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6th Annual Disaster Epidemiology Workshop Highlights Partnerships

Posted By Jessica Wurster, Ashley Conley, and Michael Heumann, Friday, June 5, 2015
Updated: Friday, June 5, 2015

Dr. Redd gives the keynote address at the 2015 CSTE Disaster Epidemiology Workshop

CSTE, in collaboration with the Centers for Disease Control and Prevention (CDC), National Association for County and City Health Officials (NACCHO), and Safe States Alliance, recently hosted the 6th Annual National Disaster Epidemiology Workshop on May 13-14 in Atlanta, Georgia. The workshop convened epidemiologists from state, territorial, and local health departments across the country along with partners from CDC, other federal agencies, academic institutions, and non-governmental organizations. Over 70 people attended in person and over 50 people participated via live webinar. The theme of the workshop was “Stronger Together: Building Partnerships and Moving Disaster Epidemiology Forward.”

Dr. Stephen C. Redd, MD, RADM, Director of the Office of Public Health Preparedness and Response at CDC, was the workshop’s keynote speaker. He discussed strategies to improve the response to public health emergencies, focusing on four emergencies: Bird Flu (2005-2009), H1N1 (2009-2010), Ebola (2014-2015), and the Haiti Earthquake (2010). Dr. Redd emphasized the importance of planning, emergency operation centers, adaptability, and risk communication when developing preparations for emergency responses.

The CSTE Disaster Epidemiology Subcommittee provided an overview of its major activities and accomplishments during the last year. The workshop was recorded and is now available to stream on the webinar library. Many workshop presentations are available on the CSTE Disaster Epidemiology Subcommittee webpage. The workshop included the following five sessions:
  1. Global Disaster Epidemiology Response to Ebola: Utilizing Innovative Surveillance Approaches for Monitoring and Tracking Cases, Contacts, and Travelers
    • State and Local Preparedness Efforts for Ebola Response
    • Challenges and Triumphs: Georgia’s Ebola Active Monitoring System
    • Monitoring of Individuals with Risk of Exposure to Ebola Virus Disease — United States, November 3, 2014 – March 8, 2015
    • Ebola Response in Rural Liberia
  2. Surveillance During Disasters: Building Partnerships in the Use of Technology and Tools
    • Partnering to Enhance Electronic Death Registration for Disaster Analysis
    • Developing a Primer to Improve Public Health Surveillance during Disasters
    • Healthy Shelters – Shelter Surveillance Workgroup
  3. Exploring the Role of Research in Moving DE Forward — Initiatives from NIEHS and NIOSH
    • NIH Disaster Research Response (DR2) Project: A Model for Overcoming the Challenges
    • Texas One Gulf
    • View from NIOSH on Disaster Responder Safety and Health: ERHMS and the Disaster Science Research Initiative
  4. Strengthening Partnerships for Conducting Disaster Epidemiology
    • An Introduction to Poison Control in the 21st Century
    • Interprofessional Education and Collaboration; A response to a Disaster
    • Unaccompanied Children: Surge and Surveillance
  5. Innovative Approaches and Partnerships for Disaster Response to Recent Events
    • The Use of CASPER in Two Communities Affected by the 2014 South Napa Earthquake
    • The Colorado Flood Disaster: The Impact on a Small Community
If you have any questions or would like more information about the CSTE Disaster Epidemiology Subcommittee, please contact Jessica Wurster.
Jessica Wurster, MPH is an Associate Research Analyst at the CSTE national office. Ashley Conley, MS, CPH, CHEP is chair of the Disaster Epidemiology Subcommittee and works as an epidemiologist at the city of Nashua Division of Public Health and Community Services in New Hampshire. Michael Heumann, MPH, MA is a CSTE consultant with HeumannHealth Consulting LLC. To see workshop presentations and join the subcommittee, visit CSTE’s Disaster Epidemiology page.

