1. Introduction to North Carolina Epidemiology Teams
Welcome to Introduction to North Carolina Epidemiology Teams.

2. Presentation Overview
What is an Epi Team?
Who belongs to an Epi Team?
What are the responsibilities of an Epi Team?
How does an Epi Team function?
What is an example of an Epi Team investigation?
This presentation addresses basic information about local Epidemiology Teams, or Epi Teams, in North Carolina. We will begin by defining an Epi Team. Then we’ll talk about who belongs to the team, and the primary responsibilities of the team. Next we’ll discuss some details about how an Epi Team functions. And finally, we will provide an example of an Epi Team investigation in North Carolina. SOMETHING ABOUT ICS

3. Learning Objectives
List the roles on a local health department Epi Team
Describe the primary responsibilities of an Epi Team
Give an example of a successful Epi Team investigation in North Carolina
By the end of this presentation, you should be able to:
List the roles on a local health department Epi Team,
Describe the primary responsibilities of an Epi Team, and
Give an example of a successful Epi Team investigation.

4. What is an Epi Team?
Multi-disciplinary public health response team that exists in a state of readiness to respond to public health threats
Let’s begin by defining an Epi Team. An Epi Team is a multi-disciplinary public health team whose purpose is to prevent, respond to, and recover from disease outbreaks and other public health threats identified in the community.
Note that the Epi Team is responsible not only for responding to outbreaks and other threats, but also for preventing and recovering from those events.

5. Epi Team Roles Team Leader Epidemiologist Nurse
Environmental Health Specialist
Public Information Officer
Laboratorian
Administrator
IT Specialist
The local health director, who selects…KATHY DAIL An Epi Team has many different types of members. These include team leader, epidemiologist, nurse, environmental health specialist, public information officer, laboratorian, administrator, and information technology specialist. In some cases, one person can fulfill more than one role on the Epi Team. Depending on the type of outbreak, people in certain roles may play a more or less prominent role in the investigation. We’ll talk about each of these roles in detail on the following slides.
As we review the roles on an Epi Team, remember that you do not need a specific job title to fill these roles. It is more important to have the appropriate skills and experience as needed for each role.

6. Team Leader Description
Experience in outbreak investigation and epidemiology
May be different for different outbreaks
Role can be filled by local health director or designee
The team leader should have experience in outbreak investigation and public health epidemiology. Depending on the size and organization of the health department, this could be the local health director, public health nurse, epidemiologist, or environmental health specialist.

7. Team Leader Responsibilities Convenes Epi Team
Provides oversight for investigation
Assigns tasks to other team members
Serves as contact with other agencies
Conducts regular meetings
Facilitates outbreak interventions
Reports outbreaks
The team leader is responsible for a wide range of tasks. This person:
- Convenes the Epi Team;
- Provides oversight of other team members during an investigation;
- Prioritizes and assigns tasks to other team members;
- Serves as the primary point of contact for other agencies, including the North Carolina Communicable Disease Control Branch;
- Conducts regular Epi Team meetings;
- Facilitates outbreak interventions, including communication with health care providers; and
- Reports outbreaks to the Communicable Disease Branch.

8. Epidemiologist Description Expertise in field epidemiology methods
Experience developing case definitions and questionnaires
The epidemiologist has expertise in various aspects of field epidemiology methods, including disease surveillance, outbreak investigation, and case reporting. This person may also have experience developing case definitions and questionnaires.

9. Epidemiologist Responsibilities Monitors surveillance data
Creates case definitions
Maintains line listing of cases
Trains team members on case finding and follow-up
Provides daily reports on case finding and case counts
Ensures data quality
As with the team leader, the epidemiologist has many responsibilities, both before, during, and after disease outbreaks.
The epidemiologist:
- Monitors surveillance data to establish baseline rates of disease, and to detect outbreaks;
- Creates or modifies case definitions;
- Maintains a line listing of cases;
- Trains team members on case finding and follow-up;
- Provides daily reports on case finding and case counts during an outbreak; and
- Ensures data quality and proper data collection.

10. Nurse Description Formal nursing training
Knowledge of disease prevention and treatment
Health education experience
The nurse is a key role on an Epi Team. This person should be trained in nursing, and should have thorough knowledge of disease prevention and treatment. This includes proper administration of vaccines. Finally, it is helpful for the nurse to have experience in health education.

