CSTE logo
This website uses cookies to store information on your computer. Some of these cookies are used for visitor analysis, others are essential to making our site function properly and improve the user experience. By using this site, you consent to the placement of these cookies. Click Accept to consent and dismiss this message or Deny to leave this website. Read our Privacy Statement for more.
CSTE Features
Blog Home All Blogs

A Mixed Bag for Public Health: Appropriators Favor Infectious Disease in Spending Legislation

Posted By Emily Holubowich, Friday, July 17, 2015
Updated: Friday, July 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 Holubowich provides an update on congressional activities at the recent CSTE Annual ConferenceThe week of June 22, both the House and Senate Appropriations Committees approved along party lines their respective spending bills for the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS). Starting from nearly $4 billion lower than the current, already austere funding level, the bills force draconian cuts in many programs to support increases in others. Each chamber took a slightly different approach to making these necessary tradeoffs—the House preferring big cuts to fewer programs (e.g., the Agency for Healthcare Research and Quality and Title X Family Planning, which were eliminated) and the Senate preferring to spread the pain more evenly. But in both chambers, it’s a mixed bag for public health and epidemiology.

To review, the president sought $7 billion for the Centers for Disease Control and Prevention (CDC) in FY 2016, a 2 percent increase that included $6.096 billion in base discretionary funding or “budget authority,” and $914 million in mandatory funds from the Affordable Care Act’s Prevention and Public Health Fund (PPHF). Together, this funding translated into increases for Emerging and Zoonotic Infectious Diseases (73 percent increase) and Public Health Workforce (29 percent increase) through which applied epidemiology fellows are funded.

The House Appropriations Committee grants the president’s request for CDC budget authority and PPHF, but the Senate provides CDC only $5.747 billion in budget authority (a $220 million cut compared to FY 2015) and $893 million in PPHF dollars.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) received a $107.6 million increase in the House and a $35.6 million increase in the Senate, both still less that the president’s significant, $294 million request. Within NCEZID, the new Combating Antibiotic-Resistant Bacteria or “CARB” initiative would receive $120 million from the House and only $30 million from the Senate, in each case much less than the president’s requested $264 million. We would expect much of the NCEZID funding, including CARB, to support core infectious disease surveillance capacity at state and local health departments through Epidemiology and Laboratory Capacity (ELC) grants, in addition to $40 million from the mandatory PPHF that the House and Senate both provide for the fifth consecutive year. Among our other NCEZID appropriations priorities, food safety, advanced molecular detection, and National Healthcare Safety Network are essentially flat funded—plus or minus nominal amounts—in the House and Senate.

The Public Health Workforce program, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, would also see flat funding of $52.2 million in both chambers and no supplemental PPHF funding. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but with flat funding of the program we might expect flat funding for our fellows. The president had requested a $15.2 million increase in budget authority, as well as $36.2 million in PPHF. Two years ago, Congress eliminated $15 million in PPHF dollars for Public Health Workforce in the wake of sequestration.

Funding increases in some areas such as CARB necessitated cuts to other public health programs. For example:

  • NCZEID’s “emerging infectious disease” program was cut by $11 million in the House;
  • The National Center for Chronic Disease Prevention and Promotion was cut by $100 million in the House and $146 million in the Senate;
  • CDC’s safe water program was zeroed out in the Senate and the environmental and health outcome tracking network was cut significantly in both chambers;
  • The childhood lead poisoning prevention program’s budget authority was zeroed out in both chambers (though both House and Senate do continue PPHF funding).

Given the political and fiscal environment, forward progress on Labor-HHS and other spending bills is expected to halt. The House leadership seems to have postponed floor action on appropriations bills after pro-Confederate flag amendment on the Interior and Environment spending bill caused a melee on the House floor last week. In the Senate, Democrats have vowed to filibuster all spending bills that come to the floor on the grounds that they lock in austere spending levels under sequestration. A continuing resolution to keep the government running on autopilot seems imminent come September 30. The question is whether or not it will be only for a limited period of time while Congress finalizes spending legislation before the end of the calendar year; or whether it will be for the full year if Congress determines there’s no path to a compromise on final appropriations language. And of course, the big question in Washington is will there or won’t there be a government shutdown come October 1. It’s too soon to tell, but the fact that budget experts are suggesting it—and lawmakers are already pointing fingers across the aisle to place blame—leads one to believe that a shutdown is more than a distinct possibility.

