Posted By Emily J. Holubowich,
Friday, June 30, 2017
Updated: Friday, June 30, 2017
After much anticipation, Senate Republican Leader Mitch McConnell unveiled the Better Care Reconciliation Act (BCRA) late last week – the upper chamber’s version of Affordable Care Act (ACA) repeal legislation – following the House’s passage of the American Health Care Act (AHCA) almost two months prior.
Just when you thought it couldn’t get worse, it did.
To review, Section 101 of the House’s AHCA would repeal the ACA’s Prevention and Public Health Fund (PPHF) beginning in fiscal year (FY) 2019, the loss of which would result in a 12 percent reduction in the Centers for Disease Control and Prevention (CDC) budget. More specifically, the loss of the Prevention Fund would leave Epidemiology and Capacity (ELC) grants with one-fifth less funding, immunizations with one-third less funding, and would completely eliminate all funding for core public health capacity supported by the Preventive Health and Health Services Block Grant. Former CDC Director Dr. Tom Frieden spoke on CNN this week about the impact of the Prevention Fund loss HERE.
Facing such cuts in more than a year from now is bad enough, but the Senate’s BCRA would repeal the Prevention Fund beginning in FY 2018 – just three short months from now.
Why does timing matter?
The FY 2018 appropriations process is behind schedule, and it is certain that lawmakers will not complete their work before the end of the fiscal year on September 30. That means Congress will have to pass – and the president will need to sign – a continuing resolution to keep the government running for a specified period of time while lawmakers work out their differences. By definition, a continuing resolution continues programs at the previous year’s funding levels. If the funding doesn’t exist – because it is repealed, for example – the funding can’t be continued. In the case of the Prevention Fund, this would mean that several core CDC programs – ELC, immunizations, chronic disease, Prevent Block among them – would be operating at significantly reduced capacity for a specified period of time. If Congress ultimately can’t complete its budgetary work and then passes a year-long continuing resolution, lawmakers will not have the opportunity to backfill the CDC losses created by the Prevention Fund cut through spending legislation repeal for another year.
In sum, enactment of the BCRA would pull the rug out from under CDC and core governmental functions that are essential to our nation’s health security.
Despite all of this, the future of the BCRA is tenuous at best. This week, leader McConnell delayed a vote on the bill before lawmakers leave for the July 4th recess after failing to secure the requisite 50 Republican votes to pass it – several conservative and moderate Senators have come out in opposition and/or expressed skepticism about the legislation as written. Several notable polls this week, including an NPR/PBS poll and a USA Today poll, show dwindling support for repeal/replace legislation in its current form. However, it is certainly possible that Senators will take up a revised version of the bill when they return after Independence Day; in fact, some are saying a vote could be scheduled for July 11th.
Posted By Eric Bakota,
Monday, June 26, 2017
Updated: Monday, June 26, 2017
I first became aware of Flu Near You (FNY) from a colleague while I worked at my previous job at the Tazewell County Health Department (TCHD) in central Illinois. I was the epidemiologist for the County, which housed roughly 135,000 residents. At TCHD, I was less of an epidemiologist than a general ‘data & technology’ guy. There just wasn’t enough local data to do proper epidemiological analyses. Our data was too sporadic, too sparse and too noisy. We regularly were frustrated by this problem, but accepted it as a fact of life for being in a county that didn’t have a million people.
FNY works by transforming a regular citizen into a citizen scientist. Every Monday, these citizen scientists collect the previous week’s health data about themselves and their families. They then transmit the data through the web or through the FNY smartphone app. This data is then aggregated and analyzed to determine influenza-like illness trends for states and the nation by the team at HealthMap at Boston Children's Hospital, which runs FNY. These analyses have been shown to be very consistent with CDC estimates of influenza-like activity1 .
Local and State Health Departments can easily and quickly gain access to these data. HealthMap has committed itself to sharing the de-identified data widely in the hopes that the data can lead to positive public health action. After being given access to the data, I wanted to see how many users were necessary to gain a good signal that still correlated to CDC’s ILINet data. At over 10,000 weekly participants, the data correlates very, very well (R ~ 0.96). I conducted the same analysis with 1,000 weekly participants and was surprised to see that the correlation continued to be very strong (R ~ 0.88). At 500 participants, it was still strong (R ~ 0.80). It wasn’t until approximately 200 weekly participants or fewer that the signal started dropping off and becoming unreliable.
The major conclusion from this analysis was that a local health department only needed to find 200 individuals willing to participate for this tool to be worthwhile within its jurisdiction. For most areas, this will require some active recruiting efforts, but I believe it is achievable. Once an area has reached the 200 mark, I believe public health officials can interpret FNY data with enough confidence for it to trigger public health action – say a news alert stating that influence has spiked within the county and encouraging the public to get vaccinated.
Flu Near You is tool that transforms regular people into citizen scientists
FNY, ILINet, and CDC Virological data, transformed by scaling each value as a proportion of the peak value, correlate very tightly with each other.