11. Nurse Responsibilities
Advises providers regarding disease signs and symptoms, transmission, incubation period, and treatment
Collects clinical specimens
Educates cases and contacts
Visits health care providers
Monitors contacts for symptoms
Coordinates vaccine supply and distribution
Like the epidemiologist, the nurse also has a wide range of responsibilites. This person:
- Advises Epi Team and health care providers regarding disease signs and symptoms, transmission, incubation period, and treatment;
- Collects clinical specimens;
- Educates cases and contacts;
- Visits health care providers to reinforce reporting and outbreak control recommendations;
- Monitors contacts of cases for signs and symptoms of disease; and
- Coordinates vaccine supply and distribution.

12. Environmental Health Specialist
Description
Experience with environmental field investigations
Knowledge of food and water safety regulations
Knowledge of environmental sampling
Environmental health specialists, environmental epidemiologists, or sanitarians have a unique role on an Epi Team. This person should have experience conducting environmental field investigations, knowledge of food and water safety regulations, and knowledge of proper environmental sampling procedures.

13. Environmental Health Specialist
Responsibilities
Monitors environmental surveillance data
Conducts field investigations and traceback investigations
Collects environmental samples
Provides guidance on food and water safety regulations and engineering
Implements facility-related control measures
Communicates with Division of Environmental Health
The environmental health specialist:
- Monitors environmental surveillance data;
- Conducts field investigations and traceback investigations;
- Collects environmental samples;
- Provides guidance on food and water safety regulations and engineering;
- Implements facility-related control measures; and
- Communicates with the Division of Environmental Health.

14. Public Information Officer
Description
Knowledge of risk and crisis communication
Experience developing media messages
Role may be filled by Health Educator
One person from the team should be designated as the public information officer, or PIO. This person should have knowledge of risk and crisis communication and experience developing media messages. On some Epi Teams, a health educator may fill the role of the PIO.

15. Public Information Officer
Responsibilities
Reviews provider and public alerts, fact sheets, and reporting reminders
Prepares/reviews press releases
Responds to media inquires
Ensures availability of appropriate educational materials
The Public Information Officer, or Health Educator, ensures effective communication and dissemination of public information. The PIO:
- Reviews provider and public alerts, fact sheets, and reporting reminders;
- Prepares and reviews press releases;
- Responds to media inquiries; and
- Ensures availability of appropriate educational materials.

16. Laboratorian Description Expertise in laboratory testing
Knowledge of proper specimen collection and transport procedures
Some Epi Teams may include a laboratorian. This person has expertise in laboratory testing, and knowledge of proper specimen collection and transport procedures. Smaller Epi Teams without a laboratorian may consult regional or state laboratories for guidance in this area.

17. Laboratorian Responsibilities
Provides information on proper collection and transport of clinical specimens
Coordinates submission of specimens to State Laboratory of Public Health
The laboratorian:
- Provides information on proper collection and transport of clinical specimens, and
- Coordinates submission of specimens to the State Laboratory of Public Health.

18. Administrator Description
Knowledge of local health department policies and procedures
Experience handling staff expenses
An often forgotten, but very important, role on an Epi Team is an Administrator. This person has knowledge of the policies and procedures of the local health department, and experience handling staff expenses. In any office, this person knows the “in’s and out’s” of the office.

19. Administrator Responsibilities Distributes meeting agendas
Records minutes and keeps records of meetings
Tracks staff expenses (overtime, travel reimbursement)
Assures after hours building and cell phone access
The Administrator:
- Distributes meeting agendas;
- Records minutes and keeps records of meetings;
- Tracks staff expenses, including overtime and travel reimbursement; and
- Assures after-hours building and cell phone access.

20. IT Specialist Description
Knowledge of local health department computer system
Experience with database development and management
The last Epi Team role that we will discuss is the Information Technology, or IT, Specialist. This person has knowledge of the computer system used by the local health department, and experience with database development and management.

21. IT Specialist Responsibilities
Assists in database development, modification, and maintenance
Provides technical support
Assists with data entry
Supplies team with necessary equipment
The IT Specialist:
- Assists in database development, modification, and maintenance;
- Provides technical support for computer hardware and software issues;
- Assists with data entry; and
- Supplies team with necessary equipment, including computers, phones, and copiers.