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Ebola Response Epidemiologists Interview

Posted By Chad McCoull, Friday, May 29, 2015
Updated: Friday, May 29, 2015
Untitled Document

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CIFOR Releases 2nd Edition of the CIFOR Guidelines Toolkit for Foodborne Disease Outbreak Response

Posted By Dhara Patel, Thursday, May 21, 2015
Updated: Thursday, May 21, 2015

The Council to Improve Foodborne Outbreak Response (CIFOR) is a multidisciplinary collaboration of eight national associations and three federal public health agencies whose goal is to improve methods at the local, state, and federal levels to detect, investigate, control, and prevent foodborne disease outbreaks. These CIFOR member organizations represent epidemiology, environmental health, public health laboratories, and regulatory agencies involved in foodborne disease surveillance and outbreak response. The food industry is represented in the CIFOR Industry Workgroup. CIFOR identifies barriers to rapid detection and response to foodborne disease outbreaks and develops projects that address these barriers. More information about CIFOR can be found at www.cifor.us.

CIFOR released the Second Edition of the Toolkit for the Guidelines for Foodborne Disease Outbreak Response on April 16, 2015. The second edition of the toolkit has been developed to aid in the implementation of the Second Edition of the Guidelines for Foodborne Disease Outbreak Response, which was released in 2014. The toolkit is intended to further the ability of state and local health departments to understand the contents of the guidelines, to conduct a self-assessment of their outbreak detection and investigation procedures, and to implement appropriate recommendations from the nine chapters in the guidelines.

The toolkit walks public health practitioners through a series of worksheets divided into 11 focus areas. The focus areas are designed to help jurisdictions identify recommendations from the guidelines that would be most useful for their jurisdiction. The toolkit covers the most critical elements of outbreak response, guiding users through a range of activities, including: describing current activities and procedures, prioritizing CIFOR guidelines recommendations to address needed improvements, and finally, making plans to implement the selected recommendations.

Figure 1: Outbreak Response Tracks and Focus Areas
View and download the full Second Edition of the Toolkit for the Guidelines for Foodborne Disease Outbreak Response. If you and/or members of your organization or health department would like to request hard copies, please fill out this brief survey and provide an appropriate mailing address: https://www.research.net/s/QXKVPDH.

Dhara Patel, MPH is a senior research analyst at CSTE, leading infectious disease, food safety, preparedness, and more. For more information, please contact Dhara Patel, MPH, at CSTE at (770) 458-3811 or dpatel@cste.org. Please join the CSTE Food Safety Subcommittee to join the discussion and receive related updates and news.

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Meningococcal Disease Outbreak and Mass Vaccination at University of Oregon

Posted By Katrina Hedberg, Friday, May 15, 2015
Updated: Friday, May 8, 2015
Untitled Document

In early January 2015, a University of Oregon undergraduate student who lived off campus developed fever, hemorrhagic conjunctivitis, and a non-blanching rash, but no symptoms of meningitis. Blood cultures yielded Neisseria meningitidis, serogroup B. Lane County Public Health staff identified close contacts and arranged for antimicrobial prophylaxis.

Without prompt antibiotic treatment, meningococcal disease is essentially 100 percent fatal. Those who survive may have negative long-term health effects (e.g. hearing loss, loss of limbs, etc). Household members of cases have an attack rate 500 to 1,000 times higher than the general population.1 Even with antibiotics, the fatality rate among cases reported in Oregon during 2005 to 2014 was 8.5 percent.

Meningococci come in 13 flavors, called “serogroups.” Of these, serogroups B, C, and Y each cause about one third of cases in the United States.2 Quadrivalent polysaccharide and conjugate vaccines are available US to prevent disease caused by serogroups A, C, Y and W135. Since October 2014, the FDA has licensed two new vaccines that protect against serogroup B: Bexsero® (a two-dose series) and Trumenba™ (three doses).

