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CSTE announces Janet Hamilton, MPH as new Executive Director

Posted By CSTE Staff, 6 hours ago
Updated: 20 hours ago


The Council of State and Territorial Epidemiologists (CSTE) is pleased to announce the selection of Janet Hamilton, MPH, as new Executive Director, effective March 29, 2020. As Executive Director, Hamilton will work directly with the Executive Board and senior management team to lead and shape CSTE’s mission of advancing the field of applied public health epidemiology in the U.S.  


She will also oversee CSTE’s strategic objectives, public health partnerships, and operations. Hamilton will replace current Executive Director Dr. Jeffrey Engel, who announced his retirement in November 2019.   


“With the ongoing COVID-19 pandemic response, CSTE is fortunate to welcome a new Executive Director who really understands applied epidemiology from the state and national perspective and has hands-on state public health department experience from her previous role in the Florida Department of Health,” said Dr. Sharon Watkins, current CSTE president and Pennsylvania State Epidemiologist. “Janet’s scientific and policy expertise has truly boosted CSTE’s national profile, and I am pleased we’ll have this continuity of leadership at such a crucial juncture.” 


Prior to her selection as Executive Director, Janet served as CSTE’s Senior Director of Science and Policy, leading organizational efforts to strategically combine applied epidemiology science with policy efforts to advance public health and applied epidemiologic public health practice. Hamilton is an epidemiologist with over 15 years of public health work experience at the national, state, and local levels. In 2019, Janet spearheaded the efforts of a coalition of partners to modernize public health surveillance through the Data: Elemental to Health campaign, which secured an initial appropriation of $50 million to the Centers for Disease Control and Prevention (CDC) to support this foundational need. She has also helped lead CSTE’s response to EVALI and now COVID-19. Prior to CSTE, Janet worked in the Florida Department of Health, where she oversaw surveillance programs, both the epidemiologic scientific content and the surveillance systems that support them. Hamilton also served as CSTE’s Executive Board President during the 2017-18 term, and as Surveillance and Informatics Steering Committee Chair from 2011 to 2015. 


“It is such an honor to be chosen to serve as CSTE’s next Executive Director,” added Hamilton upon the announcement. “I am grateful for the leadership and guidance of our retiring executive, Dr. Jeffrey Engel. Public health is facing the most intense challenge of our lifetime responding to the COVID-19 pandemic, and we must do everything we can to support our members who are facing even greater challenges on the ground. Public health is meeting this moment with calm, courage and resilience. I look forward to collaborating with our Board, our federal, state, and local partners, and all of our members to foster growth and the advancement of CSTE and our field.” 


Hamilton replaces outgoing Executive Director Jeffrey Engel, MD, who will retire after eight years of guiding CSTE through a successful period of growth as Executive Director. Engel will remain at CSTE as Senior Advisor for the COVID-19 response, assisting as a subject matter expert in infectious disease epidemiology.  

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CSTE 2020 Annual Awards: Recognizing Excellence and Outstanding Achievement in Applied Epidemiology

Posted By Sarah Zimmerman and Simental “Sy” Francisco, BS, Wednesday, February 26, 2020
Updated: Tuesday, February 25, 2020
Simental Francisco accepts the 2019 RWJF Award from Sarah Park, Hawaii State Epidemiologist and CSTE Board Vice President.

Each year, CSTE presents several awards recognizing excellence in applied epidemiology among our members and partners, owing to the strength and diversity in our work and membership. While some CSTE awards are decided via an annual Call for Nominations, others are eligible for self-nomination. Please see the CSTE Awards page for more details.

Note: The deadline for nominations for the 2020 Pumphandle Award, Distinguished Leader and Distinguished Partner Awards, and other awards is March 1, 2020.

Last year, CSTE presented the Robert Wood Johnson Foundation (RWJF) Award for Outstanding Epidemiology Practice in Addressing Racial and Ethnic Disparities Award to Simental "Sy" Francisco from Navajo Nation Epidemiology Center. His abstract, “Initial Data Finding from Results of the Navajo Nation Health Survey: A Foundation for Development of a Navajo Behavioral Risk Factor Surveillance Systems,” addresses racial and ethnic disparities to improve public health practice through effective use of data and epidemiology in the Navajo Nation. Health disparity research on American Indian and Alaska Native (AI/AN) populations spread across 560 federally recognized tribes is underrepresented in state Behavioral Risk Factor Surveillance (BRFSS) reporting due to the complex issues surrounding the responsibility for public health services in AI/AN populations. Francisco leads the BRFSS at the Navajo Epidemiology Center (NEC) by demonstrating Hozhó [i] of Diné [ii] People through Naałnįįh Naalkaah [iii].  

Tribal Epidemiology Centers regional locator map.