Correlation between bootstrapped samples of FNY estimated percent ILI and observed percent ILI, as reported by the CDC (grey), and laboratory confirmed influenza cases (red) at the national resolution with 95% Confidence Intervals for the 2014-2015 flu season.
Flu Near You is a participatory disease surveillance system for volunteer reports of ILI symptoms that was created in 2011 by APHA, HealthMap of Boston Children’s Hospital, and the Skoll Global Threats Fund (SGTF). In 2016, CSTE and SGTF partnered to further explore the utility of Flu Near You data as a novel data source for influenza surveillance in the state and local health department setting. For more information, please contact email@example.com.
Eric Bakota, MS is a staff analyst in the Office of Surveillance and Public Health Preparedness at the Houston Health Department. Eric is currently a CSTE Informatics-Training in Place Fellow.
1Smolinski MS, Crawley AW, Baltrusaitis K, et al. Flu Near You: Crowdsourced Symptom Reporting Spanning 2 Influenza Seasons. American Journal of Public Health. 2015;105(10):2124-2130. doi:10.2105/AJPH.2015.302696
Posted By Thuy Kim, MPH,
Friday, May 26, 2017
Updated: Friday, May 26, 2017
As summer approaches, many Americans will be searching for solace from the heat in recreational water. Each year, the week before Memorial Day is designated as Healthy and Safe Swimming Week (May 22-28). This year’s observance marks its 13th anniversary of promoting healthy and safe swimming practices for both swimmers and pool operators.
Whether it be in lakes, rivers, water parks, splash pads or neighborhood swimming pools – epidemiologists know that it is no coincidence there is an uptick of waterborne disease outbreaks during the hot summer months. The last major outbreak I investigated before I left the Alabama Department of Public Health (ADPH) in late 2016 to join the CSTE team happened to be a Cryptosporidum outbreak at a local water park. We were happy to have had cooperation from the water park owners and staff who voluntarily closed their facility for treatment. Unfortunately, we were not able to recover organisms from the water. That summer, other states also experienced waterborne disease outbreaks and our collective stories were published in a recently released MMWR.
Pictured: CSTE staff member Thuy Kim, MPH contributed to a CDC MMWR focused on a Crypto outbreak in Alabama, Arizona and Ohio in 2016.
In the spirit of this week, a few CSTE members have also written and created an educational music video on water safety. The video was written by Taishayla Mckitt and stars Miranda Daniels and Allison Roebling – all from ADPH. Please enjoy, like, comment, share and take some notes!
Thuy Kim, MPH is an Associate Research Analyst II at CSTE with a focus on Enteric Diseases.
Posted By Emily J. Holubowich ,
Friday, May 19, 2017
Updated: Friday, May 19, 2017
May 5 was filled with ups and downs on the public health funding front. On the upside, federal spending legislation for fiscal year (FY) 2017 was signed into law, bringing long overdue closure to public health funding—eight months into the fiscal year. All things considered, CSTE’s funding priorities fared well given that funding for the Centers for Disease Control and Prevention (CDC) was cut by $13 million. Funding for the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) increased by about $5 million, including a $3 million increase for the antibiotic resistance (AR) initiative and a $2 million increase for food safety. As always, we would expect much of NCEZID’s funding to support core infectious disease surveillance capacity at state and local health departments through Epidemiology and Laboratory Capacity (ELC) grants. This funding would be in addition to $40 million from the mandatory Prevention and Public Health Fund (PPHF) provided to ELC grants for the sixth consecutive year. Other NCEZID initiatives—vectorborne disease, advanced molecular protection, hospital acquired infections, National Healthcare Safety Network—were all flat funded.
On the downside, the Public Health Workforce program, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, was cut by $2 million. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but we should expect this cut to have an impact on future fellowships.
Photo credit: Emily J. Holubowich
While many were cheering the passage federal spending legislation and the avoidance of a government shutdown on May 5, the House of Representatives resurrected and passed by one vote the American Health Care Act (AHCA) as part of its efforts to “repeal and replace” the Affordable Care Act (ACA). If enacted, the legislation would terminate the PPHF beginning in FY 2019. The loss of the nearly $1 billion PPHF would result in a 12 percent cut to CDC’s total budget and a significant reduction or elimination of funding to many state and local public health programs—ELC, immunizations and the Preventive Health and Health Services Block Grant among them.
Upon its passage in the House, the Senate almost immediately rejected the AHCA, with leadership announcing their intentions to move forward in drafting their own ACA repeal legislation. A working group of 13 GOP Senators representing centrists and conservatives is working to craft a compromise, and another small group of Republicans and Democrats led by Senators Susan Collins (R-ME) and Bill Cassidy (R-LA) are simultaneously working to craft an ACA “repair” package that can garner support on both sides of the aisle. In sum, as the future of the ACA repeal is murky at best one thing is clear: don’t expect any swift action from the “World’s Greatest Deliberative Body.”
