐
PAR= − × 1000
𝑎+𝑏+c+d 𝑐+𝑑
Interpretation of PAR:
• It quantifies avoidable incidence of the disease due to exposure in entire
population
Population Attributable risk fraction(parf) or
population attributable risk proportion(parp)
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑡𝑜𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 −𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑛𝑜𝑛−𝑒𝑥𝑝𝑜𝑠𝑒𝑑
PARP = × 100
𝐼𝑛𝑐𝑖𝑑𝑒𝑛𝑐𝑒𝑡𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛
𝑃𝐴𝑅 𝐼𝑝 − 𝐼𝑢
𝑃𝐴𝑅𝑃 = =
𝐼𝑝 𝐼𝑝
𝑎+c 𝑐
−
𝑎+𝑏+c+d 𝑐+𝑑
PARP= 𝑎+c × 100
𝑎+𝑏+c+d
Interpretation of PARP:
• ………..% of disease is attributed to exposure among total population
• …… % of disease can be prevented in population (both group) if exposure is
modified or eliminated
 exercise
• A Pediatrician decided to find out the effect of father’s smoking on
the chance of his child developing ARI. He took the history of
father’s smoking from parents of all the cases coming to his OPD.
He collected the data from 660 parents. There were total 200 cases
of ARI. The history of father’s smoking was positive in 260 cases.
Out of them 104 were cases of ARI and remaining were other cases.
1. What type of epidemiological study is this?
2. Make a proper 2x2 table.
3. Calculate all the possible rates and ratios.
4. Apply a suitable statistical test.
5. Write your inference.
 exercise

• Study had been done to find the relationship between use of

artificial sweeteners and bladder cancer. The study included 3,000
cases with bladder cancer and 5,776 controls without cancer. Out of
total cases, 1,293 cases had used artificial sweeteners. Out of total
controls, 2,455 had used artificial sweeteners.

1. Identify the study design

2. Represent the above data in 2 x 2 table
3. Will you calculate the RR or the OR? Calculate the value
4. What inference can be drawn from the above data?
 exercise
• Study had done to find association between radiation therapy and
blood disorders. In a study 1000 children were followed for
exposure to radiation therapy. 400 were exposed and 600 were not
exposed. Among exposed children 12 children developed blood
diseases and 6 cases were developed the same diseases among
non-exposed.

1. Identify the study design.

2. Represent the above data in 2 x 2 table.
3. Will you calculate the RR or the OR? Calculate the value.
4. What inference can be drawn from the above data?
 exercise
• In a case control study among 200 patients admitted with Ca.
Breast in town civil of city “X”. 100 were treated with “Drug A”
and remaining 100 were treated with “Drug B”. The numbers of
deaths in both the groups were as under.

Drug A – 55 and Drug B – 20

Tabulate the data and calculate the relevant measure the strength of
association.
 Screening Test
Sensitivity True positive 𝑎
×100 = × 100
True positive+False negative 𝑎+𝑐

True negative 𝑑
×100 = × 100
False positive+True negative 𝑏+𝑑
Specificity
Positive predictive True positive 𝑎
×100 = × 100
False positive+True positive 𝑎+𝑏
value
Negative predictive True negative 𝑎
×100 = × 100
False negative+True negative 𝑎+𝑏
value
% of false negatives False negative 𝑐
×100 = × 100
False negative+True negative 𝑎+𝑐

% of false positives False positive 𝑏

×100 = × 100
False positive+True negative 𝑏+𝑑
 exercise

• A screening test (PAP smear) was done for cervical cancer. Results are
given below
PAP smear Disease positive Disease negative

Positive 400 150

Negative 100 4350

Find out sensitivity and specificity of the test

Calculate false positive and negative rate
Also calculate predictive value of positive and negative test
 Mortality Indicators

Crude death rate No. of deaths in a given year in a given area

× 1000
Mid − year population of same year of same area
(CDR)
Crude birth rate No. of births in a given year in a given area
× 1000
Mid − year population of same year of same area
(CBR)
 Mortality Indicators
Specific death rate No. of deaths of specific disease or age group or period
× 1000
(SDR) Mid − year population