Meningococcal disease has declined steadily in Oregon since its 1996 peak. It has declined in the United States over the past 20 years, to recent annual incidences 0.3 to 0.5 cases per 100,000 people.
This is in spite of carriage rates of 5 to 10 percent in many communities.3

Seventeen days after the first U of O case, another student developed signs of meningococcemia, the diagnosis of which was confirmed by blood culture yielding N. meningitidis, serogroup B. Again, Lane County Public Health worked with U of O to identify close contacts and arranged prophylaxis. No epidemiologic link between the two ill students could be identified. The day after the second student fell ill, a third U of O undergrad developed malaise and possible fever; a few days later this student was admitted to hospital where serogroup B meningococcemia was confirmed. An epidemiological link was identified with one of the earlier ill students, and again close contacts were given antimicrobial prophylaxis.

Two-and-a-half weeks later, a fourth student developed severe meningococcemia and died. CDC recommends that broader community vaccination be considered when ≥3 cases of infection by a single meningococcal serogroup have occurred within a three-month period, without direct epidemiological links between the cases, and yielding an attack rate of >10 cases per 100,000 in the community at risk.4 The lack of direct links between cases implies that the infection has escaped the ring of antimicrobial prophylaxis and signals risk to the broader group: the cat has gotten out of the bag.

Vaccines were offered to students at the Student Health Service and then through local pharmacies. The U of O arranged for vaccinators and undertook a mass vaccination campaign using Trumenba™ at the campus basketball arena March 2-6. Through the Student Health Service, Lane County Public Health, pharmacies, and the mass vaccination effort on campus, approximately 8,800 students were immunized. Despite school being in session, news of the event ubiquitous on campus, mass vaccination clinics, and incentives of free t-shirts, store gift cards, and, yes, even pizza, more than 13,000 students remained unvaccinated.

Two more cases of serogroup B meningococcemia have since been confirmed. Vaccination efforts continue, and as of 28 March, 9,193 students had been immunized — 42 percent of the 22,000 target group, which is the entire undergraduate population at the University.

Collaborative Effort

The overall response to this outbreak required close collaboration between the University of Oregon, Lane County Department of Health and Human Services, the Oregon Public Health Division, CDC, as well as local pharmacies. The challenge now is to ensure that students complete their vaccination series. Thankfully, no additional cases of meningococcal disease have occurred in U of O students since early March.
1. Hoek MR, Christensen H, Hellenbrand W, Stefanoff P, Howitz M, Stuart JM. Effectiveness of vaccinating household contacts in addition to chemoprophylaxis after a case of meningococcal disease: a systematic review. Epidemiol Infect 2008;136:1441–7.

2. CDC. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2013;62(RR02):1– 22.

3. CDC. Meningococcal disease. In: Atkinson W, Wolfe S, Hamborsky J, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases. 12th ed. Washington, DC: Public Health Foundation, 2011. p. 193–204.

4. CDC. Evaluation and management of suspected outbreaks of meningococcal disease. MMWR 2013;62(RR02):25–7

Katrina Hedberg, MD, MPH is state epidemiologist and state health officer at the Oregon Public Health Division. For information on CSTE’s work in this domain, see the 2014 position statement 14-ID-06 on meningococcal disease and join an Infectious Disease subcommittee, such as Vaccine-Preventable Disease.

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New Disaster Epidemiology Framework Published

Posted By Jessica Wurster, Friday, May 8, 2015
Updated: Friday, May 8, 2015
Untitled Document
With every natural or man-made disaster, there is a need for health data to make decisions, to allocate resources, and to provide situational awareness on the health of the affected community. Once integrated into the disaster management cycle, disaster epidemiology can provide the evidence base to inform and enhance response capability within the public health infrastructure. The Council of State and Territorial Epidemiologists (CSTE) in collaboration with the Centers for Disease Control and Prevention, National Center for Environmental Health (CDC/NCEH) has created a framework for the inclusion of disaster epidemiology in the disaster management cycle. The framework has recently been published in the American Journal of Public Health1 to assist practitioners at all levels in planning for and responding to emergencies.