All eyes now turn to FY 2018, and the release of the President’s budget on May 23. The full budget will provide more information about the administration’s specific funding priorities—we’re anticipating cuts and consolidations galore! But of course, it will be up to Congress to ultimately decide how to prioritize spending. The budget resolutions that will emerge from the House and Senate Budget Committees in June will set the tone for ongoing discussions about public health funding and largely determine the fate of spending bills going forward. Deep cuts to spending in the budget resolutions will be rejected by Democrats, making it nearly impossible to move any appropriations legislation—legislation that will require bipartisan support to clear either chamber.
For more information about funding levels for your specific priorities, please click here for a copy of the omnibus spending legislation, and click here for a copy of the accompanying report that provides more detailed instructions about public health funding levels and intended purposes.
Emily Holubowichis Senior Vice President at CRD Associates and serves as CSTE’s Washington representative, leading our advocacy efforts in the nation’s capital.
Posted By CSTE Staff,
Friday, May 12, 2017
Updated: Thursday, May 11, 2017
CSTE is pleased to announce an exciting lineup of speakers at this year’s annual conference in Boise, Idaho with diverse professional backgrounds and insightful presentations to share. Our 2017 speakers will share their perspectives on applied public health epidemiology, with a focus on the 2017 conference theme - “Cultivating an Environment for Better Health.”
Keiji Fukuda , MD, MPH– Jonathan M. Mann Memorial Lecture
Keiji Fukuda is the Director and a Clinical Professor at the University of Hong Kong School of Public Health. He previously worked at the World Health Organization (WHO) in several capacities including Assistant Director-General (ADG) and Special Representative of the Director-General for antimicrobial resistance; ADG for the Health Security and Environment Cluster; and Director of the Global Influenza Programme. Before that, he worked at the U.S. Centers for Disease Control and Prevention (CDC) as the Epidemiology Section Chief, Influenza Branch and as a Medical Epidemiologist in the Viral Exanthems and Herpesvirus Branch, National Center for Infectious Diseases. Professor Fukuda has been a global public health leader in many areas including health security; emerging infectious diseases including seasonal, avian and pandemic influenza, SARS, MERS and Ebola; antimicrobial resistance; development of the Pandemic Influenza Preparedness Framework; implementation of the International Health Regulations; food safety; and chronic fatigue syndrome. He has considerable experience in epidemiological research and field investigations, media communications and international diplomatic negotiations including those held to establish a historic Heads of State level meeting on antimicrobial resistance at the United Nations in 2016. He has a BA in Biology, an MD; an MPH; was trained in the Epidemic Intelligence Service at CDC and is certified in internal medicine by the American Board of Internal Medicine.
Caleb Banta-Green, PhD, MPH, MSW
Caleb Banta-Green is a Principal Research Scientist at the Alcohol & Drug Abuse Institute, an Affiliate Associate Professor at the School of Public Health and Affiliate Faculty at the Harborview Injury Prevention & Research Center at the University of Washington. He conducts research and provides community and professional technical assistance on opioid use disorder treatment and opioid overdose interventions. He is currently analyzing data from an NIH funded clinical trial on opioid overdose prevention and has recently started at clinical trial to test an opioid use disorder treatment intervention for those released from prison. He is evaluating a HHS SAMHSA funded community based overdose prevention intervention and working with the Washington Department of Health on developing opioid overdose surveillance systems. He has been the Seattle representative to the NIH NIDA drug epidemiology workgroup since 2001. In 2012, he served as the Senior Science Advisory in the White House drug policy office working on opioid overdose prevention.
CAPT. Martin (Marty) Cetron, MD
Dr. Cetron is director of the Division of Global Migration and Quarantine (DGMQ) at the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). He previously served as director of DGMQ when it was within the National Center for Preparedness, Detection, and Control of Infectious Diseases. DGMQ’s mission is to prevent the introduction and spread of infectious diseases into the U.S. and to prevent morbidity and mortality among immigrants, refugees, migrant workers and international travelers. Dr. Cetron’s primary research interest is international health and global migration with a focus on emerging infections, tropical diseases and vaccine-preventable diseases in mobile populations.
Since coming to CDC in 1992, Dr. Cetron he has led a number of domestic and international outbreak investigations, conducted epidemiologic research and been involved in domestic and international emergency responses to provide medical screening and disease prevention programs to refugees prior to U.S. resettlement. He played a leadership role in CDC responses to intentional and naturally acquired emerging infectious disease outbreaks, including the anthrax bioterrorism incident, the global SARS epidemic, the U.S. monkeypox outbreak and the H1N1 pandemic. Dr. Cetron is also part of CDC’s Pandemic Influenza Planning and Preparedness Team. He holds faculty appointments in the Division of Infectious Diseases at the Emory University School of Medicine and the Department of Epidemiology at Rollins School of Public Health.
