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Zika Virus: An Emerging Infectious Disease in the Western Hemisphere and an Emerging CSTE Response

Posted By Paul Etkind, CSTE Consultant, Saturday, June 30, 2018
Updated: Friday, June 29, 2018

The Zika Virus Preparedness Resources Toolkit is now available on CSTE’s website, with sections devoted to General Information, Epidemiology, Data Management, Laboratory Guidance, Maternal and Child Health, and more.

Zika virus was initially identified in Uganda in 1947. It made surprise appearances in the Pacific Island of Yap (Micronesia) in 2007, and then in other island groups in the Pacific in 2013. Reports of cases in Brazil began accumulating in March 2015. This was Zika’s first appearance in the Western Hemisphere. By May 2015, Brazil was reporting locally acquired cases. The Zika outbreak in the Western Hemisphere presented some surprising challenges as the case counts rose rapidly and the number of affected countries also increased at an alarming rate. An association with microcephaly among infants exposed in utero represented one of the initial surprises. The second was the suggestion, since confirmed, that this arthropod-borne virus could also be transmitted sexually. This second surprise, not seen before, was a potential game changer. Prevention and control was no longer limited to traditional adult and larval mosquito spraying, eliminating mosquito breeding habitats, and the use of repellants by residents. By February 2016, the World Health Organization (WHO) declared Zika virus disease to be a Public Health Emergency of International Concern.

Many U.S. territories reported local Zika transmission, then in July 2016, locally acquired cases of Zika were identified in Florida. Zika virus prevention and control was a national public health priority. The Council of State and Territorial Epidemiologists (CSTE) supported Zika preparedness and response activities for local, state, and federal public health partners. Activities included: placing three Zika fellows in health departments, supporting six deployments to Puerto Rico for Zika response, and coordinating response efforts between CSTE members and the Centers for Disease Control and Prevention (CDC). Supplemental funding from CDC through CSTE supported development of a toolkit of Zika-related tools that can be used to accelerate state and local public health preparedness planning and operational readiness.

The Zika Virus Preparedness Resources Toolkit, which is now publicly available on CSTE’s website, has sections devoted to the following topics: General Information, Epidemiology, Data Management, Laboratory Guidance, Maternal and Child Health, Vector Research and Management, Policy Statements, and an Appendix with definitions and explanations of acronyms used in the toolkit. Each section contains reference and educational materials along with forms and letters that can be adapted and used by other jurisdictions. CDC’s supplemental funding also supported five national “Zika: Notes from the Field” webinars, which focused on Case Surveillance, Mosquito Surveillance, Diagnostics, Strategies for Expanding Surveillance, and Control and Prevention Strategies. The recordings of these webinars are also available in CSTE’s Webinar Library.

This toolkit is intended to be a content resource for applied epidemiologists and their colleagues to save time and effort looking for sources or materials that they can use in developing their own prevention and control policies and strategies. The primary vector species, Aedes aegypti and Aedes albopictus, are already distributed across much of the United States. Viral spread is of greater concern. As we move forward, we hope applied epidemiologists and other public health professionals will find this toolkit useful in strengthening their jurisdiction’s vector-borne disease surveillance and control programs to not only prevent Zika virus disease, but also other mosquito-borne diseases as well.

For more information on CSTE’s Vector-Borne Diseases and Public Health Emergency Preparedness Subcommittee activities, contact Jordan Peart at

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Posted By CSTE, Thursday, June 7, 2018
Updated: Thursday, June 7, 2018

Are you ready for the #CSTE2018 Annual Conference in West Palm Beach? Here’s the rundown on how to get the most out of your experience:

1. Download the 2018 CSTE Conference mobile app prior to your arrival in West Palm Beach. Do this by searching the App Store or Google Play for “CSTE Conferences” or visiting on your mobile browser. Download the app for your tablet or smartphone, then filter and search through sessions on the agenda to create your custom daily Conference schedule. The app is updated regularly and allows you to download handouts, receive important announcements, see local info, connect with colleagues, and more!

2. The online agenda also has a useful, searchable index of sessions. Don’t miss out on the special events (Opening Reception, Early Career Professionals events, and more).

3. Get information on what weather-appropriate clothes to wear, shuttle information, walking directions, and maps on the Conference website. The weather in West Palm Beach will be hot, so be sure to bring a water bottle, sunscreen, insect repellent, and other items you’ll want to beat the heat.