For more information about funding levels for your specific priorities, please click here for a copy of CDC’s detailed budget table.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

New Report Assesses State Activities in Non-Infectious Environmental Health Exposure Monitoring and Investigation

Posted By Jessica Wurster, Friday, July 10, 2015
Updated: Wednesday, July 8, 2015

CSTE is pleased to announce the release of the Assessment of State Activities in Non-Infectious Environmental Health Exposure Monitoring and Investigation report. The scope of state environmental health applied epidemiology activities in non-infectious conditions had never before been systematically assessed. Therefore, the Council of State and Territorial Epidemiologists (CSTE) in collaboration with the National Center for Environmental Health at the Centers for Disease Control and Prevention (CDC) undertook a national assessment to determine current processes for and experiences with the monitoring and investigation of environmental exposures and associated acute non-infectious health effects.

The purpose of this assessment is to better understand how these processes have been standardized in terms of response algorithms, case definitions, and investigation forms and protocols; how agencies store, share, and use this information; and how the activities are linked with related programs, such as occupational and injury epidemiology. The results demonstrate environmental health-related activities that are being successfully implemented in many health departments and can be used to build environmental health investigation and response capacity nationwide.

In total, 80.5 percent of the 56 requested agencies completed the assessment during the time span of December 2013 to March 2014. The report presents assessment data of 11 environment-related health conditions and nine types of environmental exposure events. Additionally, the assessment addresses whether syndromic surveillance has been used as a tool for environmental monitoring and response, the effect of the location of radiation control agency on radiation event reporting and activities, and resources and barriers to monitoring and response. To read the results of the report, click here.

The recommendations of the report are to:
  1. Focus on greater public dissemination of investigation results of case reports and exposure events.
  2. Develop a repository of procedures and tools used by the 35 jurisdictions that were willing to share these items, and make the repository available to all state and local health departments.
  3. Provide guidance on strategies for the monitoring of and response to non-reportable health conditions.
  4. Conduct within-agency training on current reporting requirements and practices.
  5. Promote the use of syndromic surveillance as a source for environment-related health conditions.
  6. Expand the current levels of national funding originating from the Environmental Public Health Tracking and the National Institute for Occupational Safety and Health at CDC.

The authors are:

Henry Anderson, MD, Wisconsin Department of Health Services
Kristina W. Kintziger, PhD, Florida Department of Health
Erin Simms, MPH, (Former) Council of State and Territorial Epidemiologists
Martha Stanbury, MSPH, Michigan Department of Community Health
Sharon M. Watkins, PhD, Florida Department of Health
Jessica Wurster, MPH, Council of State and Territorial Epidemiologists

If you have any questions or would like more information about CSTE Environmental Health programs, please contact Jessica Wurster.

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

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

CSTE Supports Antibiotic Resistance Stewardship

Posted By Marion Kainer and Jeffrey Engel, Thursday, July 2, 2015
Updated: Tuesday, June 30, 2015
Untitled Document

On June 2, 2015, the Council of State and Territorial Epidemiologists (CSTE) was one of 150 organizations invited to the White House Forum on Antibiotic Resistance. Representing CSTE was Dr. Marion Kainer, Tennessee Department of Health epidemiologist, and chair of the CSTE Healthcare Associated Infections Subcommittee.

Combatting antibiotic resistant bacteria (CARB) became a presidential priority when the National Strategy for CARB (URL ref. 1) was released in September 2014, and in 2015 President Barack Obama requested $1.2 billion of new funding to address the strategy in his FY 2016 federal budget. In this proposed budget, the Centers for Disease Control and Prevention (CDC) portion is $264 million, a line item that CSTE heavily advocated for during our Capitol Hill visit on March 25, 2015. The National Action Plan for CARB (URL ref. 2) was released in March 2015, a few days after the CSTE Capitol Hill visit.

The new CDC funding would go primarily to the Division of Healthcare Quality Promotion (DHQP) in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). Importantly for CSTE members, a portion of the new funding would establish antibiotic resistance and antibiotic use monitoring capacities in state and local health departments. Channeled through the Epidemiology and Laboratory Capacity grant, this capacity building would include a coordinating epidemiologist position and strengthened surveillance with healthcare providers using both the National Health Safety Network and the National Notifiable Diseases Surveillance System. The CSTE national office will benefit as well with expansion of the Applied Epidemiology Fellowship program to include workforce development in antibiotic resistance surveillance and antibiotic use monitoring.

To launch the CARB initiatives and encourage Congress to support the proposed funding, the Executive Office of the President hosted a White House forum. As part of the event, more than 150 food companies, retailers, and human and animal health stakeholders highlighted commitments to implement changes over the next five years to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

The forum started in the Eisenhower Executive Office (EEO) where it was announced that President Obama just signed a presidential memorandum directing federal departments to buy meats and poultry that have been raised using responsible antibiotic-use policies. The forum was opened by Dr. John Holdren, the Director of the Office of Science and Technology Policy, and included addresses by Health and Human Services Secretary Sylvia Burwell, Secretary for Agriculture Tom Vilsack, and CDC Director Tom Frieden. A-five member panel described commitments from their respective organizations; panelists included representatives from human health (acute care and long-term care), the animal health industry, Walmart, and Tyson foods. Walmart stated that in an effort to provide safe, affordable and sustainable food, they are asking meat producers, eggs suppliers and others to use antibiotics only for disease prevention or treatment and not for growth promotion. All five panelists stated that there was a very good business case for antibiotic stewardship. Dr. Jonathan Perlin (from the American Hospital Association and HCA) described the 5 “D”s of antimicrobial stewardship: right Diagnosis, Drug, Dose, Duration and appropriate De-escalation. A video of the opening panel can be found on the White House website.

