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Western States Occupational Network (WestON): Celebrating 10 Years

Posted By Song Xue, MPH, Friday, September 8, 2017
Updated: Friday, September 8, 2017

Derry Stover (NE) presents on working in occupational safety and health.

Fall not only brings the changing of leaves and cozy sweaters, but the annual Western States Occupational Network, or WestON, meeting. Every September, participants from 19 Western states come together in Denver, CO, for a day and a half meeting to advance and build capacity for occupational safety and health in the region. This year marks the 10th anniversary of the annual WestON meeting. Each year, WestON attracts over 60 participants from the NIOSH-funded Education and Research Centers (ERCs), Agricultural Centers and Training Project Grants; Federal, State and Tribal agencies; public health scientists; trainees and policymakers. Participants present and exchange ideas while identifying collaborative activities to address occupational safety and health issues in the West.


Recognizing the need to build occupational health surveillance at the state level in the West, the Council of State and Territorial Epidemiologists (CSTE), NIOSH Western States Office (now part of the NIOSH Western States Division), and Mountain and Plains Education and Research Center (MAPERC) established WestON in 2008. WestON includes participants from 19 Western states (AK, AZ, CA, CO, HI, ID, KS, MT, NE, NV, NM, ND, OK, OR, SD, TX, UT, WA, WY) who are working or strongly interested in occupational safety and health.

Western states share some collective identity based on common priority areas in workplace safety and health, such as mining, construction, and agriculture. The goal of WestON is to build and strengthen capacity among these 19 Western states to conduct state-based epidemiology, surveillance, and prevention of work-related injuries and illnesses. The framework of the WestON meeting is based on the concept that “regional” identification of common issues can help support the development of occupational epidemiology capacity in states that historically have had limited funding in this core area of public health.

Over the past 10 years, WestON agendas and topics have shifted from basic surveillance concepts to setting strategic priorities for interventions in the Western region and engaging a more diverse group of partners. Initial meetings provided participants with an opportunity to refine their surveillance skills and establish contacts in their field. More recent meetings have included participants from the NIOSH Centers of Excellence, Tribal Epidemiology Centers and journalists. The WestON meeting is one of the few venues where state, Federal and academic partners gather in a relatively small setting to share findings, promote collaboration and strategize about future activities.

WestON 2017

The 10th annual WestON meeting will take place September 13-14, 2017, in downtown Denver, with over 70 participants from the Western region. This year’s keynote speaker is Michael Grabell, a reporter from ProPublica, who will highlight workers’ compensation issues. Presentations will cover a wide array of topics, including novel uses of occupational health data, using Informatics in occupational safety and health and occupational issues related to marijuana. As with all WestON meetings, ample time will be devoted to networking and exchanging ideas for future projects. Next year’s meeting will be held in Denver on September 13-14, 2018.

How can you get involved?

Join the WestON Listserv to learn about occupational safety and health research, news, and announcements. If you would like to join, please email Song Xue at sxue@cste.org. For more information about the annual WestON meetings, please contact Yvonne Boudreau at yboudreau@cdc.gov.

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Update on CSTE International Surveillance Assessments

Posted By Rachelle Boulton, MSPH, Utah Department of Public Health, Friday, August 18, 2017
Updated: Thursday, August 17, 2017
Untitled Document

CDC’s Influenza Division uses cooperative agreements, paired with technical assistance, to assist Ministries of Health in countries throughout the world in establishing and improving capacity for sustainable epidemiologic and virologic influenza surveillance programs. Ensuring these systems generate useful, reliable data consistently involves routine assessment of how well they are functioning, identification of problems and assistance in solving those problems. CSTE frequently collaborates with CDC and the Association of Public Health Laboratories (APHL) to conduct international influenza surveillance assessments using standardized reporting tools that capture information, such as how potential influenza cases are identified at sentinel sites; how epidemiologic data and laboratory specimens are collected; how surveillance staff manage, analyze and report data; and how data quality is monitored. Following these assessments, detailed reports that provide recommendations for improvement in laboratory and epidemiologic surveillance are shared with the countries. Recently, Rachelle Boulton of the Utah Department of Health (DOH) completed two consecutive international influenza surveillance assessments in Sri Lanka and Maldives. Rachelle has graciously agreed to contribute a blog post on her experience during this opportunity.