4. CSTE is offering a variety of continuing education (CE) credits this year for physicians, nurses, health educators, veterinarians and those Certified in Public Health (CPH). For CME, CNE, CHES, and RACE there are a maximum of 12.5 hours eligible for only the conference workshops and plenary sessions. Only Certified in Public Health/CPH credits are available for all conference sessions. For questions, visit the Conference website or email Jessica Arrazola at

5. Familiarize yourself with the 2018 position statements, so you can give feedback according to your subject matter expertise. The full list of 2018 submitted position statements is available through member login on the CSTE website.

6. Are you presenting or moderating? Watch the presenter instructions and the moderator instructions YouTube videos!

7. Due to unforeseen circumstances, CSTE will no longer host the annual 5K Group Walk and Run scheduled for the morning of Tuesday, June 12, 2018. As an alternative activity, CSTE will host a sunrise yoga group session on Tuesday, June 12 at 6:30 am by the pool at the Hilton West Palm Beach. Please bring a towel and a water bottle – space for the yoga class is limited and will be available on a first-come, first-served basis.

8. Are you looking for more information on how to prepare? Read the FAQs on the conference website.

9. Share group photos of you and colleagues and interact with @CSTEconference on Twitter and on Facebook with hashtag #CSTE2018 to win gift cards and other giveaway prizes.

10. Check out the sponsored sessions to learn more about emerging software and services that are tailored to modern local, state, and federal epidemiologists’ needs.

11. Let us know what you think and how we can improve the CSTE Conference experience by completing the Annual Conference Evaluation – a link will be sent to attendees via email post-Conference. By completing the evaluation, you’ll be entered to win a $150 Amazon gift card or a free one-year CSTE membership.

We look forward to seeing you in West Palm Beach!

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Posted By Jeremy Arieh, Friday, May 11, 2018
Updated: Monday, May 7, 2018
Spring 2018 is in full bloom and CSTE’s National Office has added new staff members in recent months to support our ongoing work in applied epidemiology and public health. Please be sure to welcome the new members of our team when you have a chance, or stop in to meet many of them during the 2018 Annual Conference in West Palm Beach!

Michael Anderson
Michael earned a Master’s of Public Health in Epidemiology and a graduate certificate in Emerging Infectious Diseases from the University of Iowa College of Public Health. He has joined CSTE’s infectious disease team as a program analyst focused on the Hospital Acquired Infections portfolio. At the University of Iowa, Michael participated in research focused on parasitic infectious diseases; worked on a national vaccine trial for Leishmaniasis in canines; and wrote a manuscript about the tickborne disease anaplasmosis. He also conducted a CDC program evaluation and surveillance report surrounding an oral health pilot project for older adults in Iowa through the Iowa Department of Public Health. Apart from work, Michael enjoys community engagement through local volunteer efforts, social activities with friends, and exploring the great outdoors.

Danielle Boyd
Danielle Boyd is CSTE’s program analyst for the injury portfolio, where she oversees numerous injury workgroups and partnerships. She has helped the workgroups examine injury surveillance indicators and helped design technical assistance projects to aid states in refining their injury programs. Danielle served as a CDC Public Health Advisor from 2015-2017. She was detailed to the Toledo-Lucas County Health Department where she worked on projects related to infectious disease case management, outbreak reporting, disease surveillance, health education, and opiate-related overdose. Notably, she played an integral role on the team that designed the department’s prescription drug misuse and harm reduction program.

Danielle earned her Master’s of Public Health from Saint Louis University, and her undergraduate degree from DePauw University. In her free time, she enjoys reading and traveling.

Michelle Brown
Michelle graduated with a Bachelor of Arts in Classics and Anthropology from the University of Arizona in 2001, with concentrations in art architecture and anthropology. From 2001-2012, she lived in Oceanside, CA working in the hospitality and food industries before moving back to Atlanta in 2012. In 2015, Michelle joined Talenti Gelato as a distribution coordinator. In April 2017, she joined CSTE for the spring and summer assisting Workforce and Fellowship as staff support and in August 2017 was hired as a Program Assistant. When she’s not working, Michelle enjoys photography, building LEGO architecture models, art, spending time with her son, playing video games, and reading.

Robert Carroll
Robert Carroll is CSTE’s Web Application Developer and the newest addition to the IT/operations team. He previously worked for MDT Software and has more than six years of experience in web design and software engineering. He is a graduate of Columbus State University with a BS in Computer Science. Rob was born and raised in Atlanta, and in his free time, he and his wife enjoy reading, traveling and taking in UGA and Atlanta Falcons football games.