Case fatality rate 𝑇𝑜𝑡𝑎𝑙 No. of deaths due to a perticular disease

× 1000
Total n𝑜. 𝑜𝑓 𝑐𝑎𝑠𝑒𝑠 𝑑𝑢𝑒 𝑡𝑜 𝑡ℎ𝑒 𝑠𝑎𝑚𝑒 𝑑𝑖𝑠𝑒𝑎𝑠𝑒

Proportionate 𝑇𝑜𝑡𝑎𝑙 No. of deaths due to a perticular disease in a year

mortality rate × 1000
Total n𝑜. 𝑜𝑓 𝑑𝑒𝑎𝑡ℎ 𝑓𝑟𝑜𝑚 𝑎𝑙𝑙 𝑐𝑎𝑢𝑠𝑒𝑠 𝑖𝑛 𝑎 𝑠𝑎𝑚𝑒 𝑦𝑒𝑎𝑟

5 year-Survival rate 𝑇𝑜𝑡𝑎𝑙 No. of 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑎𝑙𝑖𝑣𝑒 𝑎𝑓𝑡𝑒𝑟 5 𝑦𝑒𝑎𝑟𝑠

× 1000
Total n𝑜. 𝑜𝑓 𝑝𝑎𝑡𝑖𝑒𝑛𝑡𝑠 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑜𝑟 𝑡𝑟𝑒𝑎𝑡𝑒𝑑
 exercise

• In a district with a mid-year population of 1,050,000 in year 2016.

Deaths due to AIDS, TB and Gastroenteritis were 20, 105 and 210

respectively. The total cases of TB and Gastroenteritis were 855 and

2080. Calculate 5 possible mortality rates.

 exercise

• In a subcentre with a population of 5000; 15 new cases of TB, 5 new

cases of Cholera, 35 new cases of Fever and 3 new cases of

pneumonia were detected in a year 2013. Total cases of TB were 30 in

2012. Calculate all possible vital rates.

 Morbidity Indicators

Incidence No. of new cases of specific disease during a

given time period
× 1000
population at risk during that period

Point No. of all current cases old + new of a specified disease

prevalence existing at a given point of time
× 100
estimated population at same point of time

Period No of all current cases old + new of a specified disease

prevalence existing at a given period
× 100
estimated mid interval population at risk
 Special Incidence Rate

Attack rate No of new cases of a specified disease during

(AR) specified time interval
× 100
Total population at risk during that time interval

Secondary No. of exposed person developing particular disease

attack rate 𝑤𝑖𝑡ℎ𝑖𝑛 𝑡ℎ𝑒 𝑟𝑎𝑛𝑔𝑒 of incubation period
× 100
(SAR) Total no. of exposed persons
 exercise

• In an Asian country with a population of 6 million people, 100000 cases

of cholera occurred in 2008. There were total 55,000 deaths in the same
year, out of these, 2800 deaths were due to cholera. Find
out:
• Incidence rate Cholera in that country for year 2008.
• The case-fatality rate from Cholera
• The cause-specific mortality rate from Cholera?
• Proportional mortality rate of Cholera
• Crude death rate
 RCH Indicators

Maternal Total no of female deaths due to complications of

mortality ratio pregnancy, childbirth or within 42 days of delivery from
(MMR) puerperal causes in an area during a given year
× 1000
Total no of live births in the same area and year

Maternal No of maternal deaths

mortality rate × 1000
women of reproductive age in the population (15 − 44)
 RCH Indicators-cont.

Perinatal No of still birth + No. of death < 7 days

mortality rate × 1000
Total no. of live births
Neonatal No of deaths of children 𝑜𝑓 < 28 days
mortality rate × 1000
Total no. of live births
Post neonatal No of deaths of children between 28 days & 1 year
mortality rate × 1000
Total no. of live births

Infant mortality No of deaths of children less than 1 year of age in an year

rate × 1000
Total no. of live births in the same year
 RCH Indicators-cont.

1-4 year mortality

No of deaths of children aged 1 − 4 yrs during an year
rate × 1000
Total no children aged 1 − 4 years at the middle of the year
(child death rate)

Under 5 mortality
rate No of deaths of children less than 5 yrs in a given year
or × 1000
Total no. of live births in the same year
child mortality rate

Child survival rate 1000 − under 5 mortality rate

10
 exercise
• Mid year population of a city in 2005was 1,020,000. the
following events occur during 2005
Total live births – 30,000
Total deaths -12,000
Maternal death-120
Deaths below 1 year-1600
Death within 28 days – 850
Still birth -280
Death within 1 week – 500
Calculate relevant rates
Calculation of Midyear population-Arithmetic progression formula
𝑃2 − 𝑃1 1 𝑃2 − 𝑃1
𝑃 = 𝑃2 + ×𝑑+
𝑛 3 𝑛
Where
P = Mid year population being estimated
P1 = earlier census population
P2 = latest census population
n = number of years between latest and earlier census
d = number of latest census (P2) and mid year population estimating year
1/3rd = adding 4 month population (March 1st – June 31st )