I had the opportunity to represent CSTE on three international influenza surveillance assessments. I traveled to Uganda in June 2016 and most recently to Sri Lanka and the Maldives in May 2017. For each assessment, I was accompanied by the CDC Project Officer and an APHL representative conducting a concurrent influenza laboratory capacity assessment. Each of my assessments lasted four to five days, and I spend the majority of my time with the epidemiology surveillance staff. Each country begins influenza surveillance with varying amounts of existing resources and infrastructure, and each country encounters vastly different challenges throughout the process of building and maintaining influenza surveillance. One of my favorite components of the assessments is the site visits to hospitals and clinics that see patients and collect epidemiologic and laboratory data. I am always impressed with the enthusiasm, dedication and ingenuity of the surveillance staff and their clinical and laboratory partners to build and maintain high-quality influenza surveillance systems for their country.

My favorite part of my most recent trip to the Maldives was the opportunity to put down the clipboard, step out of the role of the assessor and work in depth with the data alongside surveillance staff. We worked together to develop several charts and graphs that demonstrated influenza trends in the Maldives, discussed how these figures could be compiled into different reports to tell a comprehensive and meaningful story, and identify future data collection and analysis goals.

I have thoroughly enjoyed my time spent in Uganda, Sri Lanka and the Maldives, and I look forward to future opportunities to contribute to international efforts to strengthen global influenza surveillance capacity.

Additional Information:
CDC’s Influenza Division International Program
WHO’s Global Influenza Programme Surveillance and Monitoring
CDC’s Influenza Division International Program Evaluation and Capacity Review Tools
Improved Global Capacity for Influenza Surveillance. Emerg Infect Dis. 2016;22(6):993-1001.

Pictured: Rachelle Boulton (second from left) joins assessors and surveillance staff in Sri Lanka.

Pictured: Meeting the Maldivian Minister of Health in the Maldives

Pictured: The pediatric inpatient ward at Tororo General Hospital in Uganda, Africa

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Prevention Fund Lives to Fight another Day

Posted By Emily J. Holubowich, MPP, Friday, August 4, 2017
Updated: Thursday, August 3, 2017

In the wee hours of Friday, July 28, Senator John McCain (R-AZ) unexpectedly cast the deciding “no” vote on the “Health Care Freedom Act,” a bare bones version of Affordable Care Act (ACA) “repeal and replace” legislation. Senator McCain joined Senators Susan Collins (R-ME) and Lisa Murkowski (R-AK) in defeating this final amendment to the House-passed American Health Care Act, bringing debate on the bill to a close. Even though the Health Care Freedom Act was a shell of all previously introduced – and failed – repeal and replace legislation, the bill nevertheless included a provision to terminate the Prevention and Public Health Fund beginning in fiscal 2019.

What happens next is anyone’s guess. The administration is pressuring Congress to bring the bill back up for another vote or else, threatening to end cost sharing subsidy payments to insurers that will create a “death spiral” in the marketplace. Leading Senate Republicans, including the powerful Finance Committee Chairman Orrin Hatch (R-UT) and Senator John Thune (R-SD), who serves in the number three position in Senate Republican leadership, are pushing back. They insist that Republicans will move on from ACA repeal and replace to focus on tax reform. At the same time, bipartisan groups of lawmakers are coming together to find ways to “repair” the ACA.

Regardless of where the ACA debate goes from here, it is clear Republicans are intent on repealing the Prevention Fund given that provision was included in every iteration of ACA repeal and replace legislation. These bills were not the first attempt to repeal the Prevention Fund, and they certainly won’t be the last. The public health community must continue its efforts to educate lawmakers about the value of public health, and the perils of repealing the Prevention Fund.

August is an ideal time to connect with lawmakers while they’re back home in district/state to educate them on the value of public health broadly and applied epidemiology particularly. We recommend downloading this guide prepared by the Association of State and Territorial Health Officials (ASTHO), which explains why it’s important for public health professionals to interact with policymakers and how to do so.

Emily J. Holubowich, Senior Vice President at CRD Associates, is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

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Public Health Funding Hangs in the Balance

Posted By Emily Holubowich, Thursday, July 27, 2017
Updated: Thursday, July 27, 2017
Emily Holubowich, Senior Vice President at CRD Associates, is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

There was a flurry of activity on Capitol Hill last week – and this week – with big implications for public health funding. The House Appropriations Committee approved along party lines its fiscal 2018 spending bill for the Departments of Labor, Health and Human Services, Education and Related Agencies (Labor-HHS). Starting from $5 billion lower than the current, already austere funding level, the bill forces more cuts in many health programs to support increases in others. As in years past, the bill is a mixed bag for applied epidemiology.

To be sure, the bill is a marked improvement from the president’s fiscal 2018 budget request for the Centers for Disease Control and Prevention (CDC), which proposed an 18 percent cut to the agency’s total budget, deeper cuts to many of the agency’s programs, and the outright elimination of others. The House’s proposal largely rejects many of the President’s priorities, and provides the agency roughly $7 billion – nearly 2.5 percent below current levels.