Matt Cone
Matt Cone joined CSTE last spring as Marketing & Communications Coordinator to help bolster the communications department. Matt’s background is primarily in graphic design and video, but he also holds an MPH from Emory’s Rollins School of Public Health with a focus on health communications. Before coming to CSTE, Matt worked as in-house creative at public relations firm Porter Novelli, and as an interactive communications developer at Emory University. He is a lifelong resident of Atlanta, and enjoys hiking, photography, and silly Photoshop requests for friends.

Mimi Huynh
Mimi Phan Huynh is a Program Assistant at CSTE. Mimi was born and raised in Atlanta, GA and attended the Georgia Institute of Technology, where she received a Bachelor of Science in Psychology in 2015. After graduation, she focused on leading her youth group of over 1,000 students between the ages of 5 and 18, involving them in various community service projects around metro Atlanta. A year later, she began her pursuit of a Master of Public Health degree in Epidemiology at the Rollins School of Public Health at Emory University. Mimi joined CSTE in 2017 as an intern, and following her graduation this May she will join the Infectious Disease team as a Program Analyst.

Maria Israel
Mia Israel is a Program Assistant at CSTE. Mia grew up in Knoxville, TN and attended the University of Tennessee, where she received a Bachelor of Arts in Political Science and a Bachelor of Arts in Global Studies with a concentration in Politics and Economics in 2013. After graduation, she accepted a position with Teach for America in rural Arkansas, where she lived and worked for three years teaching high school math and coaching new teachers. After getting married in 2016, Mia moved to Atlanta, GA to pursue a Master of Public Health degree in Behavioral Sciences and Health Education at the Rollins School of Public Health at Emory University. Mia joined CSTE in 2016 as an intern. She is excited to graduate with her MPH this May and transition into a full-time position with CSTE as a Program Analyst on the Substance Use and Injury team.

Shaily Krishan
Shaily Krishan joined CSTE in 2017 as a Program Analyst with the Surveillance and Informatics team. She currently supports the RCKMS and NMI portfolios, and the activities of the Surveillance Practice and Implementation Subcommittee. Shaily obtained a Master’s of Public Health, majoring in Behavioral Sciences from the Rollins School of Public Health at Emory University, and is currently completing her Certificate in Public Health Informatics at Rollins. Prior to joining CSTE, Shaily worked on several research projects at Emory University, and has experience in research project management, data management, and statistical/ geospatial data analysis.

Kiara Maddox
Kiara joined CSTE in 2017 as the Workforce and Fellowship Coordinator managing much of the Applied Epidemiology Fellowship (AEF) program. She earned her undergraduate degree in Biology from Spelman College and Master’s Degree in Public Health from Emory University. Prior to CSTE, she worked as a CDC Public Health Associate at the Tennessee Department of Health, where she focused on vector-borne disease surveillance and monitoring, as well zoonotic and foodborne diseases. She also spent much of her public health career conducting infectious disease research. For two years, she worked as a researcher on Emory University School of Medicine’s Women’s Interagency HIV Study. In her free time, Kiara enjoys spending time with her family and friends, as well rooting for the New Orleans Saints.

Hayleigh McCall
Hayleigh McCall is a two-time alumna of the University of Georgia – she holds a Bachelor of Science in Microbiology and Psychology and a Master’s of Public Health in Epidemiology. Following graduation, she worked at CDC’s National Center for Environmental Health as an ORISE fellow, where she focused on environmental health emergencies, disaster risk reduction, and drought-related health effects. Hayleigh is excited to continue her interests in environmental health epidemiology as Program Analyst for CSTE’s Environmental Health and Health Disparities portfolios. In her free time, Hayleigh enjoys playing with her Pomeranian Zambini, going to comedy shows, and spending her weekends in Athens for UGA football games.

Jackie McClain
Jackie McClain is excited to return to CSTE as Senior Grants Manager. From 2003-2006, Jackie was a Senior Research Analyst for CSTE’s Environmental and Occupational Health Program and the Fellowship Coordinator for the inaugural year of CSTE’s Applied Epidemiology Fellowship Program. After leaving CSTE, Jackie worked as a contractor for CDC’s National Center for Health Marketing's Health Communication Science Office, where she was responsible for partnership development and management of cross-agency projects. Jackie then joined the federal government as a Health Communication Specialist for the National Center for Immunization and Respiratory Disease, where she managed the childhood immunization communications campaign. Most recently, Jackie was a health communications consultant to CDC, first to the National Center for Emerging and Zoonotic Infectious Diseases and then to the National Center for Birth Defects and Developmental Disabilities. Jackie completed her MPH at the Rollins School of Public Health and has a BS from Rutgers University.

