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

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

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

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

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

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

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

Tags:  e-cigarette  epidemiology  injury  lung illnes  surveillance  vaping 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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


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

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

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

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

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

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

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


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

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CSTE at the HIMSS 2019 Conference: Reflections from a first-time Attendee

Posted By Charisse LaVell, Tuesday, April 16, 2019
Updated: Monday, April 15, 2019
  I have known about the Healthcare Information and Management Systems Society (HIMSS) Annual Global Conference and Exhibition for many years, and I finally got the chance to attend HIMSS19 in Orlando, FL as a representative of CSTE. I was briefed beforehand on the enormity of the conference, yet I was completely unsure how my experience would unfold. HIMSS is a global non-profit whose mission is to improve health through information and technology. The annual HIMSS conference draws upwards of 45,000 attendees, with over 1300 exhibitors and more than 300 education sessions. I was blown away by the diversity and caliber of vendors and their uniquely designed booths that filled the exhibit hall at the Orange County Convention Center. 




CSTE was invited by the Centers for Disease Control and Prevention (CDC) to participate in the HIMSS Interoperability Showcase to demonstrate how the Reportable Conditions Knowledge Management System (RCKMS) supports electronic case reporting between healthcare providers and public health. The Interoperability Showcase is a major exhibit at HIMSS and is comprised of several guided, real-time demonstrations presented by diverse companies that work through partnerships using innovative techniques to address current health problems. CSTE joined the Association of Public Health Laboratories (APHL), CDC, several state health departments including Tennessee, Michigan, Utah, and Washington, Epic, Netsmart, FormFast, CareEvolution, National Consortium of Telehealth Resources Centers, and American Well to present our use case: The Opioid Crisis: The Person and The Population.  For this use case, we worked together to demonstrate how emerging technologies and standards are applied to enhance public health reporting and surveillance for the opioid overdose epidemic. 



Pictured: Partners demonstrating The Opioid Crisis: The Person and The Population use case at the 2019 HIMSS Global Conference’s Interoperability Showcase. From left to right, Laura Conn (CDC), Jim Fitzpatrick (Epic), Sai Valluripalli (APHL) and Charisse LaVell (CSTE).

Pictured: Partners demonstrating The Opioid Crisis: The Person and The Population use case at the 2019 HIMSS Global Conference’s Interoperability Showcase. From left to right, Laura Conn (CDC), Jim Fitzpatrick (Epic), Sai Valluripalli (APHL) and Charisse LaVell (CSTE).


In our showcase, we simulated a patient, who is a resident of Washington, that presented to a Tennessee emergency department with an apparent opioid overdose. The opioid overdose diagnosis entered into the electronic health record (EHR) triggered the subsequent process of reporting to public health. The emergency department’s EHR system, represented by Epic, generated and sent the electronic initial case report (eICR) to the APHL AIMS secure cloud-based platform. This process invoked the RCKMS decision support service to determine whether this potential case is reportable to public health. Based on the reporting logic for both Washington Department of Health and Tennessee Department of Health, RCKMS determined that this case of opioid overdose is reportable to Washington and Tennessee. RCKMS outputted the determination with other pertinent routing information to the APHL AIMS platform for inclusion in a reportability response (RR). AIMS then routed the RR back to the Epic EHR system. Concurrently, the eICR and RR were routed to both the Washington Department of Health and the Tennessee Department of Health. Washington’s health information exchange (HIE) and Tennessee’s surveillance system consumed the eICR and the RR, while Epic received and processed the RR.



Pictured: CSTE staff member Charisse LaVell leads the crowd through a demonstration of the Reportable Conditions Knowledge Management System (RCKMS) at the 2019 HIMSS Global Conference in Orlando, FL.

As the opioid overdose epidemic has gained more visibility as a public health crisis, CSTE’s participation in this year’s HIMSS conference was invaluable in broadening attendees’ awareness of the importance of public health reporting for opioid overdoses and how RCKMS supports surveillance and electronic case reporting. Throughout the conference, I was able to share the work of RCKMS with clinical and public health professionals. Having the opportunity to represent CSTE by presenting at my first HIMSS conference was an unforgettable experience. 

Charisse LaVell is a Program Analyst supporting the RCKMS project.  For more information about RCKMS, contact Charisse at clavell@cste.org.