Dr. Cetron received his bachelor of arts degree from Dartmouth College in 1981 and his MD from Tufts University in 1985. He trained in internal medicine at the University of Virginia and infectious diseases at the University of Washington before becoming a commissioned officer in the U.S. Public Health Service in 1992.
Jacqueline MacDonald Gibson, PhD, MS
Dr. Gibson is currently an associate professor in the Department of Environmental Sciences and Engineering at the University of North Carolina, Chapel Hill. She had a 13-year career working for public policy research institutions before returning to school to earn a dual Ph.D. and entering academia.
As a senior engineer at the nonprofit RAND Corp., she served as liaison to the White House Office of Science and Technology Policy and conducted technical reviews of risk assessment methods adopted by government agencies. As associate director of the Water Science and Technology Board of the National Research Council, which advises Congress and the federal government on science policy matters, Dr. Gibson led a range of studies of issues at the interface between water science and public policy.
Studies included assessment of options for improving potable water service to small U.S. communities, evaluation of regulatory requirements for the remediation of contaminated groundwater, and assessment of research priorities for new environmental remediation technologies. She has also given briefings on these and other topics to a variety of federal officials, members of Congress and their staffs, and institutional advisory boards.
Christine Hahn, MD
Christine Hahn, MD, known for her common-sense approach to often challenging situations, has wanted to help as many people as possible since she finished her training as an Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention in 1995. She realized then she enjoys helping people live healthier lives now, as well as in the future. That led her to accept the position as Idaho’s state epidemiologist in 1996, and she continues to be the go-to authority for an array of healthcare professionals in the state, as well as the state’s public health districts. Her favorite part of the job is being able to help busy medical providers get the tools they need so they and their patients are successful. Her work overseeing the Idaho Refugee Health Screening Program has helped to provide better coordination and standardization of screening processes between clinics throughout the state in the last two years. She also has been instrumental in aligning Idaho’s immunization requirements with the CDC’s Advisory Committee on Immunization Practices, meaning that more children are starting school with the recommended panel of vaccines. As the state’s tuberculosis controller, she has advised and supported physicians treating and managing the disease.
Hahn attended Medical School at Michigan State University and completed a residency in Internal Medicine at the Mayo Clinic’s Graduate School of Medicine. She then completed a Fellowship in Infectious Diseases at Duke University Medical Center. After a two-year training program as an Epidemic Intelligence Service Officer with the CDC, she became the Idaho state epidemiologist. Hahn served on the CDC’s Advisory Committee for the Elimination of Tuberculosis until June 2012. She was recently named the Medical Director for the Division of Public Health with oversight of the Bureau of Communicable Disease Prevention and the Idaho Bureau of Laboratories. She served as president of the Council of State and Territorial Epidemiologists from 2004-2005, and remains active in that organization. She is the organization’s liaison to the CDC Advisory Committee on Immunization Practices, which sets national vaccination policy. Locally, Hahn serves on the infection prevention committees of Saint Alphonsus and St. Luke’s regional medical centers in Boise and is on the board of Idaho’s Immunization Policy Commission.
Debra Houry, MD, MPH
Dr. Houry is the Director of the National Center for Injury Prevention and Control (NCIPC) at CDC. In this role, Dr. Houry leads innovative research and science-based programs to prevent injuries and violence and to reduce their consequences. She joined the CDC in October 2014. She has previously served as Vice-Chair and Associate Professor in the Department of Emergency Medicine at Emory University School of Medicine and as Associate Professor in the Departments of Behavioral Science and Health Education and in Environmental Health at the Rollins School of Public Health. Dr. Houry also served as an Attending Physician at Emory University Hospital and Grady Memorial Hospital and as the Director of Emory Center for Injury Control. Her prior research has focused on injury and violence prevention in addition to the interface between emergency medicine and public health, and the utility of preventative health interventions and screening for high-risk health behaviors. She has received several national awards for her work in the field of injury and violence prevention.
Dr. Houry received the first Linda Saltzman Memorial Intimate Partner Violence Researcher Award from the Institute on Violence, Abuse, and Trauma and the Academy of Women in Academic Emergency Medicine’s Researcher Award. She is past president of the Society for Academic Emergency Medicine, Society for Advancement of Violence and Injury Research and Emory University Senate. Dr. Houry has served on numerous other boards and committees within the field of injury and violence prevention. She has authored more than 90 peer-reviewed publications and book chapters on injury prevention and violence. Dr. Houry received her MD and MPH degrees from Tulane University and completed her residency training in emergency medicine at Denver Health Medical Center.
Lyle R. Petersen, MD, MPH
Dr. Petersen is the director of the Division of Vector-Borne Diseases in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). The division, located in Fort Collins, Colorado, supports CDC’s mission to protect the American public from exotic and domestic bacterial and viral pathogens transmitted by mosquitoes, ticks, fleas and other vectors.