Elandis Miller
Elandis Miller is a two-time alumna of the University of Georgia, holding a Bachelor’s of Science in Biology/Pre-Pharmacy and a Master’s of Public Health in Epidemiology. Elandis joined CSTE as the Senior Evaluation Program Analyst in 2017 with over seven years of experience in evaluation and 10 years of experience in public health. She previously worked at the Georgia Department of Public Health as an epidemiologist, serving as the data manager for the Ryan White Program. Prior to this, Elandis worked at an evaluation research firm where she started as a social epidemiology intern and grew to lead and work on evaluation teams for federally funded and local initiatives and programs. She also has experience in evaluation capacity building, grant writing, program development, organizational effectiveness, technical assistance provision, quality improvement, and data management.

Jordan Peart
Jordan is originally from Jamaica and attended Harvard University, where she received a Bachelor of Arts in Human Evolutionary Biology and Minor in Global Health and Health Policy. She began her public health career as a CDC Public Health Associate at the Dallas County Health and Human Services, focusing on STD/HIV and infectious disease epidemiology. Jordan also worked as a CDC Preparedness Field Assignee at the Massachusetts Department of Public Health. She recently completed her MPH in Global Epidemiology at the Rollins School of Public Health at Emory University. In her free time, Jordan enjoys cooking, DIY projects, and spending time outdoors.

Shelia Scott
Shelia Scott has joined CSTE as the Controller on the accounting team, overseeing the general accounting operations. Shelia is a CPA with more than 20 years of public, private and non-profit accounting experience that will serve her well in her new role. Throughout her career, she has provided a wide array of accounting services for many prominent companies and non-profit organizations, including Leer Truck Accessory Centers, Elizabeth Baptist Church, American Cancer Society, Mattress Firm, BellSouth, HJ Russell & Company and United Way. Shelia holds a bachelor’s degree in accounting from Southern University at New Orleans. She enjoys reading books with her book club, attending outdoor concerts, spending time at the beach and traveling.

Sunbal Virk
Sunbal Virk joined CSTE’s Finance Team in 2017 as Grants and Contract Specialist II. She previously worked in a variety of contract and legal settings in both the public and private sectors. During her time at Ohio Northern University for her JD/LLM degree, she worked on a USAID-funded project in Iraq [Iraq Access to Justice (IA2J)] providing legal access to Iraqi minorities. She joins CSTE from Infor Global Solutions where she was responsible not only for negotiating and drafting contracts, but also successfully managing them from start to execution, and establishing procedures that streamlined the contract life cycle. In her free time, Sunbal enjoys challenging herself and discovering new interests and hobbies.

Song Xue
Song Xue joined CSTE as Program Analyst for Occupational Health and is the staff lead for WestON and SouthON. Song holds a Masters of Public Health from Emory University’s Rollins School of Public Health, and a Bachelors in Biological Sciences from the University of Pittsburgh. Prior to joining CSTE, Song interned at CDC CSELS DHIS working on a project to standardize and streamline their reportable disease program messaging systems and to standardize state eICR on a number of reportable conditions. Song also interned at the Georgia Department of Public Health, working on Hepatitis C surveillance within the state. Prior to obtaining his MPH, Song developed valuable skills in project management, team management, and budgeting at a start-up firm in Pittsburgh.

Michael Young
Michael Young became part of the CSTE family in 2017 when he joined the IT Team. He has worked in the IT field for three years. He enjoys working with computers and other electronics. Michael graduated from the University of South Carolina with a Bachelor’s in Business Administration. He has had exciting careers working in management, finance and IT. Some of his notable positions include Financial Advisor, Stock Trader and Bookstore General Manager. He currently holds two IT certifications from CompTIA and is working on a third.