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#CSTE2019 Featured Speakers

Posted By CSTE Conference, Monday, April 1, 2019
Updated: Thursday, April 4, 2019
Untitled Document
We are pleased to announce an exciting and diverse lineup of speakers for the 2019 CSTE Annual Conference, June 2-6, 2019 in Raleigh, North Carolina. Our 2019 speakers include Jonathan M. Mann Memorial Lecturer Anne Schuchat, Principal Deputy Director at the Centers for Disease Control and Prevention (CDC). This year’s Plenary sessions include topics around the theme of the 2019 Conference, "First in Flight: Recognizing Risk Takers & Risk Factors."  Our Plenary sessions include “Flying into the Winds of Political Change” (Monday, June 3), “A Bird's Eye View of Our Environment” (Tuesday, June 4), and “Navigating the Opioid Crisis: Local Success” (Wednesday, June 5). Our 2019 speakers will share perspectives on applied public health epidemiology, with a focus on best practices and recent successes. Please take a moment to view all of the 2019 speakers below.

Jonathan M. Mann Memorial Lecture

Anne Schuchat - Principal Deputy Director Centers for Disease Control and Prevention Rear Admiral (Ret.), U.S. Public Health Service

Monday Plenary - Flying into the Winds of Political Change

Rachel Levine - Secretary of Health for the Commonwealth of Pennsylvania and Professor of Pediatrics and Psychiatry at the Penn State College of Medicine

Emily J. Holubowich - Senior Vice President, Cavarocchi Ruscio Dennis Associates, LLC

Tuesday Plenary - A Bird’s Eye View of our Environment

Trish M. Perl - Professor of Medicine and the Chief of Infectious Diseases at the University of Texas Southwestern Medical School and Medical Center

Gregory C. Gray - Professor at Duke University with three affiliations: The Division of Infectious Diseases in Duke University’s School of Medicine, Duke Global Health Institute, and Duke Nicholas School of the Environment

Wednesday Plenary - Navigating the Opioid Crisis: Local Success

Van Ingram - Executive Director for the Kentucky Office of Drug Control Policy

Pam Pontones - Deputy State Health Commissioner State Epidemiologist

Continuing Education for Attendees
This year, CSTE has partnered with CDC to provide continuing education to Annual Conference attendees. We anticipate offering 12.5 hours/credits of free CE for doctors, nurses, health educators, veterinarians, general practitioners, and those certified in public health. Approval is pending. 
To learn more, visit www.csteconference.org.

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Electronic Case Reporting (eCR) is a reality at Houston Methodist and Houston Health Department

Posted By Kathryn Turner, Idaho Deputy Epidemiologist and CSTE Digital Bridge Liaison, Tuesday, December 18, 2018
Updated: Friday, December 21, 2018

Houston Methodist and Houston Health Department are the first hospital system and public health agency in the U.S. to launch electronic case reporting (eCR) using CSTE’s Reportable Conditions Knowledge Management System (RCKMS). The eCR approach was designed by key stakeholders in health care, public health, and health information technology under the Digital Bridge collaborative, an innovative partnership focused on improving data exchange between health care and public health.
Houston is the first of seven Digital Bridge pilot sites to implement eCR in production for reportable diseases. Houston Methodist utilized their electronic health record (EHR) system vendor, Epic who is also a Digital Bridge participant, with the Health Department’s Houston Electronic Disease Surveillance System, provided by their vendor, Maven. Other locations participating in the Digital Bridge eCR pilot are in California, Kansas, Massachusetts, Michigan, New York, and Utah.
CSTE has been building RCKMS with HLN Consulting and Northrop Grumman with funding from CDC since 2014. The tool provides comprehensive information on public health reporting requirements. RCKMS is comprised of three parts that ensure accurate, timely, and complete coverage of reportable conditions reporting criteria:
  • The authoring interface allows public health agencies to input, edit, and manage their jurisdiction-specific reporting criteria.
  • The knowledge repository stores these criteria for use in adjudicating eCR data sent by health care electronic health record systems containing clinical encounter information.
  • The decision support system uses the criteria in the knowledge repository to determine whether data sent in the eCR constitutes a reportable condition and which jurisdiction(s) the data should be sent. The decision support system also notifies the reporting organization about the reportability of the clinical encounter.
RCKMS is part of the larger technical solution for eCR, and the launch of this real-time, automated process promises to improve the timeliness, accuracy and completeness of data, allowing public health to quickly intervene and prevent the spread of disease. RCKMS has been deployed on the Association of Public Health Laboratories (APHL) Informatics Messaging Services (AIMS) platform, the combination resulting in an all-inclusive decision support intermediary for use by public health and reporters to improve data exchange.
The pilot implementation focuses on five conditions: chlamydia, gonorrhea, pertussis, salmonellosis, and Zika virus infection. Public health agencies currently receive provider case reports predominantly through time-intensive manual processes that involve paper (e.g., faxes), phone calls, or data entry into a web portal. These manual processes are time consuming, burdensome to reporters and public health, and inconsistent. To ensure accurate reporting, providers must know what, when, how, and to whom to report their clinical data. In addition, public health agencies must ensure all reporting mandate information is up to date and available to those required to report. RCKMS benefits both reporters and public health agencies by providing a centralized location for public health reporting requirements.
While Houston Methodist, Houston Health Department, and Epic may be the first partners to embark on bridging the gap in case report data exchange between health care and public health, public health agencies, health care partners, and EHR vendors across the country are excited about implementing eCR. Overall, I would encourage CSTE members to stay current on electronic case reporting activities, and especially RCKMS because it will soon be part of business as usual for public health.
The Reportable Condition Knowledge Management System (RCKMS) is an authoritative, real-time portal to enhance disease surveillance. RCKMS provides comprehensive information on public health reporting requirements to public health reporters, such as clinicians and laboratories. More information can be found on the CSTE Surveillance and Informatics Steering Committee page, Digital Bridge website, and CDC website.
HLN is a leading public health informatics consulting company focused on developing and supporting robust technical solutions addressing pressing public health needs. HLN is dedicated to the development, improvement, promulgation, and use of Open Source solutions in health information technology. For more information, visit https://www.hln.com.