22. Responsibilities of an Epi Team
Coordinate disease surveillance activities
Conduct epidemiologic investigations
Gather and analyze information from investigations
Recommend public health control measures
Educate the public
Now let’s talk about the Epi Team as a whole. The primary functions of an Epi Team are to:
- Coordinate routine and non-routine disease surveillance activities;
- Conduct epidemiologic investigations;
- Gather and analyze information from investigations;
- Recommend appropriate public health interventions for disease control to the health director; and
- Educate the public about disease prevention and control measures.
In a nutshell, the Epi Team is responsible for surveillance, outbreak investigation and control, and public education. We’ll discuss each of these responsibilities in more detail now.

23. Coordinate Disease Surveillance
Monitor routine surveillance data
Compare expected to observed numbers and rates
Investigate reports from healthcare providers
Confirm or refute rumors of outbreaks
One of the responsibilities of an Epi Team on a day-to-day basis is to coordinate disease surveillance. This includes several activities, such as monitoring routine surveillance data and comparing expected to observed numbers and rates of disease. For example, one member of the Epi Team may be responsible for monitoring reported cases of sexually transmitted diseases and comparing current surveillance data with data from past years. In addition to routine surveillance, the Epi Team is also responsible for investigating health care providers’ reports possible disease outbreaks and cases of reportable disease. These investigations can help to confirm or refute rumors of disease outbreaks.

24. Conduct Epidemiologic Investigations
Verify the diagnosis and confirm the outbreak
Define and find cases
Collect data
Tabulate and analyze data
Generate hypotheses
Communicate findings
Write final report
Conducting epidemiologic investigations of possible disease outbreaks is one of the most important functions of an Epi Team. Some of the steps in an outbreak investigation are noted here, beginning with the critical step of verifying the diagnosis and confirming the outbreak. Other activities, such as defining and finding cases; collecting, tabulating and analyzing data; and taking public health control measures are also responsibilities of the Epi Team. Throughout the investigation, the team is responsible for communicating findings to various audiences, such as the Division of Public Health, other agencies, the affected population, and the general public.

25. Gather and Analyze Information
Collect data
Interviews
Medical records
Attendance rosters
Business receipts
Organize data by person, place, and time
Analyze data
One of the most important tasks of an Epi Team is gathering and analyzing information. The Epi Team is responsible for collect data using a variety of methods such as conducting interviews; reviewing medical records and attendance rosters; and gaining access to business receipts or other administrative data, depending on the type of emergency.
As data are being collected, the Epi Team should organize the data by person, place, and time, using tools such as line listings and epi curves.
Then, the Team should analyze the data to identify likely sources of exposure and possible control measures.

26. Recommend Public Health Control Measures
Decide upon appropriate control measures
Communicate necessity of control measures to health director
Work with community partners to implement control measures if necessary
Throughout an epidemiologic investigation, it is the responsibility of the Epi Team to recommend appropriate public health control measures. As you might imagine, the recommended control measures will change as you learn more about the cause of the outbreak. The first step is to decide upon appropriate control measures given the information you have at the time. Then, communicate the necessity of control measures to the health director. Next, the Epi Team may work together with community partners to implement control measures, depending on the type of emergency. The type of community partners involved will depend on the type of outbreak, but could include hospitals, schools, child care facilities, nursing homes, private businesses, or individual families.

27. Educate the Public
Provide information about the disease or health condition to the general public or those at risk of infection
Provide guidance to agencies dealing with outbreaks
Institutional settings (e.g. long-term care facilities, correctional facilities, schools)
Food service establishments
Once you have worked with community partners to implement public health control measures, your job as an Epi Team is not complete. It is important to provide education to the public about the cause of the outbreak, the type of control measures that are being taken, and the status of the epidemiologic investigation. You should also provide guidance to the agency dealing with the outbreak. A disease outbreak is a good opportunity to provide education to agencies more generally. For example, if there was an outbreak of hepatitis B associated with a nursing home, you could remind all nursing homes in your area about infection control precautions for preventing hepatitis B transmission.
Public education is an important function of the Epi Team, even during times when a disease outbreak is not occurring. In fact, providing information to the public on a routine basis is one way to prevent outbreaks from happening in the first place.