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Announcing the #CSTE2018 Mann Memorial Lecturer & Plenary Speakers

Posted By CSTE Staff, Wednesday, April 25, 2018
Updated: Wednesday, April 25, 2018
Untitled Document
We are pleased to announce an exciting and diverse lineup of speakers for the 2018 CSTE Annual Conference, June 10-14, 2018 in West Palm Beach, Florida. Our 2018 speakers include Jonathan M. Mann Memorial Lecturer Eric Klinenberg, Professor of Sociology and Director of the Institute for Public Knowledge at New York University, author and scholar. This year’s Plenary sessions focus on the topics “Addressing Health Disparities at the Local Level” (Monday, June 11), “How to Tell Our Story” (Tuesday, June 12), and “Populations: A New Look” (Wednesday, June 13). Our 2018 speakers will share their perspectives on applied public health epidemiology, with a focus on this year’s conference theme - “Let the Sun Shine: Using Data to Weather the Storms.” Please take a moment to view all of the 2018 speakers below.

Jonathan M. Mann Memorial Lecture

Eric Klinenberg - Professor of Sociology and Director of the Institute for Public Knowledge

Monday Plenary - Place Matters: Addressing Health Disparities at the Local Level

Eric C. McDonald - Medical Director, Epidemiology and Immunizations Services Branch, Public Health Services, County of San Diego Health and Human Services Agency

Sonia Angell - Deputy Commissioner New York City Department of Health and Mental Hygiene

Tuesday Plenary - How to Tell Our Story

William Schaffner - Professor of Preventive Medicine in the Department of Health Policy as well as Professor of Medicine in the Division of Infectious Diseases at the Vanderbilt University School of Medicine

Sandra Mullin - Senior Vice President, Policy, Advocacy, Communication Vital Strategies

Wednesday Plenary - Populations: A New Look

Letitia K. Davis - Occupational Health Surveillance Program Massachusetts Department of Public Health

Carol Brady - Project Director for the Florida Maternal, Infant and Early Childhood Home Visiting Program

Continuing Education for Attendees
This year, CSTE has partnered with APHA and NBPHE to provide continuing education (CE) to Annual Conference attendees. We anticipate offering CE for doctors, nurses, health educators, veterinarians, Certified in Public Health (CPH) and general practitioners. Registration for CPH is now available as part of conference registration. Approval is pending for other types of CE with more details to come.
To learn more, visit

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Posted By Liljana Baddour, MPH and Martin A. Kalis, MA , Friday, April 13, 2018
Updated: Friday, April 13, 2018

This blog was shared with CSTE for publication by CDC's National Center for Environmental Health.

 About 1 in 9 Americans get their drinking water from a private well. We cannot ignore the importance of keeping drinking water safe to prevent needless morbidity and mortality.

The Association of State and Territorial Health Officials (ASTHO) 2016 Profile Survey found that 52 percent of state health agencies offer private water supply safety services, such as well testing and education on well maintenance. So what can you do to strengthen your jurisdiction’s ability to prevent illness from unsafe drinking water? CDC and their partners have produced a new online learning series for health departments to improve their private safe drinking water programs.

The Safe Water Program Improvement e-Learning Series (SWPI) is designed for health department staff to strengthen services to people who use wells, cisterns, springs, and other private drinking water systems not covered by the Safe Drinking Water Act. Participants have access to nine no-cost SWPI courses in the series.

Using the 10 Essential Environmental Public Health Services and the Environmental Public Health Performance Standards, SWPI provides examples of using each essential service to identify and fill gaps in drinking water programs.

Continuing education units are available from the National Environmental Health Association upon completing the courses and final evaluation.

Through SWPI course content, case studies, scenarios, and sample plans, find the resources your health department can use to improve safe drinking water in your jurisdiction. Enroll in SWPI today or share this blog with someone from your health department or partner agency who could use this training to improve water programs in your jurisdiction.

SWPI was developed by CDC, the National Network of Public Health Institutes, Texas Health Institute, Tulane University’s South Central Partnership Public Health Training Center, and the National Environmental Health Association (NEHA).

Liljana Baddour, MPH, is Senior Manager for Workforce and Education Initiatives at the National Network of Public Health Institutes (NNPHI), one of CDC’s core partners for SWPI. Martin A. Kalis, MA, is a Public Health Advisor with CDC’s Water, Food, and Environmental Health Services Branch and is a CDC co-lead for SWPI.