The NEC is one of 12 Tribal Epidemiology Centers (TECs) that work in partnership with local or area tribes to improve the health and well-being of tribal members by offering culturally competent approaches to eliminate health disparities faced by AI/AN populations by monitoring health status, maintaining disease surveillance, conducting health research, conducting disease outbreak investigation, reporting health data, providing technical assistance, and identifying priority health concerns.   

A core function of TECs is the collection of data related to, and monitor progress made toward meeting, each of the health status objectives for Indian Tribes, Tribal Organizations, and Urban Indian Organizations (I/T/U) in their respective Indian Health Service (IHS) service areas. The Navajo BRFSS provides behavioral risk factor data on adults residing in the Navajo Nation. Initial data findings from the results of the Navajo Nation Health Survey fulfill an original premise to provide tribal-specific data from and build a foundation for a tribal nation-specific BRFSS to identify risk factors of Navajo adults; collect data specific to Navajo Nation by in-person interviews; and key data finding results to select target audiences. 

Implementing a tribal BRFSS has public health implications. The implementation of the Navajo BRFSS includes successes learned from piloting and testing; conception of a sampling design, study methodology, and procedural survey protocol as a surveillance system representative to AI/AN populations; recognizing the prevalence of health risk behaviors among Navajo adults; comparisons with other populations to identify health disparity; definition of health measures, e.g., Healthy People 2010/2020, identifying measurable baseline data; a tribal BRFSS process representative and exclusive to AI/AN population-based health; and strengthening support continual tracking, measurement, and evaluation of health status progress with the Navajo BRFSS as a primary data source to support secondary data sources.    

This work highlights the importance of culturally appropriate survey methods in developing a tribal BRFSS, which provided information for tribal leaders to support tribal epidemiology and surveillance done by Simental Francisco and his team.    

Simental Francisco's abstract for Initial Data Finding from Results of the Navajo Nation Health Survey: A Foundation for Development of a Navajo Behavioral Risk Factor Surveillance Systems can be found here. If you would like to learn more about Tribal Epidemiology Centers and the work they do, you can read more at tribalepicenters.org.  

[i] Hózhó is the wellness philosophy of the Diné (Navajo) People, comprised of principles that guide one's thoughts, actions, behaviors, and speech. 

[ii] Diné is an autonym used by the Navajo for themselves in their own language. 

[iii] Naałnįįh Naalkaah translated literally, means “disease surveillance” in Navajo. 

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The Role of Substance Use in Birth Defects Surveillance

Posted By Luigi Garcia-Saavedra, MPH, Whitney Coffey, MA, Elizabeth McCarthy, MA, Wednesday, January 29, 2020
Updated: Tuesday, January 28, 2020

Birth defects (also known as congenital anomalies or congenital disorders) are structural or functional anomalies that occur in utero and are both common and costly. They may be inherited or environmentally induced. Identification of birth defects may occur prenatally, at birth, or much later in life (e.g. renal agenesis).

In the U.S., some estimates indicate one in every 33 babies born each year has a birth defect. Some birth defects can have a minimal impact on quality of life, whereas others are more severe and contribute to long-term disability. Not only are individuals with birth defects impacted, but so too are their families, health care systems, and societies.


Where the cause of the birth defect is known, prevention strategies have been developed to reduce risk. Avoiding use of harmful substances is one such strategy and continuous opportunities to connect a pregnant woman to services and prevention education exist. CDC defines Fetal Alcohol Spectrum Disorders (FASDs) as ‘a group of conditions that can occur in a person whose mother drank alcohol during pregnancy. These effects can include physical problems and problems with behavior and learning. Often, a person with an FASD has a mix of these problems.’ Though etiology of this condition is well known, data from the 2015-2017 Behavioral Risk Factor Surveillance System (BRFSS) showed that 11.5% of pregnant women reported current drinking.  


Alcohol is only one of the substances newborns may be exposed to in utero with negative impacts. Neonates exposed to opioids, benzodiazepines, and barbiturates (OBB) in utero who experience withdrawal signs and symptoms have Neonatal Abstinence Syndrome (NAS).  


Recently, the CSTE NAS Standardized Case Definition (NAS-SSCD) was developed through a cooperative partnership. The CSTE NAS Workgroup includes representatives from state and local public health jurisdictions, CDC, and other partners. Ratified by the Council in June 2019, this tool aims to serve as a primary resource for comparative assessment of jurisdictional and longitudinal trends in NAS by establishing uniform classification guidance. NAS-SSCD includes a tiered case definition to be applied in both provider-reported clinical documentation and administrative data. This resource will allow for better understanding of the incidence and burden of NAS, as well as monitoring for long-term effects. Additionally, standardized surveillance will facilitate the assessment of the needs of the mother-infant dyad before, during, and after pregnancy. 


