Full Answer Section

1. Define the Population at Risk:All patrons of the Eclipse Cafeteria on the morning of the incident.
2. Case Finding:Not necessary as all cases were identified readily.
3. Analytic Studies:Comparing what the 11 men ate compared to others.
4. Environmental Investigation:Inspecting the cafeteria for potential sources of silver contamination.
5. Control Measures:Identifying and removing the contaminated food item.
6. Implementation of Control Measures:Stopping the sale of the contaminated food.
7. Communication:Informing the public and healthcare providers about the incident.
8. Evaluation:Monitoring for additional cases and ensuring the effectiveness of control measures.

Epidemic Curve:

The epidemic curve for this incident would likely be a point source outbreak. This curve shows a single spike in cases on the day the contaminated food was consumed, followed by a sharp decline as the contaminated food source is removed. (Unfortunately, I cannot directly display images here).

Calculation of Incubation Period:

The story doesn’t provide information on the exact timing of symptoms. However, the incubation period for argyria can range from weeks to years.

Questions by Dr. Greenberg:

1. What did you eat for breakfast this morning?
2. Have you ever worked in a silver mine or other job with significant silver exposure?
3. Do you take any medications or supplements regularly?

Questions by Dr. Pellitteri:

1. Did you notice anything unusual about the taste or color of your food this morning?
2. Did you use any unusual utensils or dishes at the cafeteria?
3. Have you eaten at any other restaurants recently?

Questions for Cafeteria Employees:

1. What new ingredients or food items were used in the breakfast menu today?
2. Were there any issues with food storage or preparation this morning?
3. Did any cleaning products or equipment come into contact with the food?

The Culprit:

The culprit was likely a food item at the Eclipse Cafeteria that was contaminated with silver.

Uniqueness of the Men:

The 11 men might have chosen a specific food item that was not consumed by others, leading to their concentrated exposure to silver.

Additional Questions:

1. For the patients: Did you experience any other symptoms besides the blue color (e.g., metallic taste, stomach upset)?
2. For the cafeteria employees: Did anyone taste the food before serving it, and did they notice anything unusual?

These questions could help identify if there were other early signs of contamination and if anyone else might have been exposed but not yet developed the blue color symptom.