1. is for Epi Epidemiology basics for non-epidemiologists

2. Session II Part I An Epidemiologist’s Toolkit

3. Overview 1.Public health, allied health, and community collaborators 2.Public health laboratories 3.Data, technology, and the media 4.Centers for Disease Control and Prevention 5.Universal epidemiological methods

4. Learning Objectives Understand the significant roles of both the human and technological elements of epidemiological practice Recognize the diverse professionals within and beyond public health that contribute to the success of epidemiological surveillance and investigations

5. Learning Objectives Recognize key sources of epidemiological data Recognize ways in which epidemiologists work with the media Understand how the Centers for Disease Control and Prevention serves as a resource for training, technical support, and surveillance and reporting of epidemiological data

6. Human “Tools”

7. Colleagues & Collaborators Public Health Regional Response Teams First responders Environmental health specialists Public Health Laboratories Disease investigation specialists

8. First Responders Traditional Fire Department Law Enforcement HazMat Emergency Medical Services Department of Transportation Environmental Protection Agency Non-traditional Hospitals Public Health Laboratories Public Works

9. Outbreak Investigation Triad

10. Roles of an epidemiologist Determines existence of an outbreak Determines a case definition, –e.g., “Onset of illness on or after February 1, 2005, with at least 2 of the following: diarrhea, fever, and vomiting” Conducts interviews with cases, family members, contacts and controls Generates a research hypothesis Chooses an appropriate study design if an analytic study is conducted Reviews, analyzes, and interprets interview, analytic study, and laboratory data

11. Outbreak Investigation Triad Roles of an environmental health specialist Collects and tests food, water, or other environmental elements of interest Inspects food service establishments for sanitation violations or deficiencies

12. Outbreak Investigation Triad Roles of a public health laboratorian Cultures blood and / or stool samples Identifies a pathogen and even the strain of pathogen via DNA fingerprinting (known as Pulse Field Gel Electrophoresis)

13. What Do Public Health Laboratories Do? Confirm a situation that an epidemiologist is investigating –Everyday food borne illnesses –Bioterrorism biological threats Serve as a liaison between the public and the public health system –Surveillance, monitoring, reporting Essential to public health practice –Part of the public health infrastructure –Protect community health

14. Surveillance, Monitoring, Reporting Surveillance –Vector borne diseases –Communicable diseases –Food borne and waterborne diseases Monitoring –Newborn screening and genetics –Radiation monitoring and detection –Food safety or other environmental issues Reporting –Two-way with state health departments

15. Association of Public Health Laboratories National non-profit promoting policy and supporting practice at state and local levels Has an Emergency Preparedness and Response initiative Working relationship with CDC, EPA, FBI, Department of Homeland Security

16. CDC Division of Laboratory Systems Goal: “Assure availability of consistent laboratory capacity for public health across the nation.” Demonstration Projects in four states (WA, NE, MN, MI) Partnership Assessment Training Standards

17. Epidemiology Tools Used at the Local Level Common and uncommon tools used in investigations and response How partnerships enhance outcomes - Within Public Health - Outside Public health

18. Investigation 1 Tuberculosis

19. TB Exposure Investigation Background Hospital Nurse with active TB died Several unknowns: –duration of infectiousness –number of patients exposed –number of hospital visitors exposed –identity of hospital visitors No base-line data to compare screening findings

20. TB -Tools to Answer the Unknowns Need strong relationships & diplomacy –Hospital staff (clinical & administration) –Neighboring health districts –State health department –Laboratory –Media –Community –Local health department staff

21. TB – Investigation & Response Social & Professional Contacts –Coordinating three districts –Hospital employee and staff screening Screening and testing patients and visitors –Approx. 900 patients & 1500 visitors Outside help needed

22. TB: Evidence Based Decisions Time to answer the unknowns –Period of infectiousness Patient Reaction Rates over time of exposure –What patients were exposed? Social & Professions infection rates Do we expand time of exposure period?

23. TB - Outcomes 2500 people screened –2300 tuberculin skin tests 2100 (92%) read –128 positives –> 350 x-rays 120+ hours of clinic time New TB testing policy and employee illness monitoring at the hospital

24. Investigation 2 Foodborne Outbreak

25. Foodborne Outbreak (FBO) Background 200 bed residential facility Unknown cause of 30 GI illness complaints Mentally handicapped population

26. FBO – Tools Required Relationships –Facility staff –Laboratory –Media –Medical Examiner –Environmental Health program

27. FBO – Tools Required Dedicated & knowledgeable Epidemiology Response Team Interviewing skills Outbreak investigation techniques Analytic skills Reliable references Diplomacy & advocacy

28. FBO - Results Cause of illness – Clostridium perfringens 30 ill residents, 1 associated death Improved food preparation and monitoring Additional staff Legislative measures for more funding Eat Chopped Pork BBQIll Not IllTotal Yes (exposed)302858 No (not exposed)11112 Total313970 AR = 51.7; RR = 6.2069; p = 0.000587

29. Common Toolbox Items Control of Communicable Disease Manual VDH Communicable Disease Manual VDH Epidemiology web site www.vdh.state.va.us/epi/regs.asp www.vdh.state.va.us/epi/regs.asp www.vdh.state.va.us/epi/bulletin.asp CDC web site www.cdc.gov www.cdc.gov World Health Organization www.who.int/en/ www.who.int/en/ Pro-Med Mail www.promedmail.org www.promedmail.org And of course, paper & pen