In Missouri (MO) and New Mexico (NM), NAS-SSCD has been used to align reporting of NAS cases. Stakeholder education surrounding the motivation and aims of NAS-SSCD continues. Further, the 2018 MO birth defect surveillance pilot (which included NAS) indicated the many benefits of active surveillance of birth defects and perinatal conditions of interest. As a result, MO’s birth defect surveillance system will incorporate NAS as a condition of interest for future analyses due to the condition originating from in utero exposure, similar to FASDs. 


Surveillance on birth defects, in utero exposures, and behaviors associated with birth outcomes is a useful tool to inform prevention programs. However, surveillance is most effective when coupled with the provision of services to affected families. A proposed CSTE policy brief associated with NAS-SSCD, which outlines avenues for resource planning and allocation for these services, is in development. 


Presently, the NM Birth Defects Prevention and Surveillance Program (NMBDPSP) and Children’s Medical Services (CMS) have been partnering to connect services to families diagnosed with any birth defect and, more recently, with NAS. NMBDPSP surveillance and data sharing between agencies creates a systematic approach to assure that each family is given information about resources available to them and that they have access to the medical and social services they may need. This collaboration increased the percentage of birth defect-impacted families receiving services from around 50% (in 2017 when the collaboration began) to approximately 70% by 2018.


Another important birth defect-related activity, in addition to surveillance and provision of services, is education of the general public and care providers. Creation and dissemination of messaging containing not only basic health care information, but also prevention advice, research updates, and resource guides are vital. These products can enable self-efficacy in communities affected by adverse birth outcomes. The NMBDPSP is developing these types of educational materials for families with information on specific conditions (with a focus on substances such as tobacco, pain medications, and alcohol). New birth defect surveillance analyses findings in MO will be added to existing public-facing dissemination resources.


During National Birth Defects Prevention Month, it is important to remember that an area encompassing many diverse birth outcomes requires a diverse group of people working together to improve the quality of life of all of those affected. 


CSTE’s Neonatal Abstinence Syndrome (NAS) Workgroup was formed in 2017 to better understand how states define and operationalize NAS and to develop a standardize surveillance case definition. The workgroup developed and conducted an NAS Definition Environmental Scan to understand the current ways in which NAS is defined and used the data to develop the NAS Standardized Surveillance Case Definition Position Statement, which was passed at the 2019 CSTE Annual Conference.


About the authors - Luigi Garcia-Saavedra, MPH, is a Birth Defects Epidemiologists Supervisor for the New Mexico Department of Health and CSTE NAS Workgroup Co-lead; Whitney Coffey, MA, is a Research Analyst for the Missouri Department of Health and Senior Services and CSTE Workgroup Co-lead; Elizabeth McCarthy, MA, is a Research Manager for the Missouri Department of Health and Senior Services.

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An Update on CSTE’s 2019-2020 Presidential Priorities

Posted By Sharon Watkins, PhD, CSTE President and Pennsylvania State Epidemiologist, Wednesday, January 15, 2020
Updated: Wednesday, January 15, 2020


Happy New Year to all CSTE members and non-member applied epidemiologists in our community! We have reached the midway point of my tenure as CSTE president, and I’d like to update readers on my Presidential Priorities for the term and offer a progress report on the status of this work. Each year, the CSTE President sets forth a list of Presidential Priorities.

These are key areas impacting the field of applied epidemiology that the organization, Executive Director and Executive Board work to advance during the year. Presidential Priorities change from year to year, and I immediately began working to articulate and implement my priorities in Fall 2019. Working closely with CSTE staff, I identified two Presidential Priorities that align closely with goals in CSTE’s 2018-2020 Strategic Plan.

The identified priorities are:

• Priority B3, Under Strategic Pillar B (Develop, Expand & Diversify the Epidemiology Workforce) – Develop & Foster Leadership

• Priority A2, Under Strategic Pillar A (Establish Leading Edge Public Health Applied Epidemiology) – Co-Develop Infectious & Non-Infectious Disease Surveillance Initiatives

I am pleased to report that work is well underway in the CSTE National Office to implement both priorities. To develop and foster the next generation of epidemiology leaders, I proposed the development of a forum/platform to train mid-level leaders, some of whom are former CSTE fellows, and provide them opportunities for additional mentorship, exposure to advocacy and public policy, and partnership across states, disciplines and outside organizations. The idea is similar to APHL’s Emerging Leader Program.

In response to this priority, the CSTE Workforce Team is currently working to develop an interactive mid-level leadership training opportunity to be launched in 2020. Additional focus upon this priority will offer early career epidemiologists more exposure to the national picture in our field, and I look forward to the new trainings becoming reality.