Census population - 1st March

Mid year population- 1st July
 exercise

• The census population of India in 2001 was 1027 million, it was 1210
million in 2011. Estimate mid year population of India for 2015 by
arithmetic progression method.
 Fertility Indicators

General fertility rate No of live births in an area during the year

× 1000
(GFR) mid year female population age 15 − 44 in the
same area in same year
General marital No of live births in an year
fertility rate × 1000
mid year married female population in
(GMFR) the age group of 15 − 44 years
Age specific No of live births in an particular age group
fertility rate (ASFR) × 1000
mid year female population of the same age group
Age specific marital No of live births in an particular age group
fertility rate × 1000
mid year married female population of the same age group
(ASMFR)
 Fertility Indicators
Total fertility rate 45−49
5× 15−19 𝐴𝑆𝐹𝑅
(TFR) 1000

Total marital fertility 45−49

5× 15−19 𝐴𝑆𝑀𝐹𝑅
rate (TMFR) 1000

Gross reproduction 45−49

5× 15−19 𝐴𝑆𝐹𝑅 𝑓𝑜𝑟 𝑓𝑒𝑚𝑎𝑙𝑒 𝑙𝑖𝑣𝑒 𝑏𝑖𝑟𝑡ℎ𝑠
rate 1000
(GRR)
Net reproduction rate 45−49

(NRR) 5× 𝑓𝑒𝑟𝑡𝑖𝑙𝑖𝑡𝑦 𝑟𝑎𝑡𝑒 × 𝑠𝑢𝑟𝑣𝑖𝑣𝑎𝑙 𝑟𝑎𝑡𝑒

15−19
 exercise
• A primary health center with 30,000 population, gives the following data
of 1 year. – calculate possible fertility rates.

Age groups Number of women Number of live

births in 1 year
15-24 2000 500
25-34 1800 250
35-44 1400 90
Total 5200 840
 Epidemiological Indices of Tuberculosis

Incidence of infection 𝑁𝑜.𝑜𝑓 𝑛𝑒𝑤 𝑝𝑒𝑜𝑝𝑙𝑒 𝑠ℎ𝑜𝑤𝑖𝑛𝑔 𝑡𝑢𝑏𝑒𝑟𝑐𝑢𝑙𝑖𝑛 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒

×1000
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 𝑠𝑡𝑢𝑑𝑦

Prevalence of Infection 𝑁𝑜.𝑜𝑓 (𝑛𝑒𝑤+𝑜𝑙𝑑) 𝑝𝑒𝑜𝑝𝑙𝑒 𝑠ℎ𝑜𝑤𝑖𝑛𝑔 𝑡𝑢𝑏𝑒𝑟𝑐𝑢𝑙𝑖𝑛 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒

×1000
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 𝑠𝑡𝑢𝑑𝑦

Incidence of disease 𝑁𝑜.𝑜𝑓 𝑛𝑒𝑤 𝑠𝑝𝑢𝑡𝑢𝑚 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝑐𝑎𝑠𝑒𝑠

×1000
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 𝑠𝑡𝑢𝑑𝑦

Prevalence of disease 𝑁𝑜.𝑜𝑓 𝑛𝑒𝑤+𝑜𝑙𝑑 𝑠𝑝𝑢𝑡𝑢𝑚 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝑐𝑎𝑠𝑒𝑠

×1000
𝑇𝑜𝑡𝑎𝑙 𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛 𝑢𝑛𝑑𝑒𝑟 𝑠𝑡𝑢𝑑𝑦
 exercise

• A PHC catering 30,000 population has given the data about

tuberculosis from January 2008 to December 2008 – calculate
relevant epidemiological indices.