Dr. Petersen earned his medical degree from the University of California, San Francisco. His career at CDC began in the Epidemic Intelligence Service (EIS) in 1985. During that time, he completed CDC’s Preventive Medicine Residency Program, received a Master of Public Health degree from Emory University, and served in several posts, including the Chief of the HIV Seroepidemiology Branch. In 1996, Dr. Petersen accepted an assignment in Germany, where he helped guide that country’s efforts in creating a new national infectious disease epidemiology program at the Robert Koch Institute in Berlin. In 2000, he returned to the United States to serve as the Deputy Director of Science of the Division of Vector-Borne Diseases, and he became the division’s Director in 2004.
Continuing Education through CDC
This year, CSTE has partnered with CDC to provide continuing education to Annual Conference attendees. We anticipate offering CE for doctors, nurses, health educators, veterinarians, certified in public health and general practitioners. Approval is pending with more details to come.
Posted By Liljana Baddour, MPH and Martin A. Kalis, MA,
Friday, May 5, 2017
Updated: Thursday, May 4, 2017
Mosquitoes are responsible for transmitting diseases to millions of people worldwide, with substantial morbidity and mortality. Epidemiologists know mosquitoes spread diseases such as West Nile virus, dengue, chikungunya and Zika. Preventing and reducing the spread of many of these diseases depends on controlling mosquito vectors or interrupting human-vector contact. Several factors, including the type and timing of mosquito control activities, are critical to reducing mosquito populations.
A new online training is now available for the public health workforce that focuses on vector control and pest management, and incorporates the 10 Essential Environmental Public Health Services and the Environmental Public Health Performance Standards developed by CDC’s National Center for Environmental Health (NCEH).
The online learning series Vector Control for Environmental Health Professionals (VCEHP) provides the knowledge and resources necessary to prevent and control vector-borne illnesses spread by insects, rodents, ticks and more. VCEHP provides resources on using an integrated pest management (IPM) approach.
The online curriculum of 11 courses geared toward environmental health professionals is:
Credible: It includes the latest science and evidence from vector control experts.
Practical: It addresses concrete principles, practices and resources for vector control.
Free and Flexible: Professionals can take the courses they want, when they want.
Available for Continuing Education Units: The National Environmental Health Association offers optional CEUs.
Pictured: VCEHP includes a subset of courses particularly helpful for understanding and addressing Zika virus and other mosquito-borne diseases. Photo credit: CDC/ Prof. Frank Hadley Collins, Dir., Cntr. for Global Health and Infectious Diseases, Univ. of Notre Dame
Performance assessment and improvement for vector control programs.
Biology and control of bedbugs, ticks, rodents, and mosquitoes.
Vector control and pest management in specific locations like schools, restaurants, and hotels.
We invite you to access or share VCEHP and get started today to prepare for mosquito season.
Texas Health Institute, Tulane University and the National Environmental Health Association.
VCEHP was developed by CDC, the National Network of Public Health Institutes, Liljana Baddour, MPH, is Senior Manager for Workforce and Education Initiatives at the National Network of Public Health Institutes (NNPHI), one of CDC’s core partners for VCEHP. Martin A. Kalis, MA, is a Public Health Advisor with CDC’s Environmental Health Services Branch and is the CDC lead for VCEHP.
Posted By Janet Hui , MPH,
Friday, April 7, 2017
Updated: Friday, March 31, 2017
This February, CSTE attended the 2017 HIMSS Annual Conference and Exhibition in Orlando, Florida. HIMSS – the Healthcare Information and Management Systems Society – is a global non-profit whose mission is to improve health through information technology. Their annual conference is one of the largest health IT conferences in the world, with over 40,000 representatives from health care and health IT attending this year. The enormous HIMSS exhibit hall featured some of the biggest names in health care and technology, such as Allscripts, Cerner, Epic IBM and many others.
This year, CSTE was invited by CDC to participate in the HIMSS Interoperability Showcase to demonstrate the Reportable Conditions Knowledge Management System (RCKMS). The Interoperability Showcase is a guided exhibit at HIMSS, where companies and organizations partner together and demonstrate how different technologies can work together to address a health problem. For our use case, CSTE partnered with the Association of Public Health Laboratories (APHL), Utah Department of Health, Epic and others to demonstrate how new technologies and standards can be used to enhance public health (PH) surveillance. Together, we demonstrated the electronic case reporting flow for a potential case of Zika virus infection.
During the Showcase, we simulated a patient visiting a clinic in Utah and receiving a positive PCR result for Zika virus, which triggered the process of PH reporting. The clinic’s EHR, represented by Epic, built and sent an initial electronic case report (elCR) to the APHL AIMS platform, which invoked the RCKMS decision support service to determine that this potential case should be reported to Utah Department of Health. AIMS routed the eICR and a Reportability Response (RR) to the Utah Department of Health and a RR to the Epic EHR system. Utah consumed the eICR and RR into their surveillance system, and Epic received and processed the RR.
