1. Alternative Career Pathways John D. Tilden, DVM, MPH Food Safety Epidemiologist Michigan Department of Agriculture

2. “We must be architects of change and not it’s victims” Don Gingrich, Iowa pork producer

3. Overview My Career Pathway The Information Explosion Field Epidemiology Investigations Lessons Learned

4. Graduation Day: My Plans Large animal herd health Maybe some mixed animals Definitely no: –pigs –poultry –research –more schooling

6. Timeline 1983 MSU 1983-1985Mixed Animal Practice, Frederick, MD 1985-1986School of Aerospace Med., San Antonio, TX 1986-1989United States Air Force (MI) 1989-1990Johns Hopkins University (MD)

7. Timeline (continued) 1990-1991USDA, APHIS, Washington, DC (Food Safety Policy) 1991-1993USDA, APHIS, Puerto Rico (International Development,) 1993-1995Epidemic Intelligence Service, CDC 1995-1996Pseudorabies Eradication, S.W. Michigan 1996-PresentFood Safety Epidemiologist

8. Emerging Threats and the Information Explosion Data saturation Tendency to specialize Potential career springboard –funding source for further education –Positions created to address newly identified needs

9. Food Safety Disciplines Biology Epidemiology Microbiology Public Health Animal Health

12. Epidemiology The study of the distribution and determinants of diseases and injuries in populations.

13. Dr. John Snow, September, 1854

14. Exposure + + - - Total 90 03 93 9 3 12 Fisher’s Exact p value =.005 Disease Statistical Evidence

15. The Centers for Disease Control and Prevention Part of the U.S. Department of Health and Human Services Initiated in the 1940’s to control malaria in southern states Grew and evolved –disease outbreaks –effective treatment –education –prevention strategies

16. Current CDC Structure National Center for Infectious Diseases National Center for Health Statistics National Center for Environmental Health National Center for Injury Prevention and Control National Institute for Occupational Safety and Health (NIOSH)

17. Why Conduct Field Investigations? Increase understanding of disease –“natural experiments” Assist prevention efforts Political pressure

18. Or Tip of an Iceberg? Isolated Snow Flake? Checking out apparently isolated cases:

19. 6/278/29/610/1111/1512/201/242/274/3 0 1 2 3 4 5 6 7 8 9 10 11 12 Date Number of Patients Recall Usual listerosis incubation period Fatal Non-fatal Multistate Outbreak of Listeriosis, United States, 1998-1999 Plant Construction

20. Disease Investigations Citizens Private practitioners Local department of public health State government CDC Universities Number of Cases

23. Thumbnail sketch of field epidemiologic investigations 1. Receive report of disease 2. Confirm diagnosisCase Study 3. Determine if increased potential for disease transmission exists 4. Intervention warranted? 5. Further investigation warranted? 6. Additional case findingCase Series Formulate a case definition Descriptive analysis of cases (person-place-time) Hypothesis generation 7. Intervention warranted? 8. Test hypothesis via analytic epidemiologic studies cohort studies (example: foodborne illness outbreaks) case-control studies (example: rare disease investigations) 9. Intervention warranted? 10. Disseminate information Presentations Publications

24. Cryptosporidium 1907: First described 1976: First human case 1981: First AIDS patient diagnosed 1983: Person-to-Person transmission 1984: Waterborne transmission (Well) 1987: Waterborne transmission (Surface) 1988: Waterborne transmission (Pool) 1993: March 1993 - 403,000 ill in Milwaukee 1993: August - 7 ill in Madison, WI

25. Non-Foodborne Routes of Disease Transmission

26. E. coli 0157:H7 1982: First recognized as a foodborne pathogen 1984: Person-to-person transmission 1985: Association with HUS Documented 1990: Waterborne transmission 1991: Acid tolerance: apple cider 1992: Most common cause of bloody diarrhea 1993: Heat resistance November 1994 - 17 ill in Seattle, WA

28. Lessons Learned If its not fun, its not epidemiology Ride the Funding Waves Never Say Never Stick to What You Care About

29. Lessons Learned Freedom to change is important Keep your options open

30. “Progress is the activity of today that ensures a tomorrow” Ralph Waldo Emerson