Within CDC’s budget, the Public Health Workforce activities, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, are cut by roughly $5 million, with total proposed funding of $45 million. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but with a cut in funding for the program we might expect a cut in available funding for our fellows. The president had requested a $7 million cut in the program.

The National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) receives $599.5 million, $33.4 million less than current funding, but $122.5 million more than the president’s request. Within NCEZID, the emerging infectious diseases programs absorbs most of the proposed cut. Most other programs receive flat funding – antibiotic resistance ($163 million), advanced molecular detection ($30 million), food safety ($54 million), vector-borne diseases ($26.4 million) – which means we might expect Epidemiology and Laboratory Capacity (ELC) grants to be flat funded since much of ELC funding is driven by NCEZID’s overall budget.

Interestingly, the House’s spending bill would appropriate funding from the Affordable Care Act’s (ACA) Prevention and Public Health Fund, including flat funding of $40 million for ELC and $12 million for hospital acquired infections at the same time the House voted to repeal the Prevention Fund beginning in fiscal 2019 as part of its ACA repeal effort, the American Health Care Act (AHCA). As we’ve noted before, elimination of the Prevention Fund would deal a devastating blow to CDC and public health more broadly, resulting in a 12 percent cut to CDC’s overall budget, a 20 percent cut to ELC, a 33 percent cut to immunizations, and complete elimination of all funding for core public health capacity supported by the Preventive Health and Health Services Block Grant.

On Tuesday, the Senate narrowly agreed to begin debate on ACA repeal or rather, the various repeal options released to date, and potentially others yet to be released. Of the bills made publicly available, all include repeal of the Prevention Fund.

First up was a vote on the Better Care Reconciliation Act (BCRA) – the repeal and replace legislation that would repeal the Prevention Fund beginning fiscal 2019. The BCRA was rejected by a vote of 43-57. On Wednesday, Senators rejected 45-55 the Obamacare Repeal Reconciliation Act (ORRA), the “repeal” only bill that was vetoed by President Barak Obama in early 2016. If enacted, ORRA would've repealed the Prevention Fund immediately more or less, and rescinded unobligated funds.

As a last ditch effort to pass some sort of ACA repeal, Senate Majority Leader Mitch McConnell is reportedly considering a “skinny repeal” bill that may be more likely to gain 50 votes needed for passage, since it would simply eliminate the penalty for the ACA's individual mandate – possibly along with its employer mandate and some taxes on the health care industry. There are also credible reports this “skinny repeal” will include a provision to repeal the Prevention and Public Health Fund to ensure the bill complies with reconciliation instructions. If introduced, this legislation would likely be the last and final bill to be considered, possibly around 5:00 am Friday morning (check out this helpful article and up-to-date flowchart on the procedural timetable here).

With Congress set to leave Washington for the August recess, there won’t be any further activity on fiscal 2018 spending legislation until after Labor Day when they return to the Capitol. At that time, we should have a better sense of where the Prevention Fund stands and when the Senate will consider its own public health spending bill. In any event, a continuing resolution to keep the government running on autopilot after September 30 will be needed.

In the meantime, August is an ideal time to connect with lawmakers while they’re back home in district/state to educate them on the value of public health broadly and applied epidemiology particularly. We recommend downloading this guide prepared by the Association of State and Territorial Health Officials (ASTHO), which explains why it’s important for public health professionals to interact with policymakers and how to do so. With all the threats facing public health, your voices are needed now more than ever.


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Public Health Informatics skills are essential to integrate health systems

Posted By Jeremy Arieh, Friday, July 21, 2017
Updated: Thursday, July 20, 2017

Field experiences from five Health Systems Integration Program fellows


Health systems integration is defined as the collaborations between public health and clinical health sectors. The Institute of Medicine’s call to integrate public health and clinical health sectors to improve and promote better population health and public health’s emphasis on prevention emphasizes the need to develop leaders intersecting public health and clinical health sectors. Health systems integration professionals are needed to complement discipline-specific expertise and work across program or disease-specific public health practice.


Recognizing a need for health systems integration professionals, the Centers of Disease Control and Prevention (CDC), Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO) collaboratively offered a one-year training program, the Health Systems Integration Program (HSIP). HSIP was the only national program to train health systems integration professionals at state and local health departments. HSIP placed experienced public health or clinical health practitioners with a masters or doctoral degree into state and local health departments. Fellows provided a service to the host agencies, and received training through the fellowship program, such as leadership, project management and public health informatics. Determined together with the host sites, fellows worked on data-driven projects that address community-level health concerns and improve population health. These projects were rooted in the HSIP core competencies. These competencies included five domains: analysis, assessment and evaluation; policy development and program planning; communication and cultural competency; public health sciences; and health systems.