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Design and Implementation of the Minnesota Drug Overdose and Substance Abuse Pilot Surveillance System (MNDOSA)

Posted By Terra Wiens, MPH, CSTE AEF Class XV Fellow, Friday, March 9, 2018
Updated: Thursday, March 8, 2018

The recreational use of drugs and other substances is an emerging and important public health threat. In Minnesota, there was a 16% increase in fatal drug overdoses between 2015 and 2016. Similarly, non-fatal emergency department (ED) visits for opioid overdoses have been increasing steadily over the past 10 years. Since 2010, there have been at least four clusters of synthetic drug use in various communities in Minnesota. The burden that drug overdoses impose on health care systems is difficult to quantify. Many ED visits attributed to recreational drug use do not have a diagnosis of drug overdose, but have diagnoses of symptoms and signs related to substance abuse (e.g., altered mental status, acute respiratory failure, etc.). As such, these visits are not readily identified from typical data sources.

During the epidemiologic investigation of one of the aforementioned clusters, epidemiologists from the Minnesota Department of Health (MDH) discovered that identifying cases through chart review was impossible, as a wide variety of ICD codes were used. This cluster highlighted the need for a surveillance system to identify patients who present to the ED and/or are hospitalized for drug use or substance abuse.

In collaboration with key partners, MDH designed the Minnesota Drug Overdose and Substance Abuse Pilot Surveillance System (MNDOSA). This innovative surveillance system aims to: (1) determine the burden of overdose and substance abuse in Minnesota hospitals, (2) identify clusters of drug overdoses in near real time to provide situational awareness to stakeholders, (3) identify substances causing atypical clinical presentations, clusters, and severe illness and/or death, and (4) describe at-risk populations in order to focus and guide prevention efforts. MNDOSA is unique and novel as it collects real-time data rather than relying on data sources that have long delays in reporting, allowing for a near real-time response and notification of stakeholders.

This surveillance system combines reporting of drug overdose cases at three pilot hospitals, enhanced toxicology testing of clinical specimens, medical record reviews for a subset of patients, and the utilization of public health codes in medical records to monitor trends in drug and substance abuse and overdose in Minnesota. Active reporting includes real-time reporting to MDH of ED and in-patient admissions at the participating hospitals where the principal diagnosis is attributed to the recreational use of one or more of the following: Schedule I drugs, opioids (including prescription opioids, fentanyl or fentanyl analogs), synthetic, non-prescription drugs, prescription drugs, drug combinations, natural substances for recreational purposes, and other substances, including inhalants. ED visits and/or hospitalizations attributed to alcohol use alone are excluded from surveillance. Comprehensive data is abstracted from medical records for a subset of patients.

Clinical specimens for a small number of patients are submitted to the MDH Public Health Laboratory for enhanced toxicological testing. This testing is necessary because clinical specimens are often not obtained from non-fatal drug overdose patients in the ED. Additionally, hospital laboratory panels do not detect many of the new, synthetic drugs. The MDH Laboratory has the capacity to detect a vast array of prescription, illicit, and designer drugs. Laboratory results are used for surveillance purposes only, and the results will enhance understanding of the drugs/substances circulating in Minnesota.

In addition to active reporting, this surveillance incorporates an informatics-based, passive approach. Public health codes will be assigned to patients’ medical record for ED visits and hospitalizations attributed to the recreational use of the aforementioned drugs/substances, allowing MDH to monitor trends and patterns in drug/substance use and overdose in Minnesota.

Surveillance started in November of 2017 with plans to continue until December 2020, at which time the feasibility of continued surveillance will be assessed. MNDOSA is supported in part by funding from CSTE. The lessons learned thus far include:

  • Capacity to report patients varies by ED – this pilot explores multiple methods of both active and passive reporting to assess feasibility and determine the best method of reporting
  • Ability to utilize the electronic medical records to flag clinical specimens for submission to the MDH laboratory or assign public health codes to the chart also varies by site
  • Some ED staff have concerns about reporting identifiable data on patients likely engaged in criminal activity (i.e. illicit drug use), which we addressed by agreeing to eliminate identifying information from the data as soon as possible
As the burden of recreational drug and substance use and abuse continues to increase nationwide, advancing our understanding of this epidemic is imperative. The Minnesota Drug Overdose and Substance Abuse Pilot Surveillance System will track drug overdoses and substance abuse resulting in ED visits at participating hospitals and ultimately give public health officials a better understanding of the rapidly-changing landscape of recreational drug overdose and substance abuse in the state.

(Image: Poster created by Elly Pretzel at MDH with input from Poison Center in response to the investigation of synthetic drug use in 2013).

Terra Wiens is a CSTE Class XV AEF Fellow at the Minnesota Department of Health. Her fellowship focus area is Behavioral Health. The fellowship is supported by CDC Cooperative Agreement Number 5U38OT000143.