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2018 CSTE Student Scholar Melanie Firestone - Highlights from the 2018 Annual Conference

Posted By Melanie Firestone, MPH, Friday, October 19, 2018
Updated: Friday, October 19, 2018

Editor’s Note: In spring 2018, CSTE awarded its third student scholarship to Melanie Firestone, MPH. This year, the award was renamed the Jeffrey P. Davis Student Scholarship. Melanie has written a blog post on her experience as the first recipient of the Jeff Davis Scholarship, which was named in honor of the late CSTE past president and longtime Wisconsin State Epidemiologist.

Thunder applauds while
in place, shed new light.

I was thrilled to be chosen as the 2018 recipient of the CSTE Student Scholarship. I was especially honored to learn I was the first recipient of the scholarship in honor of Jeffrey P. Davis. In the spring, I learned the impact of Dr. Davis’s work through Dr. Mike Osterholm’s emerging infections course at the University of Minnesota. While attending the 2018 Conference, I learned that Dr. Davis and I shared a common love for something in addition to public health – haiku. In his honor, I chose to start with the haiku above, since he was known for beginning his presentations with haiku.

Participating in the CSTE Annual Conference has long been a goal of mine, and I was particularly interested in attending this year because of the theme “Using data to weather the storms.” Public health is about problem solving, but it takes reliable surveillance data and collaboration to do so. CSTE allowed me to connect with people from state and local health departments along with federal agencies and academia to see firsthand how different agencies across the U.S. are using data to combat public health challenges. This year’s meeting was the largest gathering of epidemiologists to date and we learned that there is now approximately one epidemiologist per 100,000 population (2017 Epidemiology Capacity Assessment).

At CSTE, I was drawn to the sessions about foodborne disease and outbreak investigations since this is my particular area of interest. Through the pre-conference workshop and sessions, I gained a deeper understanding of the challenges faced by state and local epidemiologists in regards to foodborne disease surveillance. I particularly benefited from sessions that wrestled with challenges of how to effectively integrate the increased use of culture independent diagnostic tests (CIDTs) and whole genome sequencing (WGS). CIDTs can rapidly identify the general pathogen causing illness, but because they do not produce an isolate they do not yield subtyping information that can be used to identify clusters of illnesses. WGS, by contrast, provides more fine-tuned subtyping information, but takes significantly longer than the previous “gold standard” of pulsed field gel electrophoresis (PFGE). As surveillance activities evolve, there is an increased need to adapt approaches for investigating foodborne illnesses in order to rapidly stop and prevent them from occurring. As a result, many of these sessions provided an opportunity for state and local health departments to discuss how they are adapting to these changes and to learn from each other about how to handle challenges. At CSTE, innovations are tested against the reality of our public health systems.