Since 2013, 24 fellows have participated in the training and provided a service to seven local and nine state health departments. HSIP Class II (2015-2016) had eight fellows matched to four state and four local health departments. Five Class II fellows’ experiences (Marion Tseng, Ekaette Joseph-Isang, Bree Allen, Koneng Lor and Crystal Boston-Clay) were utilized to examine the skills required for health systems integration professionals. For this report, fellows selected one project from fellowship assignments, and summarized the project outcomes and impacts from their activity reports. Fellows’ selected project summaries were analyzed to identify common skills required for successful health systems integration.


These five fellows selected projects covering areas ranging from disease surveillance, population health assessment to policy. Fellows identified public health informatics skills as the most critical in accomplishing health systems integration projects. Public health informatics is defined as, “the systematic application of information, computer science and technology to public health practice.” Having skills to practice public health informatics is fundamental to ensuring the robust use of data to guide public health actions. The fellows found that public health informatics skills were important to many of the health systems integration competencies. For example, public health informatics skills helped fellows describe how evidence-based approaches and linking public health and health care perspectives can be used to improve the population’s health care needs and delivery.


 Pictured: CSTE’s Class II Health System Integration Program fellows in 2016.


At Chicago Department of Public Health, Marion led a project to establish an electronic provider reporting interface for chlamydia and gonorrhea cases. Public health informatics skills helped Marion to understand requirements for this electronic provider reporting interface, and ensure the interface meets data needs of all stakeholders. Ekaette established an Informatics Workgroup at the Kentucky Department for Public Health. She presented and led group brainstorming sessions to help participants understand how public health informatics could enhance data use to guide public health practice. In Minnesota, Bree connected local public health departments and health care providers to encourage the use of electronic health records data for community population health assessments. She applied public health informatics skills, such as communication and systems thinking, to engage stakeholders to gather lessons learned and developed an informatics framework and toolkit. In Marion County, Indiana, Crystal improved community partnerships and enhanced timeliness of electronic laboratory reports to Indiana Health Information Exchange. She exercised public health informatics skills rooted in the project management methodology to conduct business process analysis and communicate with stakeholders regarding project milestones. Koneng completed a pilot stakeholder survey and made recommendations for improving an existing information mapping system at Washington State Department of Health. She engaged stakeholders by frequently communicating project progress, and connected with subject matter experts to inform the recommendations.


Public health informatics skills are critical for health systems integration professionals to leverage actionable data-driven information to engage and collaborate with partners. The HSIP fellows built and strengthened multi-disciplinary and cross-sector partnerships, and facilitated data exchange among these partners. Public health needs health systems integration professionals to collaborate with non-traditional multisector stakeholders to implement data-driven solutions that improve population health. Health systems integration professionals can be trained through on-the-ground experiential learning, such as the HSIP fellowship


This blog post was supported in part by appointments to HSIP administered by CSTE and funded by CDC Cooperative Agreement 3U38-OT000143-01S3. The authors would like to thank all HSIP Class II host sites, mentors and fellows: April Moreno, Anna Oberste and Michael Ray for their contribution to this blog post.


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CSTE Zika Deployment Update

Posted By Gabriela Escutia, San Diego Health & Human Services Agency, Friday, July 14, 2017
Updated: Thursday, July 13, 2017
Sociocultural context as a guide to connecting the office and the field during a public health emergency
Note: CSTE received funding from a cooperative agreement with the Centers for Disease Control and Prevention to provide epidemiological workforce surge capacity in Puerto Rico. Consultants were deployed to help support the Zika response efforts – they did this by implementing evidence-based policies developed by CDC to further capacity building efforts during a public health emergency. AEF Fellow Gabriela Escutia of the San Diego Health & Human Services Agency recently returned from deployment to Puerto Rico. To date, CSTE has supported six consultants who provided 245 days of in country support. Additional deployments will continue in 2017 if requested by CDC.
Each year, CSTE’s applied epidemiology fellowship (AEF) offers recent epidemiology graduates the opportunity to experience applied epidemiology in a real-world setting. This is a powerful way for a young epidemiologist to set forth in a career direction. Following the completion of my MPH in epidemiology at Oregon State University, my passion to comprehend social inequalities through public health led me to pursue a two-year applied epidemiology fellowship. I was placed at the Centers for Disease Control and Prevention (CDC), U.S./Mexico Quarantine station, and the County of San Diego Epidemiology program in San Diego, California.