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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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CDC and CSTE Collaborate, Train Future MMWR Authors

Posted By Sonja A. Rasmussen, MD, MS, Editor-in-Chief, Morbidity and Mortality Weekly Report (MMWR), Friday, October 27, 2017
Updated: Friday, October 20, 2017

This past spring, CDC and the Council of State and Territorial Epidemiologists (CSTE) joined forces to co-host an intensive writing training series for the Morbidity and Mortality Weekly Report (MMWR). Led by MMWR Executive Editor Charlotte Kent, PhD, MPH and CSTE Senior Program Analyst Jessica Arrazola, DrPh, MPH, CHES, the workshop was designed to increase the number of quality submissions from state, territorial, local, and tribal (STLT) health agencies and to train junior authors, strengthening their capacity to write reports appropriate for publication in MMWR.

CSTE was a natural partner for this initiative, as CSTE outlined the need for scientific writing training specific to MMWR in a special report. It was this report that also prompted the development of a toolkit of scientific writing resources for public health practitioners.

Dr. Kent and our MMWR team conducted three webinars, which were open to the public. The webinars provided an overview of MMWR and focused on cross-cutting skills and strategies for writing for scientific publications. The recorded webinars were well-attended, attracting 200 participants per webinar session. The success of this effort confirmed that there’s broad interest in writing for MMWR as well as the need for scientific writing guidance among STLT staff.

In addition to the webinars, MMWR and CSTE identified 21 junior STLT authors, selected through a competitive application process, to attend a two day in-person training. These novice authors were paired with an experienced author for mentorship and assistance in the development of an MMWR submission. In addition to Dr. Kent and myself, workshop mentors included: Paul Etkind, DrPH, MPH; John S. Moran, MD, MPH; Paul Z. Siegel, MD, MPH; and Rich Vogt, MD. The in-person training allowed for peer-to-peer feedback about their draft manuscripts and covered important topics such as engaging the media, social media outreach, and legal and ethical implications of publishing public health data.

I had the privilege of serving as mentor to Maureen Leeds, MPH, an epidemiologist for the Minnesota Department of Health. Today, MMWR is pleased to publish the first of the novice STLT authors’ manuscripts titled, “Timeliness of Receipt of Early Childhood Vaccinations Among Children of Immigrants — Minnesota, 2016,” which was written by Maureen.

"It was an honor to be accepted into this first training group, and I'm grateful for the support provided by CSTE and my CDC mentor. It's exciting to be published for the first time, especially in MMWR," shared Maureen.

Congratulations, Maureen! We look forward to publishing the work of all of our MMWR and CSTE trainees.

Photo caption: Maureen Leeds, MPH, (second from the left) and other workshop participants discuss opportunities for publishing in MMWR.

Photo caption: Dr. Charlotte Kent, MMWR Executive Editor, leads discussion of a case study about publishing in MMWR.

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2017 CSTE Student Scholar Carrie Clippinger – Highlights from the 2017 Annual Conference

Posted By Stephen Clay, Friday, October 20, 2017
Updated: Wednesday, October 18, 2017
CSTE President Joe McLaughlin, 2017 Student Scholarship winner Carrie Clippinger and Executive Director Jeff Engel.
Pictured: CSTE Vice President Joe McLaughlin, 2017 Student Scholarship winner Carrie Clippinger and Executive Director Jeff Engel.

Editor’s note: In spring 2017, CSTE awarded the second student scholarship to Carrie Clippinger, MPH of Pennsylvania. Carrie is a recent Penn State College of Medicine graduate looking to begin her career in epidemiology with a focus on substance use, mental health and suicide prevention. Carrie has written a blog on her experience as the 2017 CSTE Student Scholar.

I am honored to have been chosen as the 2017 recipient of the CSTE Student Scholarship. Attendance at the 2017 Annual Conference was especially exciting, as it was the largest gathering of applied epidemiologists in U.S. history. It was my first time visiting the host city Boise, Idaho, and I enjoyed exploring the friendly mountain desert city, known for its scenic trails and Basque culture.

Participating in such a large event has given me valuable perspective into the work of public health professionals. As a recent graduate, it was refreshing to see real world and cutting-edge application of epidemiological principles. Although insightful work was presented in every track, I was most drawn to discussions of mental health and substance use, which align with my professional work. The topic of the hour was opioids, and it was fascinating to learn how government epidemiologists across the nation – with vastly different authority and resources at their disposal – are tracking this epidemic with the tools available. Despite huge differences in how each agency tackled this problem, most presenters agreed that strong community cooperation was an integral component of their opioid epi work.