A highlight of the conference was being able to attend the Jonathan Mann lecture and hear this year’s speaker, Dr. Eric Klinenberg. I first discovered his work as an undergraduate student where I was required to read his book, Heat Wave: A Social Autopsy of Disaster in Chicago in my freshman sociology class. I have since read some of his other works, which provide good examples of using data to understand complex problems and the importance of an interdisciplinary perspective. Dr. Klinenberg’s talk on climate change emphasized the point made by Sandra Mullin in the plenary that there is a need to move beyond statistics in order to motivate change through stories because stories are less likely to be forgotten.

Having the opportunity to network with attendees and Epidemic Intelligence Service (EIS) officers was a truly invaluable experience. I identified a dissertation topic that will be valuable to state and local health departments faced with the need to adapt to new surveillance methods. This experience also reaffirmed my interest in working in the government setting to promote effective public health change. Thank you to everyone who contributed to the student scholarship fund for making my attendance possible. This scholarship will truly serve as a meaningful opportunity to create a generation of future public health epidemiologists.

Melanie Firestone, MPH is a doctoral candidate at the University of Minnesota studying environmental health with a concentration in infectious diseases. Her primary interests are in using surveillance data to drive prevention of foodborne illnesses. For more information or to make a donation to the Jeffrey P. Davis Student Scholarship Fund, please visit www.cstefoundation.org.

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National Preparedness Month Feature: Highlight on CSTE’s Disaster Epidemiology Subcommittee

Posted By Hayleigh McCall, CSTE Program Analyst for Environmental Health, Friday, September 28, 2018
Updated: Thursday, September 27, 2018
Written in the spirit of the National Preparedness Month theme: “Disasters Happen. Prepare Now. Learn How.”

Pictured: Participants of CSTE’s 9th Annual National Disaster Epidemiology Workshop in Atlanta, GA, May 2018 (Photo credit: Hayleigh McCall, CSTE)

When thinking of epidemiologists working in public health preparedness and response, thoughts traditionally jump to many infectious disease-related activities: contact tracing in West Africa during the Ebola crisis, GIS-mapping as Zika was being locally-transmitted in the U.S., and deployments for Epi-Aids as a measles outbreak is detected. Yet, there is an entire sector of public health epidemiologists that prepare for and respond to environmental and man-made disasters – the disaster epidemiologists.

Disaster epidemiology, as defined by CDC, is “the use of epidemiology to assess the short- and long-term adverse health effects of disasters and to predict consequences of future disasters.” Its goal is to prevent further morbidity and mortality by addressing immediate and long-term needs by using gathered information to adjust priorities, allocate resources, and plan for future needs and/or disasters. In simpler terms, disaster epidemiology provides reliable and actionable health and needs information to public health response incident commanders, planners, and decision-makers.

With nearly one of every five CSTE members subscribing to the group, the CSTE Disaster Epidemiology Subcommittee is very active in its efforts to promote, support, and drive the efforts of disaster epidemiology at STLT health agencies. Meeting on the third Wednesday of every month at 2:00 pm ET, the group discusses best practices, lessons learned, and ongoing challenges related to current disaster situations via monthly presentations. In addition, the subcommittee has three current workgroups working to develop products, such as a resource guide for epidemiologists new to the field, a guidance document on shelter surveillance, and tools and resources for epidemiologists to collaborate with emergency managers.
Further advancing the nation’s capacity in disaster epidemiology, the CSTE Disaster Epidemiology Subcommittee, in collaboration with CDC, invites STLT epidemiologists to participate in an Annual National Disaster Epidemiology Workshop in Atlanta, GA. In May 2018, over 200 participants (100 in-person and 100 virtual) came together at the 9th Annual Workshop to address and discuss the tools and assessments that can and have been utilized prior to, during, and post-disaster. Recordings of each day of the workshop, as well as an annotated agenda with time-stamps of presentations, can be found in the CSTE Webinar Library.
As you may know, September is National Preparedness Month, and the CSTE Disaster Epidemiology Subcommittee encompasses this National Preparedness Month’s theme of “Disasters Happen. Prepare Now. Learn How.” Epidemiologists who work in this arena accept that disasters happen and learn how to prepare now through data collection and analysis pre-, during, and post-disaster. However, given the complexity of recent and current disasters, epidemiologists traditionally separate from public health emergency responses and are welcome and encouraged to join! If interested in joining and/or learning more, please visit the CSTE Disaster Epidemiology Subcommittee webpage or contact Hayleigh McCall at hmccall@cste.org.

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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 jpeart@cste.org.

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