Pictured: Gabriela in the field in Puerto Rico conducting surveys with a group of entomologists (photo credit: Gabriela Escutia)

Just a few months into my fellowship, Zika virus disease (ZIKV) emerged in the Americas, and a year later, the U.S. declared a public health emergency in Puerto Rico. By September 2016, there were over 20,000 symptomatic ZIKV cases reported in Puerto Rico. In October 2016, I was deployed to Puerto Rico to assist in the emergency response to Zika. Working on the frontlines of the Zika outbreak in Puerto Rico has been one of the richest experiences of my career in applied epidemiology.

During my deployment, I assisted in a household cluster investigations project to identify factors associated with the underreporting of ZIKV in Puerto Rico. I supported the collection of demographics, household characteristics, recent illness and health care-seeking behaviors by conducting interviews of households within 100 meters of households where patients with confirmed ZIKV disease lived in five municipalities in Puerto Rico. My work varied from conducting surveys to transporting specimens and field materials to cluster locations. The interviews were conducted in the Spanish language.

Pictured: A bottle of mosquitos used during outreach activities (photo credit: Gabriela Escutia)

As epidemiologists, we are responsible for studying the distribution of disease in populations for the design of appropriate interventions; however, this can become complex during a public health emergency, as sometimes urgent problems that demand immediate solutions arise. Early in my field work, I realized that my experience would be incomplete without observing the social aspects of the situation. With almost 50% of the population living below poverty in Puerto Rico, there is no doubt that health on the island is determined by access to social and economic opportunities. As a young epidemiologist in training eager to learn, I quickly drafted an observation items list to use every time I went into the field. I learned that the way you knock on the door in a middle-class neighborhood was not the same way you would in a low-income neighborhood.

My Zika deployment also took me from the familiarity of the office to an environment where I gained a new perspective on the role of an epidemiologist. As epidemiologists, we get the best answers by going into the field and talking to people. In the field, I gained a greater understanding of Puerto Rican culture through observation. For instance, applying mosquito repellent might not be a cultural practice, as some elderly people I met in Puerto Rico believe that repellent disrupts the natural ecosystem and might harm the lizards around their homes that eat the mosquitos.

At the Puerto Rico Department of Health Emergency Operations Center (EOC), health officials played an important role in closely monitoring the outbreak and providing a platform for deployed and local health professionals to collect and analyze information for response activities. I joined the behavioral science team as a data manager. Our team was responsible for conducting a two-phase interview among pregnant women to assess the distribution of Zika prevention kits and CDC educational materials. This included the distribution of topical insect repellent, condoms to avoid potential sexual transmission of Zika, and mosquito dunks to reduce mosquito populations in standing water, which were delivered through Women, Infants, and Children (WIC) clinics. During a public health emergency, timely access to relevant data is essential. Time is limited and population needs must be addressed.

Pictured: Gabriela’s last day at the Emergency Operations Center with a behavioral science team (photo credit: Gabriela Escutia)

As a CSTE/CDC Applied Epidemiology Fellow, my deployment to Puerto Rico during the Zika emergency response further developed me into an experienced epidemiologist. The opportunity enriched my field knowledge and allowed me to learn from the best at CDC and those in the field, while working on the front line of a public health emergency. It was a life-changing moment – a diverse combination of applied epidemiology, from interacting and learning from the community to managing complex data sets in limited time. The experience was extremely rewarding because as an applied epidemiologist you know some of your recommendations can lead to improving the public’s health, in this case our future generations.

Gabriela Escutia is a CSTE Class XIII AEF Fellow in the San Diego Health & Human Services Agency Quarantine Unit

This publication was supported by Cooperative Agreement Number 5U38OT000143 from CDC. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.

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From Bad to Worse…Senate version of Health Reform Bill could devastate Public Health

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.

Background Information

For background information, including a detailed analysis on the impact the loss of this fund will have on state public health departments, please view the Trust for America’s Health factsheets and analysis.

Emily Holubowich, Senior Vice President at CRD Associates is CSTE’s Washington representative and leads our advocacy efforts in the nation’s capital.

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Flu Near You, local data for local action

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 mschroeder@cste.org.


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

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Happy Healthy and Safe Swimming Week 2017 Everyone!

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.

Tags:  cryptosporidiosis  infectious disease 

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Wild Ride for Public Health Funding

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 Holubowich is Senior Vice President at CRD Associates and serves as CSTE’s Washington representative, leading our advocacy efforts in the nation’s capital.

Tags:  epidemiology  infectious disease  surveillance 

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