28. How Does an Epi Team Function?
Meetings
Communication
Incident Command System
Coordination with Public Health Regional Surveillance Teams and Division of Public Health
Now that we have covered the responsibilities of an Epi Team, let’s talk about some practical issues related to the function of the Team. This section will include meetings, communication, the Incident Command System, coordination with Public Health Regional Surveillance Teams, or PHRSTs, and coordination with the North Carolina Division of Public Health.

29. Regular Meetings Review routine surveillance data
Discuss notification procedures
Develop procedures for disseminating information to general public
Provide Epi Team members with training opportunities
The first step to having a well-functioning Epi Team is to convene the team regularly, even in the absence of an outbreak or other public health emergency. This regular meeting provides opportunities for Epi Team members to review routine surveillance data; discuss notification procedures for health care providers and the NC Communicable Disease Control Branch during a possible disease cluster or outbreak; and develop procedures for disseminating information to the general public about disease outbreaks and other public health threats. Finally, regular meetings provide Epi Team members with training opportunities. For example, the Epi Team can work through case studies together as a group to simulate decisions and actions that should be taken during an actual epidemiologic investigation. These activities can also help Epi Team members to clarify their roles and responsibilities in different situations.

30. Daily Meetings Provide updates about investigation progress
Make decisions about next steps
Assign people to each action
During a disease outbreak or another public health emergency, your team will meet more frequently, possibly every day during the incident. The purpose of these meetings is to update team members about investigation progress, make decisions about next steps and actions to be taken, including public health control measures, and identify people responsible for each action.

31. After-Action Review What methods worked well?
What mistakes were made and how to prevent these in the future?
What changes to the process of outbreak investigation should be made?
Who will be responsible for seeing these changes implemented?
Was communication flow maintained?
How did the media affect the outbreak?
Following a disease outbreak or another public health emergency, your Epi Team should have a meeting called an after-action review. This meeting should serve as a forum to discuss what worked and what did not work so team members can learn from any mistakes made.
This slide includes examples of questions that might be discussed during the after-action review:
- What methods worked well?
- What mistakes were made and how to prevent these in the future?
- What changes to the process of outbreak investigation should be made?
- Who will be responsible for seeing these changes implemented?
- Was communication flow maintained? and
- How did the media affect the outbreak?

32. Epi Team Contact Information
Maintain database of all team members
Name, specialty, best way to contact
Phone numbers (work, home, cell)
Pager number
address
Emergency contact
Distribute to all team members
Update regularly
Besides meeting regularly, there are several aspects to good communication within your Epi Team. To begin, you should maintain a contact database for all Epi Team members.
The following information may be included in the database:
Name, specialty, and the best way to contact;
Phone numbers, including work, home and cell phone numbers;
Pager number;
address; and
Emergency contact information.
This information can be summarized on one sheet of paper and distributed to all team members in person and by if possible. The database should be regularly updated to be sure contact information is current.

33. External Communication
Provide regular updates to external partners
NC Division of Public Health
Other state agencies (e.g. Div of Env Health)
Public Health Regional Surveillance Team
Local stakeholders – hospitals, healthcare providers, other government leaders/agencies, community organizations
General public
Maintain routine communication
In addition to communicating within your Epi Team, it is critical to provide regular updates to external partners, especially during an outbreak. Usually you begin with the appropriate branch of NC Division of Public Health. Depending on the situation, it may be important to communicate with other state agencies, such as the Division of Environmental Health. You should also maintain regular communication with your PHRST. The PHRST can often provide needed expertise and resources in the event of an outbreak investigation.
The Epi Team should also communicate with local partners. The specific partners will vary depending on the type of outbreak, but may include other local government agencies or leaders, community-based organizations, hospitals, long-term care facilities, and many other groups.
Last (but certainly not least), it is important to provide updates to the general public through the media.
Keep in mind that your Epi Team should communicate with all of these groups on a regular basis, not only during outbreak investigations.

34. Documentation Regular meeting minutes Daily investigation log
All steps taken in the investigation
Decisions made and rationale
Contacts: name, position, contact info
Meeting minutes
Photographs
One important component of internal and external communication is written reports. For internal communication with the Epi Team, it is important to record and distribute minutes from regular meetings. Minutes include topics covered in the meeting, decisions made during the meeting, actions to be taken, and people responsible for those actions.
During an investigation, documentation such as a daily investigation log is critical. The log includes meeting minutes, but more importantly, it includes all steps taken in the investigation and the outcomes of those actions. It should also include what decisions were made and the rationale for those decisions. It is useful to also include the information that was available at the time of decision making. Keep track of any contacts made during the investigation, including health care providers, other public health professionals, and laboratorians. Be sure to get their name, position, and a way to contact them. Finally, you can use photographs as a tool to document an investigation. Photographs of the site of an outbreak or the potential source of exposure could be useful later in the investigation.