Particulars Tuberculin +ve Sputum +ve

Old cases 11,160 76
New cases 540 25
Total 11,700 101
 Filarial indices

Microfilarial rate 𝑁𝑜.𝑜𝑓 𝑠𝑙𝑖𝑑𝑒𝑠 𝑠ℎ𝑜𝑤𝑖𝑛𝑔 𝑚𝑓 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑖𝑡𝑦

× 100
𝑁𝑜.𝑜𝑓 𝑠𝑙𝑖𝑑𝑒𝑠(𝑝𝑒𝑟𝑠𝑜𝑛𝑠) 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑

Filarial disease rate 𝑁𝑜.𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛 𝑠ℎ𝑜𝑤𝑖𝑛𝑔 𝑓𝑖𝑙𝑎𝑟𝑖𝑎𝑙 𝑑𝑖𝑠𝑒𝑎𝑠𝑒 𝑓𝑒𝑎𝑡𝑢𝑟𝑒𝑠 × 100
𝑁𝑜.𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑

Filarial endemicity 𝑁𝑜.𝑜𝑓 𝑠𝑙𝑖𝑑𝑒𝑠 𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒 +𝑝𝑜𝑠𝑖𝑡𝑖𝑣𝑒 𝑓𝑒𝑎𝑡𝑢𝑟𝑒𝑠+𝑏𝑜𝑡ℎ × 100

rate 𝑁𝑜.𝑜𝑓 𝑝𝑒𝑟𝑠𝑜𝑛𝑠 𝑒𝑥𝑎𝑚𝑖𝑛𝑒𝑑
 exercise
• A routine clinical survey for filariasis was carried out in a
community health center serving 1 lakh population, following
data were collected.
• Night blood smears collected -30,000
• Persons showing mf positive – 300
• Person showing mere signs of filariasis – 80
• Persons showing both mf positive and signs -10.
Calculate possible filarial indices
 Aedes egypti indices
House index No. of houses Infected
× 100
No. of house inspected
Container index No. of positive containers
× 100
No. of containers inspected
Breteau index No. of positive containers
× 100
No. of houses inspected
Pupae index No. of houses with pupae
× 100
No of houses inspected
 Flea Indices
General flea index No of rat flea collected from rat examined
Total no of rat examined
Rodent infestation rate No of bait consumed by rodent
× 100
Total no of bait collected from specific area
Burrow index It is the average number of free living fleas per species per rodent
burrow

X.Cheopis index It is the average number of X. Cheopis per rat.

Specific % of flea It is the percentage of different species of fleas that are found on rats

Landing/biting Rates of capture using hand-nets or aspirators

collection per man hour
 MALARIOMETRY (MEASUREMENT OF MALARIA)
Epidemiological parameters Entomological parameters

Prevalence rates of malaria Incidence rates of malaria

(pre-eradication era) (eradication era Vector indices

1. Annual blood examination rate

1. Child spleen rate 1. Adult vector density
2. Annual parasite incidence
2. Average enlarge spleen 2. Human blood index
3. Annual falciparum incidence
3. Child parasite rate 3. Sporozoite rate
4. Plasmodium falciparum%
4. Parasite density index 4. Biting density
5. Plasmodium vivax%
5. Infant parasite rate 5. Innoculation rate
6. Slide positivity rate
6. Proportional case rate
7. Slide falciparum rate
 Malaria Parameters-Pre eradication era
Total no of children with enlarged spleen
Child Spleen rate × 100
total no of children 2 − 10 yrs of age
Average enlarged
denoting the average size of the enlarged spleen
spleen

Infant parasite rate Total no of infant who show parasite in their blood films
× 100
total no of blood films checked of infants
Total no of children(2 − 10 years) who show parasite in their blood films
Child parasite rate × 100
total no of blood films checked of children (2 − 10 years)

Parasite density index Proportion of fields positive for all stages

(PDI) × 100
no of fields examined
Total no of cases 𝑑𝑖𝑎𝑔𝑛𝑜𝑠𝑒𝑑 𝑎𝑠 𝑐𝑙𝑖𝑛𝑖𝑐𝑎𝑙 𝑚𝑎𝑙𝑎𝑟𝑖𝑎
Proportional case rate × 100
total no of patient attending hospital or dispen𝑠𝑎𝑟𝑖𝑒𝑠
 Malaria Parameters- eradication era
Annual blood examination No of slides examined
rate (ABER) × 100
Population under surveillance
Annual parasite incidence Confirmed cases of malaria during a given year
(API) × 1000
Population under surveillance
Annual falciparum Confirmed cases of p.falci during a given year
incidence (AFI) × 1000
Population under surveillance
Slide positivity rate Total slidespositive 𝑓𝑜𝑟 𝑚𝑎𝑙𝑎𝑟𝑖𝑎 𝑝𝑎𝑟𝑎𝑖𝑠𝑡𝑒
× 100
Total slides examined
Slide falciparum rate Total slides positive for P. falciparum
× 100
Total slides examined
P.falciparum % (PF %) Total slides positive for P. falciparum
× 100
Total slides positive for malaria parasite
P.vivax % (PV%) Total slides positive for P. Vivax
× 100
Total slides positive for malaria parasite
 Malaria Parameters –Vector Indices