Pictured: CSTE staff member Janet Hui leads a demonstration of the Reportable Conditions Knowledge Management System (RCKMS) during the 2017 HIMSS Conference in Orlando, FL.
Overall, CSTE’s participation in this year’s HIMSS Conference was very productive in educating attendees on CSTE’s role in the work of public health reporting, RCKMS and other technology currently being developed in the surveillance/reporting realm. The Conference presented a great opportunity to engage fellow public health professionals on the ongoing work of RCKMS, and I look forward to participation in future HIMSS Conferences.
Janet Hui is CSTE’s Associate Research Analyst on the RCKMS initiative. For more information about the ongoing RCKMS work or other projects in the Surveillance/Informatics area, contact Janet at firstname.lastname@example.org.
Posted By Jeremy Arieh and Emily Holubowich,
Thursday, March 23, 2017
Updated: Thursday, March 23, 2017
Each year, members of CSTE’s executive leadership team visit Washington, DC to meet with key Congressional offices on behalf of the applied epidemiology profession. Advocacy is one of CSTE’s integral functions, and the activity is a key component of the overall CSTE mission. On March 8-9, President Joe McLaughlin of Alaska, President-Elect Janet Hamilton of Florida, Secretary-Treasurer Sarah Y. Park of Hawaii, Senior Board Advisor Tim Jones of Tennessee and Executive Director Jeff Engel attended meetings with members of the U.S. House and Senate, and the Centers for Disease Control and Prevention’s (CDC) Washington office as part of the 2017 “Hill Day.”
Pictured (L-R): Janet Hamilton, Jeff Engel, Tim Jones, Sarah Park, Emily Holubowich and Joe McLaughlin attend CSTE Hill Day at the U.S. Capitol.
Led by CSTE’s Washington representative Emily Holubowich, advocacy efforts during this year’s Hill visits hinged upon the preservation of CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) funding, which in fiscal year 2016 awarded over $240 million to help states detect, prevent and respond to the growing threats posed by infectious diseases, including foodborne and vaccine-preventable diseases. In particular, CSTE’s meetings focused on proposed cuts to the Prevention and Public Health Fund (PPHF) as part of legislation to repeal and replace the Affordable Care Act (ACA). The loss of the PPHF would deal a $900 million blow to the CDC’s budget, and a $50 million blow to epidemiology capacity at the state and local level. This funding comprises around 12 percent of the CDC’s overall budget, and it is a vital aspect of our nation’s public health infrastructure. Cuts of this magnitude could severely hamper core CDC programs, such as immunization, workforce capacity, vector-borne disease management and more.
With the House’s introduction of the American Health Care Act (ACHA) to repeal the ACA earlier in the week, this year’s Hill visit was very well-timed, as CSTE leaders spoke to the proposed PPHF cut during meetings with Senate and House staff. Our packed March 8th agenda began with an ASTHO briefing at the Capitol Visitors Center. The briefing featured panel discussions on hot topic issues, such as Zika prevention and opioid addiction. CSTE Senior Board Advisor and Tennessee State Epidemiologist Tim Jones joined a panel of state health department experts from Georgia, Florida and Minnesota to convey his experiences during Tennessee’s Zika response.
Pictured: Tim Jones highlights Tennessee’s Zika response during an ASTHO panel, entitled Zika Response: State & Territorial Public Health Acting to Protect America’s Health.
From there, CSTE attended meetings with Senate and House staffers, including the offices of Sen. Lisa Murkowski of Alaska, Sens. Marco Rubio and Bill Nelson of Florida, Sen. Brian Schatz of Hawaii, Sen. Richard Burr of North Carolina, Sens. Lamar Alexander and Bob Corker of Tennessee and Sen. Chris Coons of Delaware. Meetings were held with staff of the Senate Health, Education, Labor & Pensions (HELP) Committee and Senate and House Appropriations Subcommittees on Labor, Health and Human Services, Education & Related Agencies. Our Hill visits concluded with a meeting with staff at the CDC Washington offices on March 9th.
Pictured: CSTE leadership met with staff in the offices of Sens. Richard Burr, Lisa Murkowski, Marco Rubio, Brian Schatz and several others.
As part of our ongoing advocacy efforts, CSTE once again partnered with the Association of Public Health Laboratories (APHL) in co-signing request letters to Senate and House appropriators urging support of CDC’s core epidemiology and laboratory programs in the FY 2018 federal budget. The letters emphasize the need for vital funding of Emerging and Zoonotic Infectious Disease prevention and Public Health Workforce and Career Development.