The second Presidential Priority focuses on the co-development of Infectious Disease and non- Infectious Disease surveillance initiatives, and this is also the basis for the 2020 Presidential Priorities Award via abstract submission. Like years past, applied epidemiologists across the U.S. will have the opportunity to submit their abstract for the Presidential Priorities Award, so long as the abstract exemplifies partnership and participation between ID and non-ID entities on an outbreak or surveillance initiative. Projects demonstrating a use of data that supports cross-disciplinary partnership and a harmonized response with the best use of available tools will better compete for the award.

CSTE’s ongoing Data: Elemental to Health campaign is an example of a cross-disciplinary project that has been successful in the last year, as the effort yielded $50 million in new federal funding to modernize CDC’s data infrastructure. Ongoing national responses to the opioid crisis and the EVALI outbreak are also recent examples of ways that ID and non-ID epidemiologists are partnering on surveillance initiatives that require a harmonized approach.

We have received a number of abstracts already for the 2020 Presidential Priorities award, and I look forward reviewing these projects and determining the potential for a breakout session that will take place at the 2020 Annual Conference to discuss the award-winning project. Overall, it has been a privilege to serve as your president in 2019 and now 2020. I look forward to further implementing these priorities and to all CSTE will achieve in the future.

Dr. Sharon Watkins is CSTE’s Executive Board President for the 2019-2020 term and the Pennsylvania State Epidemiologist.

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Congress Funds $50 Million to Modernize Public Health Data Systems and Boosts CDC’s Budget

Posted By Celia Hagan, MPH, Vice President, CRD Associates, Saturday, December 21, 2019
Updated: Saturday, December 21, 2019

It has been an exciting year since the launch of the Data: Elemental to Health campaign in February! CSTE has been working non-stop to advocate for funding to improve public health data systems. After the successful inclusion of new funding in the House appropriations bill, the entire process came to a halt when Congress could not agree to a spending package by September 30 resulting in two continuing resolutions.

But good things come to those who wait/never stop advocating for data modernization! Late Friday night, the President signed the FY20 spending bill into law solidifying $50 million in new money for CDC’s efforts to modernize public health data systems! This is a huge win for public health and the new funds will help pave the way towards a 21st century public health data superhighway. A big thanks to all of you that participated in our digital days of action to urge your elected officials to support data modernization. It goes to show that every voice counts!

Here are some highlights of CSTE’s activity over the past year for the Data: Elemental to Health campaign:

·         Janet Hamilton, CSTE’s Director of Science and Policy, testified about public health data needs before the House Labor, Health and Human Services, Education, and Related Agencies Appropriations Subcommittee;

·         Dr. Sharon Watkins, CSTE’s President and State Epidemiologist for the Pennsylvania Department of Health, testified about public health data needs in front of the House Science, Space, and Technology Committee;

·         Four authorizing bills, two in the House and two in the Senate, were introduced to support public health data modernization:

o   H.R. 2479 Section 45001 of the Leading Infrastructure for Tomorrow’s (LIFT) America Act;

o   H.R. 5321 Public Health Infrastructure Modernization Act of 2019;

o   S. 1793 Saving Lives Through Better Data Act;

o   S. 1985 Section 405 of the Lower Health Care Costs Act;

·         CSTE released a comprehensive report, Driving Public Health in the Fast Lane: The Urgent Need for a 21st Century Data Superhighway, to highlight the current challenges with public health data systems and outlining the path towards interoperability;

·         CSTE submitted written statements for two Congressional hearings on e-cigarettes.

There is more good news! Funding for CDC as a whole increased this year. FY20 includes a total of $8 billion for CDC which is $636 million above FY19 and $1.4 billion above the President’s Budget Request. A breakdown of areas of interest are listed below:

·         $230 million to address tobacco and e-cigs; an increase of $20 million

·         $622 million to Emerging and Zoonotic Infectious Diseases; an increase of $2 million

o   $170 million to the Antibiotic Resistance Initiative; an increase of $2 million

o   Flat funding for vector-borne diseases at $38.6 million

o   $14 million for Lyme disease; an increase of $2 million

o   $188.7 million for the Emerging Infectious Disease line; an increase of $31.8 million

o   Flat funding for AMD at $30 million

·         $555.4 million to Public Health Scientific Services; an increase of $59 million

o   $50 million in NEW funding for public health data modernization!

o   $9 million for all other surveillance, epidemiology, and informatics

o   Public Health Workforce is flat funded at $51 million

·         For the first time in 20 years there is $12.5 million in new funding to support firearm injury and mortality prevention research in the National Center for Injury Prevention and Control

·         $852.2 million for public health preparedness and response; a decrease of $5.7 million

o   Flat funding for the Public Health Emergency Preparedness Cooperative Agreement at $675 million

·         $85 million for the Infectious Disease Rapid Response Reserve Fund; an increase of $35 million.