Adult vector density No of mosquitoes collected

No of man hours spent in search
Human blood index No. of female anopheline mosquito positive for human blood in their stomach
× 100
No. female anopheline mosquito dissected

Sporozoite rate No. of female anopheline mosquito positive for sporozoites

× 100
No. of female anopheline mosquito dissected

Biting density Average incidence of anopheles bites per day per person
It is determined by catching the vectors using human bait.
Inoculation rate Biting density × sporozoites rate
 exercise

• A PHC with a Population of 30,000 has examined 4000 peripheral

blood slides during 1 year. 55 slides were positive for P.vivax. 15

slides were positive for p. falciparum. Calculate the possible malarial

parameters.
 vaccine requirement
• Things to be required for vaccine calculation
No. of beneficiaries:-
oPregnant women
oInfant
The wastage Multiplication Factor (WMF)
Recommended vaccine and their vaccine doses- as per
EPI schedule
 beneficiaries

For Pregnant Women:

The survey will give the number of pregnant women identified in an
area at the time of conducting of the survey.

Annual target of pregnant women

= actual number of pregnant women as per head count X 2 (TWO)

Annual target infants :

= actual number of infants as per head count
Recommended vaccine and their vaccine doses- as per EPI schedule

TT for pregnant women 2 doses per women 10 doses/vial

BCG: 1 dose per child 10 doses/vial
OPV: 5 doses per child 20 doses/vial
Pentavalent: 3 doses per child 10 doses/vial
DPT (booster doses): 2 doses per child 10 doses/vial
Hepatitis B: 1 doses per child 10 doses/vial
Measles: 2 doses per child 5 doses/vial
IPV 2 doses per child 50 doses/vial
 Exercise

• If the population of an area is 50,000, the birth rate being

30/1000 and IMR is 100/1000 live births calculate the

vaccine requirements.
 Vaccine coverage rate
Total no.of children received (X)vaccine
(X)Vaccine coverage rate= × 100
Total no.of children eligible for (X ) vaccine

dropout rate – for multi-dose vaccine

Penta1-Penta3 dropout rate =
Doses of Penta1 administered − Doses of Penta 3 administered
× 100
Doses of Penta1 administered
Penta1-Measles dropout rate =
Doses of Penta1 administered − Doses of Measles administered
× 100
Doses of Penta1 administered
 Vaccine effectiveness

V𝐚𝐜𝐜𝐢𝐧𝐞 𝐞𝐟𝐟𝐞𝐜𝐭𝐢𝐯𝐞𝐧𝐞𝐬𝐬 𝐕𝐄 % =
𝐴𝑡𝑡𝑎𝑐𝑘 𝑟𝑎𝑡𝑒𝑢𝑛𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑 − 𝐴𝑡𝑡𝑎𝑐𝑘 𝑟𝑎𝑡𝑒𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑
× 100
𝐴𝑡𝑡𝑎𝑐𝑘 𝑟𝑎𝑡𝑒𝑢𝑛𝑣𝑎𝑐𝑐𝑖𝑛𝑎𝑡𝑒𝑑
 exercise

• In a medical college hostel, there is a tank which holds 45,000

liter of water. Horrock’s test shows blue colour in 5th cup.

Calculate the required amount of bleaching powder for

disinfection. Describe the principle and procedure of Horrock’s

test
 exercise

• A circular well of 10 meter diameter with 15 meter depth of water is to

be chlorinated. Horrock’s test shows blue colour in the 3rd cup. Calculate

the required amount of bleaching powder for disinfection. Explain the

procedure of well disinfection. How will you confirm satisfactory

disinfection?
 exercise

• A swimming pool having 100 meter length, 60 meter breadth

with 10 meter depth of the water is to be disinfected,
calculate the amount of bleaching powder required to
disinfect the swimming pool. Horrock’s test shows blue
colour in the 4th cup. What measures you advice for
swimming pool sanitation?