Our presence on Capitol Hill was more important than ever. Last week, President Trump provided a preview of his FY 2018 budget and proposed an 18 percent cut to HHS. The high-level budget summary does not specify the level of cuts to CDC, but one must assume that the full budget released in May will include deep cuts given the cuts proposed for the Department itself. CSTE will continue to educate lawmakers about the value of disease surveillance activities at the state and local levels, and work with our partners in the public health community to protect CDC from further cuts.
Click HERE to view a table of ELC and HAI funding for each state in FY 2016.
Posted By Erica Washington, MPH, CPH, CIC, CPHQ,
Friday, February 17, 2017
Updated: Wednesday, February 15, 2017
When considering the state of antibiotic resistance proliferation in today's health care landscape, the words “The Bugs are Fighting Back!” may come to mind. While this may sound like a D-list ‘80s movie, it succinctly summarizes the rapid pace of antibiotic resistance evolution, and the urgent need for stewardship in prescribing and surveillance practices. Antibiotics are ubiquitous in today's society: they are in foods, prescribed as medicine and at one point were even widely used in soaps. Each of these factors spurned the growth of resistant organisms for which antibiotics have reduced efficacy. Some consequences of antibiotic-resistant infections are longer and more complicated illnesses, increased doctor visits and increased mortality. In light of the vast problem of existing and emerging resistance, I chose to address surveillance of antibiotic prescribing practices and antibiotic threats as my project for my Informatics-Training in Place Program (I-TIPP) fellowship.
I join a myriad of stakeholders who have focused their attention on the need for antibiotic stewardship over the last several years. These efforts to combat antibiotic-resistant bacteria were propelled further by the 2015 White House Report titled National Action Plan for Combating Antibiotic-Resistant Bacteria. The report established several goals to fight “super bugs,” such as reducing the incidence of Clostridium difficile by 50 percent, reducing carbapenem-resistant Enterobacteriaceae infections by 60 percent, and maintaining the prevalence of ceftriaxone-resistant Neisseria gonorrhoeae below two percent (of all of the multi-drug resistant organisms, stating the emergence of Gonorrhoeae as a drug-resistant threat typically gets the biggest gasp from my audiences of infection preventionists and stakeholders).
The need for antibiotic stewardship is readily apparent in Louisiana, where I am pursuing my fellowship in theLouisiana Department of Health. According to Centers for Disease Control and Prevention's (CDC) Healthcare-Associated Infections 2015 Prevention Status Report, only 29.5 percent of acute care hospitals in Louisiana reported having antibiotic stewardship programs that incorporated all seven core elements deemed critical by CDC. These seven core elements include leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Although this data references only acute care hospitals, antibiotic stewardship is needed across the health care spectrum. The seven core elements for antibiotic stewardship are recommended for implementation in all settings where prescribing occurs, including long-term acute care hospitals and nursing homes.
Similar to the Prevention Status Report's revelation of lack of antibiotic stewardship programs, CDC's 2014 Community Antibiotic Prescriptions Report shows data demonstrating that Louisiana's doctors' offices, emergency departments and hospital clinics administer antibiotics that are unnecessary at a rate of 1,021-1,285 prescriptions per 1,000. Overprescribing can be attributed to a number of factors. One study published in British Journal of General Practice showed that reduced antibiotic prescribing is associated with lower patient satisfaction, which may be why doctors overprescribe unnecessary medications. According to The Pew Charitable Trusts (PCT), common inappropriate uses of antibiotics in health care are for asthma, allergies, bronchitis, middle ear infections, influenza, viral pneumonia and viral upper respiratory infections. PCT has listed reducing inappropriate antibiotic use for all conditions by 50 percent by 2020 as a national goal.
Through my I-TIPP fellowship, I have identified current informatics capacities at acute care hospitals, promoted use of the National Healthcare Safety Network's (NHSN) Antibiotic Use and Resistance Module (AUR), educated facilities about the need for robust antibiotic stewardship activities and notified acute care hospitals about the eligibility of Meaningful Use Stage 3 incentives for participating in both the antibiotic use and antibiotic resistance features of the AUR. In July 2016, I conducted an introductory webinar on the AUR and in September 2016, I conducted a survey among acute care NHSN users to assess their electronic reporting capacities to participate in the AUR. Information administered in the initial webinar on AUR was reinforced at three, in-person workshops that were presented statewide in November 2016. These workshops focused on the NHSN and Emerging Infectious Disease, which are an integral part of Louisiana's health care-associated infections activities. Infection preventionists and patient safety personnel were the target audience for these workshops, however some pharmacists participated as well, in light of the demonstration of the AUR Module.
Effectively intersecting with people to generate outcomes that impact population health has been the key to my success in the fellowship thus far. Understanding the needs of each facility that has indicated an interest in signing up for the AUR Module, determining what their current capacities and barriers to creating competent antibiotic stewardship programs, and showing how Meaningful Use participation can help them has been integral to my project. Through I-TIPP, I have been able to refine my communication skills and problem solving methods to achieve public health goals that will better the health of Louisianans as we fight back against super bugs.