At the end of the day, CSTE’s priorities fared extremely well in the year-end spending bill! Thanks to CSTE’s strong advocacy and presence on Capitol Hill, many of CSTE’s priorities saw increases in funding. Our advocacy successes this year are a good example of your membership fees at work! Without the commitment and strength of CSTE’s members, all of our wins would not be possible. Thank you for your dedication and support.

Additional information about funding levels for your specific priorities can be found in the spending bill, and in the accompanying report that provides more detailed information. 


Celia Hagan, MPH is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC

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CSTE Testifies at U.S. House Science, Space, and Technology Committee Flu Vaccine Hearing

Posted By Celia Hagan, MPH, Vice President, CRD Associates , Tuesday, December 17, 2019
Updated: Monday, December 16, 2019

This time of year, many people get sick. It’s cold outside, you’re cooped up indoors, and holiday stress is in full swing. Your symptoms may start with a cough and a sore throat. Could it be a cold? Then your muscles start to ache and the fatigue, headaches, and chills set in—it’s the flu.

Although flu viruses circulate in the U.S. year round, a peak of activity in the fall and winter months defines the flu season. Consider: while we know flu season will come each year, the season itself is unpredictable – when and where it will start, what virus strain will be circulating, how severe will the season be, and how well will the vaccine strains match. This unpredictability necessitates robust public health surveillance. The respiratory virus changes quickly making it challenging to develop a fully effective vaccine to prevent and mitigate illness. Tracking the virus is a multinational effort that relies on year-round public health surveillance and data collection.

It’s this complicated, yet coordinated scientific process of seasonal flu vaccine development that drew interest from the U.S. House of Representative’s Science, Space, and Technology Committee, which held a Fighting Flu, Saving Lives: Vaccine Science and Innovation hearing on November 20. Today, a universal flu vaccine—a one-and-done dose that would provide lifetime immunity—does not exist, hence the need to get annual flu vaccines each fall. The Committee was interested in understanding the full cycle from basic research to vaccine development, production, distribution and public health surveillance. The House Science, Space, and Technology Committee used this year’s flu season to highlight the scientific and innovation challenges around vaccine development and also focused on efforts to discover alternative influenza vaccine manufacturing processes from the current egg-based process.

CSTE’s President Dr. Sharon Watkins, State Epidemiologist for the Pennsylvania Department of Health, was invited to testify to share the public health perspective and express the need for better public health data. She highlighted that collecting and exchanging public health data is critical to detect and respond to flu outbreaks, gain an understanding of potential changes in the virus, and deliver life-saving vaccines. In her testimony, Dr. Watkins emphasized the need for interoperable data systems to share data, such as birth and death records and immunization registries and the need to be seamlessly connected to hospital emergency departments. Highlighting CSTE’s recent report, Driving Public Health in the Fast Lane: The Urgent Need for a 21st Century Data Superhighway, Dr. Watkins also spoke of the challenges public health faces when it has to rely on paper-based, manual data exchange methods. In the midst of the vaping epidemic that is occurring concurrently with flu season, it is important for public health professionals to distinguish between the two. As part of her written testimony, a four-page sample of a 350-page faxed medical record for an e-cigarette case showed that it is largely illegible and takes a public health professional significant amounts of time to input into the health department’s system. Dr. Watkins’ testimony helped to emphasize the need to improve public health data systems that has been an ongoing effort of CSTE’s through the Data: Elemental to Health Campaign.

Pictured: CSTE President and PA State Epidemiologist Sharon Watkins, PhD and Dr. Anthony S. Fauci, MD, Director, National Institute of Allergy and Infectious Disease, NIH, on November 20 during a hearing of the U.S. House Science, Space and Technology Committee.

Dr. Watkins testified alongside Dr. Tony Fauci the Director of the National Institute of Allergy and Infectious Disease at the National Institutes of Health, Dr. Dan Jernigan the Director of the Influenza Division in the National Center for Immunization and Respiratory Diseases (NCIRD) at the Centers for Disease Control and Prevention (CDC), and Dr. Robin Robinson, former head of the Biomedical Advanced Research and Development Authority (BARDA) and current Vice President of Scientific Affairs at RenovaCare. Dr. Fauci discussed NIH’s research efforts to discover a universal flu vaccine through its collaborations with academia, philanthropic organizations, and biotechnology and pharmaceutical companies. Dr. Jernigan emphasized that the flu vaccine is the single best way to protect yourself, and that CDC is working with other federal partners to use cutting edge science to improve the effectiveness of seasonal flu vaccines. He also discussed the importance of public health surveillance data to help inform policy recommendations and better vaccines. Dr. Robinson discussed his former role as head of BARDA, preparedness efforts to build national stockpiles of pre-pandemic flu vaccines, and BARDA’s activities to improve vaccine manufacturing.