The attendees were then split into the animal health sector that remained in the EEO and the human health sector group that relocated to the Cash Hall of the Treasury Building. We walked past the West Wing, cut through the North Side of the White House (through areas labeled “no tours beyond here”). The rest of the day was spent in four sessions (each with three panelists) moderated by CDC staff: hospitals (Dr. Arjun Srinivasan), outpatient use (Dr. Lauri Hicks), long term care (Dr. Nimalie Stone) and diagnostics (Dr. Jean Patel). Panelists included Kaiser Permanente and CVS. Both described their use of health information technology to support appropriate antimicrobial use, making it easy for providers to make the right choice; each performed audits and provided provider-specific feedback. They leveraged basic interoperability and infrastructure that was encouraged through meaningful use. Strengthening IT infrastructure, including interoperability, audit, and feedback as well as decision support, was a common theme. Other themes from the day included:
  • Optimal use of data
  • The need for meaningful and valid measures
  • The importance of transparency
  • The ongoing need for better surveillance
  • Financial incentives
  • Better tools (especially diagnostics that communicated results not only to the provider at the point of care, but also to the electronic health records)
  • A need for a “culture change” in healthcare and education and training, including meaningful involvement of patients, families and consumers

Multiple attendees were able to ask questions of the panelists and share perspectives. The human face of antimicrobial resistance was highlighted by the attendance and comments of family members of patients who suffered and/or died from the consequences of antimicrobial resistance.

The CARB initiative is broad in scope, engaging the animal and human health enterprise, the public and private sector, and interventions from prevention to new drug development. CSTE is committed to be the voice for prevention and improved surveillance of antibiotic resistance and use as it affects human health; always at the cutting edge of program and workforce development in applied epidemiology for public health practice.

Marion Kainer, MD, MPH, FRACP, FSHEA is director of the Healthcare Associated Infections and Antimicrobial Resistance Program at the Tennessee Department of Health. Jeffrey Engel, MD is executive director of the Council of State and Territorial Epidemiologists. For more information about antibiotic resistance, please visit CSTE’s Infectious Disease Steering Committee page.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

The Road to a Resource for Applied Chronic Disease Epidemiologists

Posted By Annie Tran, Friday, June 26, 2015
Updated: Friday, June 26, 2015
Untitled Document

In June 2015, CSTE released a new resource to help orient chronic disease epidemiologists them to the changing demands of state public health.As was found in the Chronic Disease module of the 2013 Epidemiology Capacity Assessment (ECA), only 16 percent of chronic disease epidemiologists (CDEs) at state health departments had “some epidemiology coursework.” This number is a decrease from the 2009 ECA showing only 25 percent of practicing CDEs had previous epidemiology coursework. 2009 data also show nearly half of state health departments have substantial capacity 1 . With only a small fraction of existing CDEs trained in epidemiology and most health departments lacking chronic disease capacity, CSTE saw the need for additional training and resources to support chronic disease epidemiologists in state health departments.

In 2012, Dr. Sara Huston, then chair of the Chronic Disease/Maternal and Child Health/Oral Health Steering Committee, convened a group of impassioned CDEs to discuss the idea of a resource to guide CDEs through the first days of leading a CD program. This idea evolved over months of dialog, and what began as a collection of ti ps, tools, and leading practices became a more comprehensive manual to orient leading CDEs at state and local health departments, based loosely on the State Epidemiologist Orientation Manual. At the helm of this project was Dr. Renee Calanan, Chronic Disease Epidemiology Capacity Subcommittee chair and current chair of the Chronic Disease/Maternal and Child Health/Oral Health Steering Committee.

Under her direction, a small but dedicated workgroup drafted nine chapters (and several appendices) to form the Chronic Disease Epidemiologist Orientation Manual: A Resource for Applied Epidemiologist. This labor of love was published in June 2015 and contains chapters on understanding the role of a lead CDE, technical challenges faced by CDEs (data governance, data sources and indicators, data interpretation and dissemination, etc.), and organizational challenges that affect CDEs (integration, collaboration, system dynamics). In writing this manual, the authors intend for it to be a quick-start menu of resources for lead chronic disease epidemiologists working in state, territorial, tribal, or local health departments. It is not meant to be a comprehensive epidemiology manual.