Disaster epidemiology actions and the disaster management cycle
The framework includes methods such as rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations (such as risk factor analyses, health outcome studies and evaluations of interventions). These tools and methods can be practiced throughout the disaster management cycle and can provide actionable information for planners and decision-makers responsible for emergency preparedness, response and recovery. “Disaster epidemiology” (applied epidemiology for disaster settings) is being integrated into the public health response to disasters, and is providing the evidence base to inform and enhance response capability from the local to state and national levels of emergency response.
We invite you to read about this new framework, consider how your organization may integrate epidemiological methods into your disaster response efforts, and give us feedback if you have suggestions or tips on how to help partners collaborate on disaster epidemiology.
To access the article, please click here:

The Role of Applied Epidemiology Methods in the Disaster Management Cycle.
Josephine Malilay et al. Am J Public Health. 2014;
104:2092–2102. doi:10.2105/AJPH.2014.302010

The article was written by Josephine Malilay, PhD, MPH, Michael Heumann, MPH, MA, Dennis Perrotta, PhD, Amy F. Wolkin, DrPH, MSPH, Amy H. Schnall, MPH, Michelle N. Podgornik, MPH, Miguel A. Cruz, MPH, Jennifer A. Horney, PhD, MPH, CPH, David Zane, MS, Rachel Roisman, MD, MPH, Joel R. Greenspan, MD, MPH, Doug Thoroughman, PhD, MS, Henry A. Anderson, MD, Eden V. Wells, MD, MPH, and Erin F. Simms, MPH.

If you have any questions or would like more information about the CSTE Disaster Epidemiology Subcommittee, please contact Jessica Wurster.

Jessica Wurster, MPH is an associate research analyst at the CSTE national office. To learn more, visit CSTE’s Disaster Epidemiology page.

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New Report Makes Epi Writing Capacity Recommendations

Posted By Jessica Pittman, Wednesday, April 29, 2015
Updated: Tuesday, April 28, 2015
Untitled Document
Over the past year, CSTE has conducted an assessment on the scientific writing needs and trends for applied epidemiologists. Applied epidemiologists communicate complex public health information in writing with various audiences, including conference presentations and peer-reviewed manuscripts for journals. This work is done with varying degrees of preparation, mentoring, or resources. The CSTE Scientific Writing Workgroup as part of the Epidemiology Methods subcommittee facilitated data collection and the CSTE national office performed the data analysis. The Applied Epidemiology Scientific Writing Trends, Needs, and Recommendations, 2014 provides you with constructive recommendations to promote professional development focused on scientific writing skills.

Click here to read the Executive Summary and Full Report of the Applied Epidemiology Scientific Writing Trends, Needs, and Recommendations, 2014.

The results are grouped into four categories: scientific writing and publishing experience, barriers to scientific writing, facilitators to scientific writing, and desired tools and resources for scientific writing. Respondents almost exclusively had a master’s degree or higher level of education (94%), and 62% reported CSTE membership. Seventeen percent of respondents had worked in applied epidemiology less than two years, while 13% of respondents had worked in applied epidemiology for 20 or more years. More respondents worked at state health departments (64%) than local health departments (23%), with the remainder representing federal and tribal agencies and academia. A select few results are listed below:
  • Only 58% of respondents published work in the peer-reviewed literature as a job function.
  • State health department epidemiologists were nearly twice as likely to report that publishing their work was a requirement of a funding source as local health department epidemiologists.
  • Publishing among those with academic appointments (19% of the sample) was statistically more likely than among applied epidemiologists who did not have an academic appointment.
  • Just over half of the respondents reported having access to peer-reviewed literature (55%), oftentimes through academic appointments.
  • Organizational structure, resources, and competing demands provide a better understanding of perceived barriers to scientific writing with time to write being the most common barrier expressed by 68% of applied epidemiologists, though 28% report they receive some protected time for this task.
  • Facilitating factors that influence scientific writing in health departments included: supportive organizational culture; technical support including writers, editors and communication specialists; access to peer-reviewed literature; university partnerships and the option for electronic publishing.
  • Templates for general publications were requested by about half of participants.
  • Access to a mentoring network of experienced writers from state and local health departments was also similarly desired, and access to editors (46%) and access to technical writers (44%) were also suggested as helpful.
  • A journal club to encourage publishing and peer review was requested by two out of every five respondents.
Recommendations from the report encourage scientific writing among applied epidemiologists by: offering dedicated time to write, allowing epidemiologists to hold academic appointments, partnering with libraries or universities to ensure access to peer-reviewed literature, encouraging a supportive organizational culture to foster writing and publishing, and providing resources, such as manuscript templates, technical writers, editors, and journal clubs.