The panel was well received by the House Science, Space, and Technology Committee, and the presiding Chair of the Committee emphasized that the flu vaccine is safe and the best way to stay healthy during flu season.

To protect yourself and your loved ones from flu, which can have severe complications requiring hospitalization and sometimes result in death, the CDC recommends getting an annual flu vaccine.

Celia Hagan, MPH is vice president at Cavarocchi Ruscio Dennis Associates, LLC, which represents CSTE’s interests on Capitol Hill in Washington, DC.

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CSTE successfully activates its first ConOps Plan and a Response around E-Cigarette, Vaping Lung Illness Outbreak

Posted By Jeffrey Engel, MD, Friday, December 6, 2019
Updated: Friday, December 6, 2019

In August, CSTE activated its Concept of Operations (ConOps) Plan for emergency response for the first time. The activation was in reaction to the emerging epidemic of vaping associated lung injury in the United States. That week, there were reports of outbreaks from Illinois and Wisconsin in Epi-X, CDC’s emergency communication system, and a few days later I received a call from Minnesota State Epidemiologist, Ruth Lynfield, that her state was experiencing a similar outbreak. She was concerned about the lack of a national response given the three-state experience and anecdotal reports coming in from other states, such as Utah, California, and Massachusetts.

I quickly learned that the CDC already had three Centers involved: Injury, Environmental Health, and Chronic Disease (Office of Smoking and Health) all under the Deputy Director of Non-Infectious Diseases, and that they were managing the outbreak through a multi-state Epi Aid sending CDC Epidemic Intelligence Officers (EIS) to affected states for technical assistance. These Centers had little experience with national public health emergency responses and by August 20, well into the outbreak with hundreds of cases emerging (according to media reports) there was no central epidemiological response organized to begin surveillance, and collect and analyze case data from affected states; nor methods of lab testing of human samples and vaping fluids; nor investigations through usual mechanisms of establishing standardized case definitions, medical chart abstraction forms, and patient questionnaires. Thus, on August 21, CSTE activated its ConOps (the first organization or agency to do so) to assist states and the federal government with a national epidemiological emergency response.

I’ll stop the chronologic story telling here (as most are aware of the ongoing vaping-associated lung illness outbreak) and shift focus of this article to the ConOps process and impact on the CSTE National Office. Response to public health emergencies involves, in one way or another, activation of an incident management system. The system’s intent is to better manage and align people in an organization, ensure accurate and timely communications among stakeholders, and execute a plan that leads to a response, and eventual de-escalation back to normal operations. When CSTE activated, some staff had new job titles, reporting channels, and new responsibilities (within their skillsets), and once a new work flow was established, a daily rhythm was set. All CSTE departments were involved including program, communications, finance, information technology, and human resources.

CSTE was in Incident Command mode for nearly five weeks when we held an after-action review to discuss lessons learned and de-escalation. Importantly, we learned lessons around the activation levels articulated in our original ConOps plan, differing staff and supervisory roles, and mechanisms by which the national office staff remains updated on the emergency response and in turn provides CSTE members with regular updates. As of the writing of this blog, CSTE remains in ConOps activation and the vaping associated lung injury national outbreak continues with about 200 new cases reported per week. The CSTE-led Epi Task Force leads federal and state partners in the epidemiological response through regular calls, technical assistance, and critical communications. At this time of this writing, It appears we will scale down to a Level 1 or complete deactivation in the near future, as CDC stabilizes their new surveillance system for disease notification, analysis, and response. Overall, I am pleased CSTE has been able to execute this emergency response to the EVALI outbreak and have already discussed modifications to the ConOps plan for future emergency and/or outbreak responses.

Dr. Jeffrey Engel has been CSTE’s Executive Director since 2012. Prior, Dr. Engel was the State Health Official (2009-2012) and State Epidemiologist (2002-2009) in North Carolina and served on the CSTE Executive Board as the ID Steering Committee Chair from 2008-2009.

Tags:  e-cigarette  epidemiology  injury  lung illnes  surveillance  vaping 

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Working Together on the Transition to Whole Genome Sequencing, Making Our Food Supply Safer

Posted By Rima Khabbaz, MD, Director, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Wednesday, September 18, 2019
Updated: Wednesday, September 18, 2019

As the multi-year effort of rolling out whole genome sequencing (WGS) for PulseNet successfully completes its transition, I am pleased to report that thanks to the herculean efforts of our laboratory and epidemiology partners, the entire country is now able to sequence all foodborne disease pathogens. Public health departments across the country are starting to use the powerful tools of advanced molecular detection (AMD) to detect and investigate outbreaks and better understand antibiotic-resistant bacteria so we can stop their spread.

