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CSTE Zika Deployment Update

Posted By Gabriela Escutia, San Diego Health & Human Services Agency, Friday, July 14, 2017
Updated: Thursday, July 13, 2017
Sociocultural context as a guide to connecting the office and the field during a public health emergency
Note: CSTE received funding from a cooperative agreement with the Centers for Disease Control and Prevention to provide epidemiological workforce surge capacity in Puerto Rico. Consultants were deployed to help support the Zika response efforts – they did this by implementing evidence-based policies developed by CDC to further capacity building efforts during a public health emergency. AEF Fellow Gabriela Escutia of the San Diego Health & Human Services Agency recently returned from deployment to Puerto Rico. To date, CSTE has supported six consultants who provided 245 days of in country support. Additional deployments will continue in 2017 if requested by CDC.
Each year, CSTE’s applied epidemiology fellowship (AEF) offers recent epidemiology graduates the opportunity to experience applied epidemiology in a real-world setting. This is a powerful way for a young epidemiologist to set forth in a career direction. Following the completion of my MPH in epidemiology at Oregon State University, my passion to comprehend social inequalities through public health led me to pursue a two-year applied epidemiology fellowship. I was placed at the Centers for Disease Control and Prevention (CDC), U.S./Mexico Quarantine station, and the County of San Diego Epidemiology program in San Diego, California.

Pictured: Gabriela in the field in Puerto Rico conducting surveys with a group of entomologists (photo credit: Gabriela Escutia)

Just a few months into my fellowship, Zika virus disease (ZIKV) emerged in the Americas, and a year later, the U.S. declared a public health emergency in Puerto Rico. By September 2016, there were over 20,000 symptomatic ZIKV cases reported in Puerto Rico. In October 2016, I was deployed to Puerto Rico to assist in the emergency response to Zika. Working on the frontlines of the Zika outbreak in Puerto Rico has been one of the richest experiences of my career in applied epidemiology.

During my deployment, I assisted in a household cluster investigations project to identify factors associated with the underreporting of ZIKV in Puerto Rico. I supported the collection of demographics, household characteristics, recent illness and health care-seeking behaviors by conducting interviews of households within 100 meters of households where patients with confirmed ZIKV disease lived in five municipalities in Puerto Rico. My work varied from conducting surveys to transporting specimens and field materials to cluster locations. The interviews were conducted in the Spanish language.

Pictured: A bottle of mosquitos used during outreach activities (photo credit: Gabriela Escutia)

As epidemiologists, we are responsible for studying the distribution of disease in populations for the design of appropriate interventions; however, this can become complex during a public health emergency, as sometimes urgent problems that demand immediate solutions arise. Early in my field work, I realized that my experience would be incomplete without observing the social aspects of the situation. With almost 50% of the population living below poverty in Puerto Rico, there is no doubt that health on the island is determined by access to social and economic opportunities. As a young epidemiologist in training eager to learn, I quickly drafted an observation items list to use every time I went into the field. I learned that the way you knock on the door in a middle-class neighborhood was not the same way you would in a low-income neighborhood.

My Zika deployment also took me from the familiarity of the office to an environment where I gained a new perspective on the role of an epidemiologist. As epidemiologists, we get the best answers by going into the field and talking to people. In the field, I gained a greater understanding of Puerto Rican culture through observation. For instance, applying mosquito repellent might not be a cultural practice, as some elderly people I met in Puerto Rico believe that repellent disrupts the natural ecosystem and might harm the lizards around their homes that eat the mosquitos.

At the Puerto Rico Department of Health Emergency Operations Center (EOC), health officials played an important role in closely monitoring the outbreak and providing a platform for deployed and local health professionals to collect and analyze information for response activities. I joined the behavioral science team as a data manager. Our team was responsible for conducting a two-phase interview among pregnant women to assess the distribution of Zika prevention kits and CDC educational materials. This included the distribution of topical insect repellent, condoms to avoid potential sexual transmission of Zika, and mosquito dunks to reduce mosquito populations in standing water, which were delivered through Women, Infants, and Children (WIC) clinics. During a public health emergency, timely access to relevant data is essential. Time is limited and population needs must be addressed.

Pictured: Gabriela’s last day at the Emergency Operations Center with a behavioral science team (photo credit: Gabriela Escutia)

As a CSTE/CDC Applied Epidemiology Fellow, my deployment to Puerto Rico during the Zika emergency response further developed me into an experienced epidemiologist. The opportunity enriched my field knowledge and allowed me to learn from the best at CDC and those in the field, while working on the front line of a public health emergency. It was a life-changing moment – a diverse combination of applied epidemiology, from interacting and learning from the community to managing complex data sets in limited time. The experience was extremely rewarding because as an applied epidemiologist you know some of your recommendations can lead to improving the public’s health, in this case our future generations.

Gabriela Escutia is a CSTE Class XIII AEF Fellow in the San Diego Health & Human Services Agency Quarantine Unit

This publication was supported by Cooperative Agreement Number 5U38OT000143 from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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