The results of the Applied Epidemiology Scientific Writing Trends, Needs, and Recommendations, 2014 will be presented by webinar on Thursday, May 21st at 1pm ET and will be subsequently archived on the CSTE Webinar Library. Register for the webinar at: https://cste.webex.com/cste/k2/j.php?MTID=t527e19346509124ae87f7253b281df5d


A roundtable discussion will be held at the 2015 CSTE Annual Conference on Monday, June 14, 2015 at 1pm. The roundtable will provide an opportunity to talk about what types of resources can be developed and prioritized to support applied epidemiologists’ scientific writing.

The Applied Epidemiology Scientific Writing Trends, Needs, and Recommendations, 2014 report was created as a result of the hard work of the Scientific Writing Workgroup: Michelle Housey, Sarah Marikos, Sarah Patrick, Jessica Pittman, Maayan Simckes, Mandy Stahre, Laura Tolmedi, and Jessica Wurster.

Jessica Pittman, MPH, CHES is Associate Research Analyst at the CSTE national office. To learn more about workforce capacity, read the recent Epidemiology Capacity Assessment reports for Chronic Disease, Maternal and Child Health, Environmental Health, as well as core needs in the epidemiology workforce.

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Electronic Health Record Incentive Program Supporting Public Health Outbreak Response

Posted By Janet Hamilton, Friday, April 24, 2015
Updated: Friday, April 24, 2015

Providers are sharing data more quickly with local health departments, and when disease is spreading quickly, time is important.

Electronic information sharing has been crucial to support our response to our current measles outbreak where we have identified four measles cases in two neighboring Florida counties so far. Historically, data shared from providers was mostly paper and usually took days to get into the hands of public health officials. Now the data is electronic and it is shared in almost real time. We are using our syndromic surveillance system to look for new measles cases that may not have already been reported; review our immunization registry to rapidly identify high priority contacts of the cases to target exclusions and offer disease preventing prophylactic treatment; and when suspected infections been identified, we are getting crucial confirmatory laboratory results back electronically right into our disease surveillance system within hours of results. The system is saving public health workers time and allowing us to do a better job protecting the community as we work to halt the spread of measles.

This shift (from paper to electronic information sharing) is due in large part to the American Reinvestment & Recovery Act (ARRA), which includes many measures to modernize our nation's infrastructure, one of which is the "Health Information Technology for Economic and Clinical Health (HITECH) Act.” The HITECH Act supports the concept of electronic health records - meaningful use [EHR-MU], an effort led by Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC). HITECH proposes the meaningful use of interoperable electronic health records throughout the United States healthcare delivery system as a critical national goal.

While bringing about national adoption for any federal program is a difficult endeavor, implementation of new EHR reporting is gaining widespread adoption. The EHR Incentive Program incentivizes eligible hospitals and other entities for meaningfully using health IT as well as reporting electronic data on three public health measures: (1) immunizations, (2) syndromic surveillance, and (3) reportable laboratory results. The program differentiates between eligible hospitals and eligible professionals, and the listing of stage 2 public health objectives for each are below.