For more than 20 years, PulseNet has helped detect, investigate, and stop outbreaks and improve our food safety system nationwide, reducing the overall burden of enteric disease in the United States. In 2019, we have seen the culmination of an exceptional effort to transform foodborne disease surveillance in the era of next-generation sequencing. We hope our state epidemiology partners from Florida to Washington appreciate how their diligence in this effort will strengthen all infectious disease surveillance for years to come.

We will look to you as leaders to not only use this technology to track and prevent other diseases, but also to help us at CDC learn about the many ways this tool can be harnessed to drive future innovation and prevention research. You well know that this has been a long, arduous process and would not have been accomplished without the contributions of our federal, state, and local partners. I would like to express sincere gratitude on behalf of our agency for your dedication and commitment to this forward-thinking transition of our public health system.

As we did 23 years ago at the dawn of PulseNet, we will work collaboratively to optimize this technology and further improve our efficiencies. As with any major technological transition, technical or logistical challenges may emerge – we hear you at CDC and are committed to working with you to make this transition as smooth as possible. We think this technology will empower public health decision-making at the local, state, and federal levels, and we anticipate its increasing use internationally.

I am fortunate to be the director of a center at CDC that strives to push forward public health science, but without partnership with groups like CSTE, we’d be hard pressed to accomplish anything close to what we have done over the last few years for enteric disease prevention. I’d like to reflect on the many interactions with our state and local health department partners who have attended a number of CDC-sponsored trainings and meetings over the course of this transition. We have been most struck by the large number of bright, young public health scientists drawn to the field with laboratory, epidemiology, and environmental health training who were excited about the challenges and the potential innovations at hand. Just as it has from the beginning, PulseNet will continue to find more ways to drive the prevention of foodborne and other enteric illnesses, make our food supply safer, and keep all of us healthier.

Rima F. Khabbaz, MD, is director of the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at the Centers for Disease Control and Prevention (CDC). NCEZID’s experts work around the clock to protect people from a multitude of health threats and advance the agency’s cross-cutting infectious disease priorities, including the integration of advanced molecular detection (AMD) technologies into public health. For more information about PulseNet and the transition to whole genome sequencing, please visit NCEZID’s PulseNet Lab transition to WGS page.

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Advocacy Update: Exciting Progress for Data Modernization, But Much Left to Do

Posted By Emily Holubowich, CSTE Washington, DC Liaison, Friday, July 19, 2019
Updated: Friday, July 19, 2019

In early 2019, the Council of State and Territorial Epidemiologists (CSTE), Association of Public Health Laboratories, Healthcare Information and Management Systems Society (HIMMS), and National Association for Public Health Statistics and Information Systems (NAPHSIS) joined together to spearhead a bold and transformative campaign – Data: Elemental to Health – to secure $1 billion over the next decade to modernize the public health surveillance enterprise at the Centers for Disease Control and Prevention (CDC) and through it, state, territorial, local, and tribal (STLT) health departments. This funding would also support efforts to modernize the public health workforce by training, recruiting (e.g., student loan repayment and fellowships), and retaining skilled data scientists. Data systems require adept staff to use them, maintain them, interpret the data, and develop and deploy actionable public health interventions to save lives.
No doubt you are familiar with the proverb, “if you want to go fast, go alone. If you want to go far, go together.” Indeed, partnerships are the cornerstone of the Data: Elemental to Health campaign. Today, there are 90 entities representing patients and consumers, public health professionals, health care providers, and IT that are advancing our priorities to build a public health data “superhighway” of the 21st century. Our partners extend beyond these organizations. You have been a centerpiece of this campaign, as well. For the first time ever, CSTE helped coordinate a Day of Digital Action in June using HIMSS’s grassroots advocacy platform that allowed CSTE’s members and others to send emails to federal lawmakers about the importance of public health data, and the need to modernize IT systems. This Day of Digital Action yielded more than 1,200 messages from every state to members of Congress.
In just six months, together we’ve gone both far and fast.
As a result of our collective efforts leading the Data: Elemental to Health campaign, we’ve delivered the following results:
  • Legislation passed in the House that, if enacted, would appropriate $100 million in fiscal year (FY) 2020 for CDC to modernize the public health surveillance enterprise and workforce at the federal and STLT levels.
  • Legislation introduced in the House – the LIFT America Act – that would authorize $100 million per year for public health data modernization activities over each of the next five years.
  • Two bills introduced in the Senate – The Saving Lives through Better Data Act and the Lower Health Care Costs Act – both of which are bipartisan, that would also authorize data modernization initiatives.
With four bills in two chambers, lawmakers have made clear their support for public health data modernization in both words and deeds. Unfortunately, making these promises a reality hinges entirely on Congress and the White House’s ability to stave off devastating cuts – 10 percent across the board – that are scheduled hit defense and domestic programs, including public health in fiscal 2020. Without a bipartisan budget deal to #RaiseTheCaps, lawmakers will have no choice but to cut funding for public health, despite their best intentions. Congressional leaders are intent upon raising the spending caps and avoiding scheduled cuts. White House officials continue to participate in conversations with congressional leaders, but seem less enthusiastic about a deal, or at least, a deal that would increase funding for domestic priorities like public health (recall that the president’s fiscal 2020 budget request proposed deep cuts to public health).
In sum, our progress to date is exciting, but a broader budget deal will need to fall into place for our efforts to bear fruit. We will continue to urge Congress to #RaiseTheCaps, so we can secure much needed funding to improve the nation’s public health infrastructure.
Emily J. Holubowich, MPP is the Senior Vice President, Cavarocchi Ruscio Dennis Associates, LLC. Emily joined CRD Associates in 2009 and has nearly 20 years of experience in health and fiscal policy, government relations, strategic communications, and coalition management. She has represented CSTE’s interests on Capitol Hill since 2013.