35. Outbreak Report Outbreak detection Case definition and epi curve
Epidemiologic, environmental, and laboratory methods
Results of epidemiologic, environmental and laboratory studies
Conclusion
Recommendations
One important form of communication after a public health emergency or outbreak investigation is an outbreak report. The report creates a record of the investigation, and also can be used as a reference the next time an investigation is needed. Various members of the Epi Team may contribute to the outbreak report. The team leader will assign one or more team members to write the report, depending on the situation.
According to the North Carolina Communicable Disease Control Branch, an outbreak report should include information about how the outbreak was detected, the case definition and epi curve, the methods used in epidemiologic, environmental, and laboratory investigations, the results of those investigations, conclusions, and recommendations for response and control of the outbreak and prevention of future outbreaks. Other information that should be included in an outbreak report is shown on the following slide.

36. Outbreak Report Timeline
First clinical observation
Accurate diagnosis
Laboratory confirmation
Identification of exposure source
Report to public health authority
Report to law enforcement authority
Initiation of emergency operations plan
Initiation of control measures
Initiation of post-exposure prophylaxis
Initiation of public education
Initiation of risk advice to health care workers
Last reported case
It is useful in an outbreak report to include a timeline of important events. The timeline should include dates and/or times when the following events occurred:
First clinical observation,
Accurate diagnosis,
Laboratory confirmation,
Identification of exposure source,
Report to public health authority,
Report to law enforcement authority,
Initiation of emergency operations plan,
Initiation of control measures,
Initiation of post-exposure prophylaxis,
Initiation of public education,
Initiation of risk advice to health care workers, and
Last reported case.
Now that we’ve briefly discussed communication, let’s move on to a quick review of the Incident Command System.
Potter et al., 2007

37. Incident Command System
ICS provides a structure to manage projects or events efficiently and effectively
Epi Team members should take ICS training
Practice ICS during routine activities
The Incident Command System, or ICS, is part of the National Incident Management System, or NIMS. ICS provides a structure to manage projects or events efficiently and effectively, across multiple disciplines or agencies. Epi Team members should take ICS training as directed by the North Carolina Public Health Workforce NIMS Training Plan. One way to reinforce this training is to practice using ICS during routine activities, such as vaccination clinics, health fairs, epidemiologic investigations, and preparedness exercises and drills.

38. Coordination with DPH and PHRST
Communicate with appropriate DPH branch from the outset and at regular intervals
Contact Public Health Regional Surveillance Team (PHRST)
Define the role of each agency in an investigation
During routine activities and especially during an epidemiologic investigation, it is important for your Epi Team to coordinate its response with the Division of Public Health. The appropriate branch of DPH will depend upon the nature of the outbreak or public health emergency. Often, you’ll work with the Communicable Disease Control Branch and the Office of Public Health Preparedness and Response, but other branches, such as Occupational and Environmental Epidemiology, may also be involved.
The PHRST in your area can provide guidance and surge capacity to local health departments. For example, a PHRST representative may provide advice about specimen collection, assistance conducting interviews, and guidance about the steps of an outbreak investigation.
For successful coordination between the local, regional, and state level, it is important to communicate clearly, and to explicitly define the role of each agency. During an investigation, communication with the PHRST and the Division of Public Health should occur frequently.

39. Other Partners Media Emergency Management / EMS Law enforcement
NC Department of Agriculture
NC Division of Environmental Health
Hospitals and health care providers
Veterinarians
Universities / schools
NC State Laboratory of Public Health
Community organizations
In addition to working with the North Carolina Division of Public Health and the PHRST, you may collaborate with other groups or agencies, including
the media;
emergency management or Emergency Medical Services;
law enforcement;
the NC Department of Agriculture;
hospitals and health care providers;
universities or schools, which can include student groups such as UNC’s Team Epi-Aid;
the NC State Laboratory of Public Health; and
community organizations like churches, restaurants, or day care providers.