Table1: List of the Stage 2 Meaningful Use Public Health Objectives

Eligible hospitals reporting these three measures have gained momentum over the course of 2014. New EHR Incentive Program data show that 72 percent of stage-2 hospitals reported on all three public health measures.

The ONC recently put out a data brief called Hospital Reporting on Meaningful Use Public Health Measures in 2014. The data are encouraging:
  • Almost nine in 10 stage 2 hospitals were able to electronically report to their immunization registry
  • Three quarters of stage 2 hospitals reported syndromic surveillance data electronically to their local public health agency
  • More than eight in 10 stage 2 hospitals submitted laboratory results electronically to their local public health agency

The brief goes on to project that as more hospitals shift to stage 2 in coming years, it can be expected that electronic exchange between hospitals and public health agencies will likely increase. The ONC data brief also found that when reporting was optional instead of mandatory, fewer hospitals shared public health data with local health department officials: “While almost three-quarters of stage 2 hospitals reported, without exclusion, on all applicable public health measures, only 5% of stage 1 hospitals did the same.” As hospitals and public health departments progress to interoperability, everyone will get better data in a more timely way. Sharing of data in standardized electronic formats will improve population health, help contain dangerous outbreaks more quickly and result in better patient care coordination.

Proposed MU stage 3 objectives, the third and final phase of the MU incentive program, is currently out for public comment. CSTE will be preparing comments through the Surveillance and Informatics Steering Committee. Please join us to help craft our response as well as consider submitting responses directly from your health department.

Janet Hamilton, MPH serves as the Surveillance/Informatics Steering Committee Member-at-Large on the CSTE Executive Board and Surveillance and Surveillance Systems Manager at the Florida Department of Health. To learn more about surveillance and informatics, please join a subcommittee.
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CSTE Partnerships That Lift Our Boat, and Others

Posted By Emily Holubowich, Sunday, April 19, 2015
Updated: Friday, April 17, 2015
Emily Holubowich, Senior Vice President at CRD Associates is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital. Emily also serves as the Executive Director of the Coalition for Health Funding and founding Co-Chair of the NDD United campaign, both of which CSTE supports.

A rising tide lifts all boats. This familiar phrase is especially true in the current political and fiscal environment, where macro policy decisions—made behind closed doors, by a handful of powerful lawmakers, in the eleventh hour—have dramatic effects on even the most micro policy priorities. Sequestration is probably the best example of this fact—or maybe, that a receding tide grounds all boats.

Between 2013-2021, sequestration’s harmful cuts shrink the amount of appropriated funding available for epidemiology, public health, and all core government functions by $1 trillion.

Between 2013-2021, sequestration’s harmful cuts shrink the amount of appropriated funding available for epidemiology, public health, and all core government functions by $1 trillion. During the last two years, we have experienced some temporary and partial sequestration relief, thanks to the Bipartisan Budget Act of 2013 negotiated by Rep. Paul Ryan and Senator Patty Murray. But sequestration returns full bore in 2016, and unless Congress acts to stop it, overall funding levels for appropriated programs, such as public health, will be 17 percent less than they were in 2010, in real terms. Under this scenario, it will be difficult if not impossible for any boats to rise.

For information about sequestration and its effects,
click here
for a primer from the Center on Budget and Policy Priorities.

When there’s more health funding to go around, the better the chances that our own health funding priorities—ELC grants, workforce development—do well, and vice versa (case in point: the elimination of $15 million in public health workforce funding in 2013 when sequestration first took effect). That’s why for many years CSTE has augmented our advocacy efforts to keep our own epi boat afloat by joining with our partners in the community to ensure a strong and sustained investment in health funding, writ large.