CSTE Fellow Erica Washington presents content on the NHSN Antibiotic Use/Resistance Module at the annual Louisiana National Healthcare Safety Network/Emerging Infectious Diseases Workshops in Bossier City, LA at Willis-Knighton Health Center in November 2016.
Erica Washington is an Informatics-Training in Place Program Fellow at the Louisiana Department of Health. She received her MPH from Tulane University in New Orleans, LA. Ms. Washington's post is the fifth in a series of blogs by CSTE-sponsored fellows.
Posted By Katelynn Devinney,
Tuesday, February 7, 2017
Updated: Tuesday, February 7, 2017
Foodborne illness is not only an unpleasant experience, but also a major public health concern. Many individuals who acquire foodborne illnesses do not seek medical care and do not report their illness to health departments, which can make complete and timely outbreak detection nearly impossible. With the emergence of social media as a primary form of communication, many individuals do, however, complain to their friends and followers online about their illness, symptoms and possible causes. So, how can we harness the power of social media to stop foodborne outbreaks?
As a fellow with the Project SHINE Informatics Training in Place Program in the New York City Department of Health and Mental Hygiene (DOHMH) – with support from the Alfred P. Sloan Foundation and the National Science Foundation – I have been tasked with developing a system, using data from Twitter, to identify complaints of foodborne illness across the city. The DOHMH has a long history of applying innovative methods to improve foodborne disease surveillance. We utilize the citywide non-emergency information system, “311,” where anyone can submit a food poisoning complaint related to a New York City restaurant. Additionally, in 2011, after identifying reports of illness on the restaurant review website Yelp that were not reported to 311, DOHMH began collaborating with Yelp and Columbia University to obtain a daily feed of Yelp reviews and develop a machine learning program using text mining to identify reviews pertaining to foodborne illness. This project was supported by two former CSTE Applied Epidemiology fellows, Cassandra Harrison, MPH and Kenya Murray, MPH and resulted in the full integration of Yelp into our foodborne illness complaint system. Each year, approximately 4,000 restaurant-associated complaints are received via 311 and Yelp combined, which result in the detection of about 30 outbreaks.
Nevertheless, New York City is a large metropolitan area with more than 8.5 million residents, 78 percent of whom eat food purchased from the city’s approximately 24,000 restaurants and 15,000 food retailers at least once per week. There are ample opportunities for exposure to foodborne pathogens at New York City restaurants. Even with the integration of Yelp and 311, we remain concerned that we are not receiving all reports of restaurant-associated foodborne illness incidents in the city.
Working with Columbia University, we have developed a system very similar to that used for Yelp reviews, which pulls publicly available data from Twitter’s application program interface (API), and uses text mining and machine learning to identify tweets indicating foodborne illness. We have also developed a web-based application, which displays all Yelp reviews and tweets for epidemiologists to review and manually classify, and allows us to track follow up and conduct interviews with complainants.
Using this application, we can respond to Twitter users we believe to be tweeting about a potential food poisoning incident and ask them to complete a brief online survey. The survey asks about the restaurant name and location, date of their visit, details of the incident and contact information for follow-up. DOHMH staff attempt to interview all users who submit surveys to obtain more information about their symptoms, incubation period and a three-day food history.
The process of developing and launching the application was extensive; we encountered many roadblocks, such as accessing data through firewalls and obtaining secure public facing servers to allow survey data collection. We have only recently started tweeting and sending surveys; so far, the survey completion rate has been low (roughly two percent), but we have observed an overall positive reaction from the public to our tweets. We hope the response rate increases over time and the application is successful, so we can share our work and lessons learned with other health departments who want to incorporate social media into their surveillance and outbreak detection efforts.
Already, our project was recognized at the 2016 New York City Technology Forum as the Most Innovative Use of Social Media/Citizen Engagement. Since then, we’ve enhanced the application to allow us to automate processes and increase the sustainability of the project over time. We have also evaluated different data sources and aim to incorporate those that will increase both the timeliness and completeness of foodborne illness outbreak detection in New York City.
Pictured: New York City Social Media Foodborne Team accepting the award for
Most Innovative Use of Social Media/Citizen Engagement on November 14, 2016.
This project has been an incredible learning experience. I am very thankful to DOHMH, my mentors and Project SHINE for their continued support and guidance. None of this would have been possible without the work of Communicable Disease, Environmental Health and Information Technology staff at DOHMH, our partners at Columbia, our grant administrators at the Fund for Public Health New York and our funders. This collaboration provided me with an amazing opportunity to learn how to effectively communicate and coordinate between groups to promote innovation in informatics, which I will continue to apply throughout my public health career.
Katelynn Devinney, MPH, is an Informatics-Training in Place fellow at the New York City Department of Health and Mental Hygiene. She received her MPH from Columbia University Mailman School of Public Health. Ms. Devinney’s post is the fourth in a series of blogs by CSTE-sponsored fellows.