We hope that this manual will encourage discussion and collaboration to address challenges and spur innovation in the delivery of data-driven chronic disease epidemiology services throughout the United States. As chronic disease becomes more prevalent, CDEs know all too well that the demands of being a lead CDE can be huge, but so can the reward. And this manual can help you get that.

Annie Tran, MPH is a former senior research analyst for CSTE. For more information on the Chronic Disease Epidemiology Capacity Subcommittee, please visit the CSTE Chronic Disease/Maternal and Child Health/Oral Health Steering Committee webpage. If you have questions or comments, please contact Nidal Kram, CSTE’s staff lead on chronic disease work.
1Substantial capacity defined as less than 50% capacity to execute epidemiologic functions. A self-assessed measure.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

How Illinois Used REDCap to Support Contact Monitoring for the 2015 Measles Outbreak

Posted By Jennifer Vahora and Stacey Hoferka, Thursday, June 11, 2015
Updated: Thursday, June 11, 2015

In January 2015, the Illinois Department of Public Health (IDPH) received a measles case report, the initial case identified in what soon became the second-largest US measles outbreak, with 15 confirmed cases and many exposed contacts in suburban Cook County in 2015. IDPH had recently acquired Research Electronic Data Capture (REDCap) from Vanderbilt University, a free and secure web application for building and managing online surveys and databases. REDCap is accessible through computers, tablets, and smartphones.

REDCap was being evaluated and tested for symptom monitoring in Ebola contacts, when the measles outbreak began. The robust and customizable functionality in REDCap allowed IDPH to rapidly mobilize the tool to support the local health department’s measles contact investigation. IDPH’s Applied Public Health Informatics Fellow, Jennifer Vahora, quickly modified the Ebola module she had built the month before in order to create a measles-specific questionnaire.

IDPH worked with the Medical Research Analytics and Informatics Alliance, a non-profit entity that supports the development and maintenance of the Public Health Node (PHN). The Public Health Node, as an agent of IDPH, connects directly to the Illinois Health Information Exchange and supports the technical receipt, aggregation and transformation of data sent to IDPH for the purpose of collecting Meaningful Use data from hospitals and providers, as well as the eXtensively Drug Resistant Organism (XDRO) registry.

Within 72 hours, the measles module was ready to be demonstrated and deployed by local health departments. The survey instrument was demonstrated to the Cook County and Chicago Departments of Public Health. Whitney Clegg and AJ Beron, two IDPH CDC/CSTE Applied Epidemiology Fellows, were trained to use REDCap and lead REDCap response activities at Cook County.

Within three days of the demonstration, Cook County deployed the REDCap survey instrument and offered REDCap to 33 (52%) of 63 low-risk contacts. After initial phone communication with contacts to explain the electronic monitoring option, REDCap was offered to contacts as an alternative to daily phone calls to report body temperature and the presence of symptoms. Seventeen contacts (52%) completed at least one survey. In a post-evaluation discussion, Cook County staff indicated that REDCap reduced staff time and effort necessary for monitoring low-risk contacts, made follow-up easier, and the layout enabled a quick review for detecting contacts who failed to report their symptoms daily. To enhance the tool for future use, Chicago and Cook County requested Spanish and Polish language translation, a vaccination history data collection tool, and the ability to manage multiple contacts within one household.

IDPH presented its experience with REDCap on a CSTE webinar on state innovations in active monitoring with the Georgia Department of Public Health. To date, IDPH has received inquiries from four state and local health departments and one international institute. IDPH is currently working to develop a protocol for the use of REDCap in outbreaks, modify the existing REDCap project to meet LHD needs, and expand use of REDCap for foodborne illness outbreaks, rabies animal testing, and sharing of lab testing information. While IDPH’s use of REDCap is evolving, it has the potential utility for additional public health surveillance activities and future collaborations with other public health jurisdictions.

Jennifer Vahora, MPH is an Applied Public Health Informatics fellow and Stacey Hoferka, MPH, MSIS is a surveillance and informatics epidemiologist at the Illinois Department of Public Health. For more information on Project SHINE fellowships, please visit www.shinefellows.org or contact Workforce Director Amanda Masters. For more information on measles monitoring, please visit the CSTE website.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

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.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

Ebola Response Epidemiologists Interview

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

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

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.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

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.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)

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.

Are you a member with an important message to tell the CSTE community? Tell us about it!
Do you use social media? Stay tuned to CSTE on Facebook and Twitter for daily updates!

This post has not been tagged.

Share |
PermalinkComments (0)
Page 12 of 19
 |<   <<   <  7  |  8  |  9  |  10  |  11  |  12  |  13  |  14  |  15  |  16  |  17  >   >>   >|