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Data: Elemental to Health Campaign Building Momentum – What Can You Do?

Posted By Emily Holubowich, CSTE Washington, DC Liaison, Friday, April 26, 2019
Updated: Thursday, April 25, 2019

Global health security depends on 24/7 population-wide, fast, complete and accurate detection and reporting of diseases and conditions of high public health consequence. Every day—often unbeknownst to most Americans—public health surveillance is saving lives by detecting and facilitating the response to health threats, including E. coli contaminated lettuce, measles, antibiotic resistance, lead poisoning, influenza, health care-associated infections, opioid overdoses, Zika, and more.

Unfortunately, the nation’s public health data systems are antiquated, rely on obsolete surveillance methods, and are in dire need of security upgrades. Lack of interoperability, reporting consistency, and data standards leads to errors in quality, timeliness, and communication. Sluggish, manual processes—paper records, spreadsheets, faxes and phone calls—still in widespread use, have consequences, most notably, delayed detection and response to public health threats of all types: chronic, emerging, and urgent.

To protect our nation’s health security we need more, better, faster, and secure data. For the first time ever, the Council of State and Territorial Epidemiologists (CSTE), Association of Public Health Laboratories, National Association for Public Health Statistics and Information Systems (NAPHSIS), and Healthcare Information & Management Systems Society (HIMSS) have joined together to spearhead a  campaign to secure $1 billion over the next decade—$100 million in fiscal year 2020—to modernize the public health surveillance enterprise at the Centers for Disease Control and Prevention (CDC) and through it, the state, local, tribal, and territorial health departments. This funding would also support efforts to modernize the public health workforce by training, recruiting (e.g., student loan repayment and fellowships), and retaining skilled data scientists. Data systems require adept staff to use them, maintain them, interpret the data, and develop and deploy actionable public health interventions to save lives. 


Pictured: CSTE Executive Board members and staff visiting Capitol Hill in March to promote the new advocacy initiative, Data: Elemental to Health


Our “Data: Elemental to Health” campaign is gaining traction in Washington, DC and beyond since its launch in February:

·         More than 80 institutions representing health care providers, patients and consumers, public health professionals, and IT developers have endorsed our funding request to Congress. You can read a copy of our letter to appropriators HERE.

·         CSTE’s leadership travelled to Capitol Hill in March to discuss our proposal with officials in Congress, the Department of Health and Human Services (HHS), and the Office of Management and Budget;

·         Senator Richard Blumenthal (D-CT)—recognizing the need to modernize the data infrastructure—sent a letter to appropriators endorsing our funding request;

·         CSTE’s Director of Science and Policy Janet Hamilton was invited to testify before the House appropriations subcommittee with jurisdiction over public health funding about the dire need to build a public health data superhighway of the 21st Century. You can watch her testimony HERE and access her written statement for the record HERE.

We will soon know if our campaign has made an impact when the House appropriations subcommittee unveils its public health funding bill on/around April 30 and the full committee considers it on May 8.

You can help us between now and then by sharing this blog, our campaign flyer and letter, Janet’s testimony, and this Association of State and Territorial Health Officials (ASTHO) video about the campaign with your colleagues at the department of health, your governor, and to the extent you are comfortable, with your federal elected officials. This funding, if appropriated, will represent the most significant, strategic, transformative investment in data systems at the federal, state, and local levels ever, and we want as many people as possible to know about it.


Emily J. Holubowich, MPP is the Senior Vice President, Cavarocchi Ruscio Dennis Associates, LLC. Emily joined CRD Associates in 2009 and has nearly 20 years of experience in health and fiscal policy, government relations, strategic communications, and coalition management. She has represented CSTE’s interests on Capitol Hill since 2013.

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