1. Capability Cliff Notes Series PHEP Capability 13—Public Health Surveillance and Epidemiological Investigation What Is It And How Will We Measure It?

2. Learning Objectives Become familiar with Capability Functions Become familiar with Tasks that complete the Functions Understand how these Functions and Tasks are measured or may be measured in the future (Performance Measures)

3. Public Health Surveillance and Epidemiological Investigation Public health surveillance and epidemiological investigation is the ability to create, maintain, support, and strengthen routine surveillance and detection and epidemiological investigation, as well as to expand these activities in response to incidents involving public health. How can health departments ensure the ability to provide epidemiological assistance for disease control, whether in an outbreak, or for regular population health?

4. Public Health Surveillance and Epidemiological Investigation Functions What Is Involved In Public Health Surveillance and Investigation? 1.Conduct public health surveillance and detection 2.Conduct public health and epidemiological investigations 3.Recommend, monitor, and analyze response actions 4.Improve public health surveillance and epidemiological investigation systems

5. Capabilities and Measures Resources The following performance measures are required for this capability: Percentage of reports of selected reportable diseases received by a public health agency within the awardee-required timeframe Numerator: Number of reports of selected reportable disease received by a public health agency within the awardee-required timeframe Denominator: Number of reports of selected reportable disease received by a public health agency Percentage of reports of selected reportable diseases for which initial public health control measure(s) were initiated within the appropriate timeframe Numerator: Number of reports of selected reportable diseases for which public health control measure(s) were initiated within an appropriate timeframe Denominator: Number of reports of selected reportable diseases received by a public health agency Cont’d on next slide

6. Capabilities and Measures Resources The selected diseases that are mandatory for reporting on the performance measures are: Diseases associated with the following CDC Category A agents: o Botulism (Clostridium botulinum), all types excluding infant botulism (confirmed) o Tularemia (Francisella tularensis) (confirmed and probable) E. coli, STEC (confirmed) Hepatitis A, acute (confirmed) Measles (confirmed) Meningococcal disease (N. meningitides) (confirmed) Voluntary reporting can be done on the following: Salmonellosis (confirmed), all types excluding Typhoid Fever (Salmonella enterica serovar Typhi) Up to 3 additional diseases of interest in the awardee jurisdiction (e.g., Shigella, Pertussis, etc.) The full document BP3 Performance Measures Specifications and Implementation Guidance can be found at the following link: https://www.colorado.gov/pacific/cdphe/hpp-and-phep-performance-measures-and-capabilities

7. Function 1: Conduct public health surveillance and detection Tasks: What steps will lead to complete surveillance and detection of threats to public health? 1.Engage and retain partners who can provide health data to support routine surveillance, including daily activities outside of an incident, and to support response to an identified public health threat. 2.Conduct routine and incident-specific morbidity and mortality (illness and death) surveillance using information such as reportable disease tracking, vital statistics, syndromic surveillance, hospital discharge information, population-based surveys, disease registries, and active case-finding. 3.Provide statistical data and reports to public health and other leadership to identify populations at-risk for adverse health outcomes during an incident. 4.Maintain surveillance systems that can identify health problems, threats, and environmental hazards and respond to (or investigate) reports regularly and whenever needed.

8. Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Document the legal and procedural framework for information exchange Protocols for accessing health information Protocols to gather and analyze surveillance data Procedures to ensure 24/7 health department access Protocols to notify CDC of cases on the Nationally Notifiable Infectious Disease List Process to conduct surveillance if the primary notifiable surveillance system is disrupted Tier 1 Competencies and Skills for Applied Epidemiologists Access to health information infrastructure and surveillance systems Access to a system compatible with the National Electronic Disease Surveillance System Ensure the electronic management and exchange of information with partners

9. Function 2: Conduct public health and epidemiological investigations Tasks: What are steps for complete investigation and reporting? 1.Conduct investigations of disease, injury or exposure in response to threats or incidents and coordinate efforts with partner agencies. 2.Provide epidemiological and environmental public health consultation, technical assistance, and information to local health departments about disease, injury, or exposure and methods of surveillance, investigation, and response. 3.Report investigation results to jurisdictional and federal partners, as appropriate.

10. Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Investigation report templates Protocols to investigate health incidents or environmental health hazards Protocols for conducting investigations for populations at-risk for adverse health outcomes Authorization of joint investigations and exchange of epidemiological information Health departments are provided a uniform set of jurisdictional health-related data Staffing capacity to manage the routine epidemiological investigation systems Access to jurisdictional health monitoring systems Access to electronic databases or registries

11. Function 3: Recommend, monitor, and analyze mitigation actions Tasks: What steps will ensure that public health departments can make appropriate recommendations, and assist in public health actions that will reduce the negative effects of an incident? 1.Determine public health recommendations for the mitigation (reducing the negative effect) of the threat or incident, based upon data collected in the investigation and on applicable science-based standards outlined by Morbidity and Mortality Weekly Report, control of Communicable Diseases Manual, Red Book of Infectious Diseases or, as available, a state or CDC incident plan annex. 2.Provide information to public health officials to support them in decision-making related to mitigation actions. 3.Monitor and analyze mitigation actions throughout the public health threat or incident. 4.Recommend additional mitigation activities, based upon monitoring and analysis, throughout the incident.

12. Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Protocols for recommending and initiating containment and mitigation actions Performance monitoring Utilize health-related data for recommendations regarding populations at-risk Training in Homeland Security Exercise and Evaluation After Action Report process

13. Function 4: Improve public health surveillance and epidemiological investigation systems Tasks: How do health departments improve their surveillance and investigation? 1.Identify issues and outcomes during and after the incident. 2.Conduct meetings after the incident or exercise to identify problems that can be fixed, in areas such as programs, personnel, training, equipment, and organizational structure. Meetings should include all active participants. 3.Develop an After Action Report/Improvement Plan. 4.Communicate the After Action Report Improvement Plan to public health leadership.

14. Task Elements There are elements that health departments should keep in mind to address different aspects of the tasks: Communication of improvement plan Procedures to re-engage partners after the acute phase of a threat or incident Awareness-level training of quality improvement processes Competencies for a Public Health Informatician Access to tools for data collection, management, and analysis

15. Questions? Please contact: Rachel Coles Program Evaluator--CDPHE 303-692-2764 rachel.coles@state.co.us