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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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2017 Plenary Speakers & Mann Memorial Lecturer

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.


To learn more, visit www.csteconference.org.

Tags:  Annual Conference  epidemiology  infectious disease 

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Mosquito Season is upon us: CDC’s New Vector Control Training can help

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

Course topics include:
  • Vector-borne diseases, IPM basics, pesticide toxicology.
  • 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.
  • Risk communication.
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.

Tags:  epidemiology  infectious disease 

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