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A CSTE Fellow’s American Samoa EpiAid Response Experience

Posted By Stephanie Johnson, MPH, Class XV CSTE Applied Epidemiology Fellow, Friday, February 16, 2018
Updated: Friday, February 16, 2018

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 get real-life experience and gain valuable exposure to many facets of the job. Following the completion of my MPH in epidemiology at the University of Pittsburgh, my passion to learn more and investigate mosquito-borne infectious diseases led me to apply and accept a two-year Applied Epidemiology Fellowship. I was placed at the Centers for Disease Control and Prevention-Dengue Branch (CDC-DB) and the Puerto Rico Department of Health (PRDH) in San Juan, Puerto Rico.

A month into my fellowship, CDC-DB received a call from the territory of American Samoa requesting assistance with a dengue outbreak. The outbreak started in November of 2016 when a fisherman introduced a dengue virus strain that had not been seen in American Samoa since the 1970s. In September 2017, I deployed with an EpiAid team from Puerto Rico to work with our counterparts in American Samoa. Being part of the American Samoa team, and participating in this outbreak investigation has been a highlight of my fellowship experience so far and has opened my eyes to the reality of applied epidemiology.

Pictured: American Samoa Department of Health staff drawing blood and interviewing a person during household-cluster investigations. (Photo credit: Caitlin Cotter)

In American Samoa, I assisted in a household cluster investigation to identify people with recent dengue virus infection and identify behavioral or environmental factors associated with infection. We conducted household and individual interviews of houses within 50 meters of a confirmed dengue case. The interviewers asked about demographics, history of recent illness, use of insect-repellent, and collected blood samples of willing household members. Within two weeks, the team obtained 250 blood samples and performed interviews in six different districts on the main island of Tutuila. My work varied from organizing and maintaining field materials to managing the different interviewer and phlebotomist teams. The interviews were usually conducted in Samoan.

Pictured: The entomology team doing outdoor aspiration collecting mosquitoes. (Photo Credit: Tyler Sharp)

An additional aim of this EpiAid response was to review medical records to evaluate clinical management of hospitalized dengue patients. This information will be used to see how dengue illness might be affected by co-morbidities, timing of when care was sought, previous infection with Zika (American Samoa had a Zika outbreak in 2016), and other variables that could possibly influence severity of disease. My work involved going to the central health clinic to collect the information, and attending doctor rounds to hear their first-hand experience with dengue patients’ stories, and alert us to current patients in the ward.

My deployment took me from the familiarity of crunching numbers behind a desk to front and center fieldwork. It cemented that I love fieldwork with all that comes with it – insect repellent, unexplained delays, outdated maps, miscommunication, and the unexpected. This opportunity also showed me more of American Samoa than most people who come here as tourists get to see.

Pictured: Stephanie surveying potential mosquito breeding sites. (Photo Credit: Tyler Sharp)

As an epidemiologist, we are sometimes on the front lines of disease epidemics. My deployment to American Samoa with the EpiAid team began the Monday before Hurricane Maria hit Puerto Rico. Our originally planned team of six flew out as a team of three, with one of us leaving early due to family concerns, leaving us a team of two. I am so thankful to the American Samoa Department of Health (ASDOH) for all their help and support. The employees of both ASDOH and the field teams were fantastic. They helped my EIS officer colleague and I get to know American Samoan culture, were always available to lend a helping hand, and taught us a few words of Samoan! They also taught us about the two different types of coconut, the one you drink, and the one you cook with, as well as some of the tales and legends of the ancient Samoans.

Pictured: The EpiAid team on a hike in American Samoa (Credit: Tyler Sharp)

As a CSTE/CDC Applied Epidemiology Fellow, my deployment to American Samoa further expanded my capacity as an epidemiologist. It demonstrated to me both the interesting and exciting aspects of being on the front lines during an outbreak response, as well as the importance of time-consuming medical chart review to learn exactly how a disease can manifest. This opportunity enriched my field knowledge and allowed me to learn how to work with different cultures, different health departments, and how to bring together a lot of different people to work on an outbreak response.
Stephanie Johnson is a CSTE Class XV AEF Fellow in the Minnesota Department of Health Zoonotic Disease 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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