I was also particularly interested in discussions of suicide surveillance, a topic which I am heavily involved in rural Pennsylvania. Again, I was struck by the diverse range in epidemiologists’ ability to monitor suicides, the variance in relationships with community partners and coroners or medical examiners, and the creativity with which public health professionals across the nation are collecting and analyzing data on suicides and suicidality. There was a particular emphasis on the sensitive nature of the research, the need for flexibility to address localized concerns, and ethical considerations.

Idaho’s public health efforts were well-represented during a standout plenary on the state’s work with its refugee populations – the largest per capita of any state in the nation. I also enjoyed attending breakout sessions on public health law – a timely and impactful topic that inspired reflection on epidemiology’s role in protecting public health. Engaging presentations on climate change, tickborne disease, water supply infrastructure, and maternal and child health were also eye opening. On the whole, successful projects at the conference included novel research methods such as geomapping, the use of real-time data gathered through new technologies, and the use of syndromic data – demonstrating that epidemiology is not a static discipline. Across the board, projects showcased the power of epidemiology to adapt and innovate.

Networking with CSTE fellows and attendees was truly invaluable. Seeing and learning from the practical, meaningful work of epidemiologists from a wide diversity of career paths was a unique opportunity that holds great importance for me as a recent graduate. Thank you to everyone who contributed to the scholarship for making my attendance at the CSTE Annual Conference possible. The Student Scholarship will undoubtedly continue to be an influential experience for future recipients.

To donate to the CSTE Student Scholarship, visit

Tags:  workforce development 

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CSTE Welcomes 15th Class of Applied Epidemiology Fellows

Posted By Kiara Maddox, MPH, CSTE Workforce & Fellowship Coordinator, Thursday, October 5, 2017
Updated: Friday, September 29, 2017
CSTE is excited to welcome the 15th class of the Applied Epidemiology Fellowship (AEF) program with 25 new fellows.

Pictured: Class 15 AEF Fellows at Orientation in Atlanta (Photo credit: Robin Gaucher)

CSTE recently hosted the new fellows in Atlanta for a week-long orientation. The agenda featured faculty from CDC, CSTE, as well as current and former Applied Epidemiology Fellows. Topics included public health surveillance, outbreak investigations, use of data visualization, public health law, scientific writing, and hot topic sessions in HAI and opioids/substance use. Fellows also had the opportunity to network with their peers, fellow alumni, as well as CSTE and CDC staff working in their subject area.

Pictured: John Anderton, CDC Acting Associate Director for Communications Science, presents on Health Communications (photo credit: Matt Cone).

Fellows’ subject areas of placement this year include behavioral health, chronic disease, environmental health, infectious diseases, healthcare-associated infections, maternal and child health, infectious disease-quarantine, substance use, and a new area of infectious diseases with a Zika focus. At their host sites, fellows will work on surveillance systems and tools, conduct case investigations, build their communication skills, and participate in training, research and field activities designed to build their epidemiologic capacity.

Some expected projects of the fellows include:

  • Evaluation of the current surveillance system for coccidioidomycosis (Valley Fever) in Washington State, Mackenzie Fuller, MPH
  • Evaluating the identification and reporting of migrant workers among New York City’s TB population, Carley Perez, MPH
  • Critical evaluation of CJD (Creutzfeldt-Jakob Disease) surveillance program in Pennsylvania, Christina Butler, DVM, MPH
  • STD surveillance data for descriptive and analytical epidemiology, Kiara Diggins-Parker, MPH
  • Enhanced surveillance for Zika virus vectors, Stephanie McCracken, MPH
  • Evaluate the potential usefulness and validity of data from the National Survey on Drug Use and Health (NSDUH), Abby Hagemeyer, PhD, MPH
  • National Healthcare Safety Network catheter-associated urinary tract infection data validation, Lee Hundley, MPH
  • Evaluation of school- and home-based asthma programs, Grace Christensen, MPH

Since 2003, the CSTE AEF program’s mission has been to provide training and real-world experience to epidemiologists early in their careers. Since its beginning, 295 fellows have completed the program, and CSTE has placed fellows in 41 states and 19 local jurisdictions.

Congratulations to the new fellows!

If you are interested in hosting an AEF fellow at your agency in 2018 visit for more information or email The deadline to apply is October 20, 2017.

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