40. Tips for Success Assure staff is well-trained
Maintain open communication
Keep NC DPH and State Lab informed about outbreak events
Collect samples
Plan data analysis
Use Epi Info for data entry and analysis
Monitor status of supplies
WORK AS A TEAM!
Here are a few tips to be sure that your Epi Team is successful. First, invest time in appropriate training for Epi Teams members. There is no substitute for proper training before an outbreak or other public health emergency. Another key to success is to maintain open communication within the team, and with local, regional, and state partners. One aspect of open communication is to keep the NC Division of Public Health and the State Laboratory of Public Health informed as an outbreak or emergency progresses.
Another important tip is to collect samples. Getting laboratory confirmation of the suspected pathogen, or ruling out a particular pathogen, can greatly aid in the investigation. Plan ahead for data analysis. Analysis begins the moment you decide to collect data, not after the data collection is completed. Save time by using Epi Info for data entry and analysis. Always monitor the status of important supplies, including vaccines, personal protective equipment, and radios. Finally, and most importantly, remember to work together as a team.

41. Example of NC Epi Team Investigation
Now that you know the basics of local Epi Teams in North Carolina, we will discuss an example of a successful NC Epi Team investigation.

42. Nash County Epi Team Investigation
29 people with nausea, vomiting, diarrhea, and stomach cramps present to Nash General Hospital over 2 days
Nash County Epi Team
Starts line listing
Interviews patients to identify epi link
Advises testing for norovirus
Works with hospital for infection control measures
In 2007, the Nash County health department learned of 29 people with nausea, vomiting, diarrhea, and stomach cramps who had presented to Nash General Hospital over the course of 2 days.
The Nash County Epi Team started a line listing of suspect cases, interviewed patients to search for an epidemiologic link between them, advised the hospital to test for norovirus, and worked with the hospital to enact infection control measures. Throughout, the Epi Team used the Incident Command System in its response to the outbreak.

43. Nash County Epi Team Investigation
Epi Team sends letter to child care centers, nursing homes, schools, and restaurants about infection control
5 laboratory specimens positive for norovirus
Over 200 Emergency Room patients, 2 deaths
The Epi Team sent letters to child care centers, nursing homes, schools, and restaurants about infection control for norovirus, the suspected pathogen, and other sources of gastrointestinal illness.
Several days later, they received confirmation of norovirus in all 5 specimens which had been submitted to the State Laboratory for testing.
In all, there were 200 Emergency Room patients and 2 deaths associated with the outbreak.

44. Nash County Epi Team Investigation
Having an Epi Team that met regularly was helpful
Team responded quickly
Each team member understood his/her role
Response was coordinated
The Nash County Epi Team learned many lessons from the norovirus outbreak. Having an Epi Team that met regularly was helpful and enabled them to respond in a timely manner. The team divided up important tasks within the Incident Command System, and each team member understood his or her role. The response was coordinated, which was important because one Epi Team member was receiving information from the hospital, while another team member was receiving information from the local medical examiner. Putting together the pieces of information helped the team to realize the scope of the outbreak.

45. Importance of Epi Teams
Increase capacity of LHD
Provide structure and organization to LHD response
Provide venue for continuing training
The Nash County investigation is just one example of investigations conducted by North Carolina Epi Teams in response to emergencies and outbreaks of various sizes, but it illustrates the importance of a well-functioning Epi Team.
Epi Teams play an important role by increasing the capacity of the local health department to prevent and respond to public health emergencies. Epi Teams provide structure and organization to the local health department’s response. They also provide a venue for continuing training for team members on topics such as conducting surveillance and responding to disease outbreaks.

46. Conclusion Working as a team requires: A wide range of expertise
Clear communication
A rapid but careful and systematic approach to disease outbreaks and other public health emergencies
Working as an Epi Team requires a wide range of expertise, clear communication within the Epi Team and to other partners, and a rapid but careful and systematic approach to disease outbreaks and other public health emergencies.
Congratulations on completing the Introduction to North Carolina Epidemiology Teams training module.

47. References
NC Division of Public Health. North Carolina Communicable Disease Control Manual. Accessed April 29, 2008.
Potter MA, Sweeney P, Iuliano AD, Allswede MP. Performance indicators for response to selected infectious disease outbreaks: a review of the published record. J Public Health Manag Pract 2007;13(5):
The references on this slide were used to develop this training module.