Celebrating its 45th year, the Coalition for Health Funding is the leading voice for a strong and sustained investment in the health continuum—from public health to health research and primary care services to health workforce. CSTE and 95 other national health organizations, including Association of State and Territorial Health Officials (ASTHO), National Association of County and City Health Officials (NACCHO), and Society for Healthcare Epidemiology of America (SHEA) among them, work through the Coalition to educate lawmakers about the value of health programs and the impact of funding cuts. In July 2014, CSTE contributed a story about the erosion of ELC funding for vector-borne disease surveillance to the Coalition’s report, Faces of Austerity: How Budget Cuts Hurt America’s Health. The report was shared with and has been used by lawmakers, the administration, and the media. Our story and those of other Coalition partners are available at www.cutshurt.org.

CSTE also actively participates in the Coalition’s NDD United campaign, named by The Hill newspaper as one of the “Top 10 Lobbying Victories of 2013.” NDD United is an alliance of thousands of national, state, and local organizations working across sectors to stop sequestration and protect nondefense discretionary or “NDD” programs. NDD programs are core functions the government provides for the benefit of all Americans—benefits such as public health and education, housing and social services, infrastructure and transportation, science and law enforcement, veterans services and homeland security, energy and natural resources, etc. On February 18, CSTE joined 2,100 other organizations in signing a letter coordinated by NDD United, urging Congress to stop sequestration before it returns in 2016. A copy of the letter is available here.

CSTE will continue to advocate for an end to sequestration, and for a strong and sustained investment in the nation’s disease surveillance infrastructure. For more information about these and other efforts, please contact me at eholubowich@dc-crd.com.

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Mass Gathering at Sturgis: Preparedness, Surveillance and Whiplash

Posted By Lon Kightlinger, Friday, April 10, 2015
Untitled Document
South Dakota’s population will double this coming August—but the risk to public health will quadruple. The Sturgis Motorcycle Rally happens every year in the Black Hills of South Dakota attracting about 500,000 rally-goers. But this year, 2015, marks the rally’s mythical 75th anniversary and over a million Harley-stomping pilgrims are expected. Although not nearly as massive as India’s Kumbh Mela gathering, the Sturgis Rally presents vast challenges to public health surveillance and response.

Sturgis (normal population 6,600) is situated where the prairie’s endless horizon meets the Black Hills, sacred to the Lakota Sioux, home to Mount Rushmore and Crazy Horse monuments, and the winding roads cyclists love. South Dakota is a rural, conservative, no-frills state that welcomes the annual boisterous mass gathering of rumbling, kick-back fun. Rally-goers come from all over the world, including far-off, exotic places like California and Pennsylvania. Catering to the million motorcyclists is an army of temporary food and drink vendors, mechanics, ad hoc camp grounds, tattooists, musicians, masseuses and more, much more. Although most rally-goers are mild-mannered gentlefolks on their home turf, while in Sturgis they let their inner Easy Rider rage for the week-long party.

The South Dakota Department of Health recognizes the risk to public health a million raucous guests might encounter: summer heat, tainted food, West Nile mosquitoes, clunker drugs, excessive Natty Ice, prairie wind storms, bothered rattlesnakes, condom scarcity, daredevil cyclist traumas, no helmet laws, 80 mph speed limits, porta-potty insufficiency, forest and prairie fire alerts, contaminated water in campgrounds that are normally cattle pastures, and old men doing things not even young cowboys should attempt.

For some this is a week of grand cycling in the Wild West, but for us in public health it is an epidemiologic OK Corral. Before and during the rally we sample, test, and enforce drinking water standards; inspect and license food venders, tattooists, and body piercing artists; implement intensive disease surveillance; activate a mobile laboratory; maintain redundant communication channels; participate in the rally emergency operations center; monitor disease cases, syndromes, hospital beds, emergency department traffic, blood supply, and morgue space; and spray for mosquitoes. The capacity of the Department of Health is stretched and local health care is overextended, as are roads and normal infrastructure.

Surveillance and response networks have been long established and work well, but the glut of accidents, cases and sudden health events engulfs and strains the disease reporters and coders in the healthcare system so that even electronic syndromic surveillance triggers are less reliable. Disaster epidemiology tools used during floods, blizzards and tornadoes need to be enhanced and envisioned for a highly mobile, raucous, wittingly uncooperative crowd who would simply not allow an outbreak of diarrheal disease to disrupt the revelry.

Lon Kightlinger, MSPH, PhD is state epidemiologist at the South Dakota Department of Health.

Learn more about the various epidemiologic domains impacted by massive events, such as the Sturgis Rally, by joining a subcommittee in Surveillance and Informatics, Occupational Health, Injury, and Infectious Disease.

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Dr. Paul Farmer to Speak at Annual Conference

Posted By Alfred DeMaria, Jr., Tuesday, April 7, 2015
Updated: Thursday, April 2, 2015

For the 2015 Annual Conference, CSTE is pleased to announce Dr. Paul Farmer as the Jonathan Mann Memorial Lecturer. Dr. Farmer obtained an M.D. and Ph.D. in anthropology from Harvard University, and is board certified in internal medicine and infectious diseases. He is the co-founder of an international social justice and health organization, Director of Partners in Health,  and is renowned for his years of nonprofit leadership, numerous awards, and insightful publications on global health. Read Dr. Farmer’s biography on the conference website.

We are also pleased to announce the following plenary speakers:
  • Mary T. Bassett, MD, MPH: Commissioner of the New York City Department of Health and Mental Hygiene
  • Devra Lee Davis, PhD, MPH: Founding Director of the world’s first Center for Environmental Oncology and President of the Environmental Trust
  • Richard Jackson, MD, MPH: Professor of Environmental Health Sciences at University of California, Los Angeles and former Director of the CDC National Center for Environmental Health
  • Anne Schuchat, MD: Director of the CDC National Center for Immunization and Respiratory Diseases and Assistant Surgeon General of the United States Public Health Service
  • Nancy Krieger, PhD: Professor of Social Epidemiology at Harvard University
  • Pardis Sabeti, MD, DPhil: Associate Professor at the Center for Systems Biology at Harvard University
The 2015 Annual Conference in Boston will span four days with 240 sessions on emerging topics. Some of this year’s topics include:
  • Advanced molecular detection to improve food safety
  • Respiratory diseases, Chikungunya, measles, shigellosis Enterovirus D68, and Ebola
  • Health impacts for 9/11 rescue and recovery workers
  • Maximizing the benefits of advances in informatics
  • Marijuana-associated hospitalization rates and usage surveys
  • Novel approaches to collecting data with hard-to-reach populations
  • Addressing the challenges of Hepatitis C surveillance
  • Climate change and environmental impacts on disease
  • Addressing quality of life in older adulthood

In addition to the wide array of rapid-fire, breakout, and plenary sessions, you’ll have the opportunity to participate in a variety of activities. Conference festivities include the opening reception, connections reception, and 5K walk/run. There is also a banquet at additional cost. CSTE will present awards for outstanding leaders, partners, fellows, mentors, poster presentations, and more.

This year’s conference features a new phone app to help you schedule sessions, connect to other attendees, see conference news alerts, access an interactive floorplan, and learn local information for restaurants and activities around the Hynes Convention Center.

If you register for the conference before May 1, you can receive the early-bird discount. If you aren’t already a member, joining CSTE will allow you to get the most out of the conference experience, develop your professional capacity, network, and more. The many benefits of yearlong membership are highlighted in this new video:

CSTE Members Lead Change

CSTE members are change makers, thought leaders, and bridge builders. Discover the opportunities that CSTE membership gives you to make waves. Become a CSTE member today and save on conference registration: http://bit.ly/1HrYoDm

Posted by Council of State and Territorial Epidemiologists on Friday, April 3, 2015

https://www.facebook.com/video.php?v=1040282089318703 (Please watch in HD)



CSTE President Alfred DeMaria, Jr., MD is state epidemiologist of Massachusetts. For more information about the 2015 CSTE Annual Conference, please visit http://www.csteconference.org.


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