Transcript Document

Session 5, Part 2
Epidemiology Applications:
Forensic Epidemiology
and
Maternal and Child Health Epidemiology
Learning Objectives
Session 5, Part 2
• Define forensic epidemiology
• State two uses of forensic epidemiology
• Explain similarities and differences
between law enforcement and public
health investigations
• List maternal and child health-related
surveillance projects
Session Overview
Session 5, Part 2
• Forensic epidemiology
• Maternal and child health epidemiology
Forensic Epidemiology
Forensic Epidemiology
Epidemiologic methods applied in a setting
of potential criminal investigation
Richard A. Goodman, CDC
What is Forensic Science?
The application of science or scientific techniques
to criminal investigation or legal issue
• Pattern of blood spatter
– Physics
• Matching DNA
– Microbiology
• Association between and exposure and an outcome
– Epidemiology
Forensic Epidemiology
• First use: Courtroom
– Epidemiologic data as
evidence (1982)
– Epidemiologists as expert
witnesses
• Current and future
application: Field
investigations
– Use epidemiologic methods in
partnership with an ongoing
criminal investigation
Epidemiology in the Courtroom
• Epidemiologists assist in resolving
disease-related litigation
– Investigative experts
– Consulting experts
– Testimony experts
• Examples
– Silicone breast implants, E.
coli, tobacco use, asbestos,
medical use of marijuana
Challenges Using Epidemiology
in the Courtroom
• Epidemiology studies disease in
populations, not individuals
• Science is ever-changing
• Difficult to prove exposure caused disease
Health-related Criminal
Investigations
• Rabbit hemorrhagic disease virus; New Zealand,
1997
• Shigella; Dallas, TX, 1996
• Sarin; Japan 1990-95
• Anthrax
– New York, Florida, Washington
DC, 2001
– Hundreds of hoaxes
Field-Based Forensic
Epidemiology
• CDC
• FBI
• Local and state health
departments
• Local, state, and federal
laboratories
• State Highway Patrol
• State Bureau of
Investigation
• Hospitals and clinics
• Emergency Medical
Services
• National Guard
• Federal Emergency
Management Agency
• US Department of
Agriculture
• Homeland Security
• Attorney General’s office
• Pharmacists
• The media
Public Health and Law
Enforcement Goals
Public Health
• Make people safer
and healthier
• Prevent disease
outbreaks
• Conduct disease
surveillance and
management
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Law Enforcement
Protection of public
Prevention of criminal
acts
Identification,
apprehension, and
prosecution of
perpetrators
Safeguarding all
involved
Common Goals
• Protecting the public
• Preventing or stopping the spread of
disease
• Identifying those responsible for a threat or
attack
• Protecting employees during response
and investigative phases
Martinez D, 2002,
FBI
Criminal Intent
• Naturally occurring vs. criminally motivated
event
– Covert action
• Not initially recognized as criminal
• Detected through established surveillance
mechanisms
• Notify law enforcement when
criminal intent is suspected
– Overt action
• Perpetrator announces
responsibility
• Many are hoaxes
Covert Attack:
When to Notify FBI
• A case of smallpox or pulmonary anthrax
• Uncommon agent or disease occurring in person with no
other explanation
• Illness caused by a microorganism with markedly
atypical features
• Illness due to food or water sabotage
• One or more clusters of illnesses that remain
unexplained after a preliminary investigation
• Deliberate chemical, industrial, radiation or nuclear
release
Laws Governing an Investigation
• Public health officials have ability to
– Examine medical records of person
infected, exposed, or suspected of
being infected or exposed
– Implement control measures
– Exercise quarantine and isolation
authority
– Enter premises where entry is
necessary to enforce public health
laws
• Law enforcement must obtain a
search warrant
Evidence
• Law enforcement gathers evidence
• Public health gathers specimens
• Criteria for specimens from public
health investigations to be used in
criminal investigations
– Obtained as part of a legitimate
public health investigation
– Collected and processed with a
chain of custody
Legitimate Public Health
Investigation
• Samples taken may be used in a criminal
investigation
– Legitimate example:
• Collection of foods on a salad bar due to a
suspected outbreak
– Incorrect example:
• Evidence found using public health authority to
inspect a hotel kitchen
Chain of Custody
• Required in law enforcement
investigations
• Form provides
– Name of person collecting evidence
– Each person having custody of it
– Date item collected or transferred
– Agency and case numbers
– Victim’s or suspect’s name
– Brief description of item
Handling Credible Threat
Evidence
• Handle as evidence and establish a chain
of custody
• Process evidence through an approved
Laboratory Response Network (LRN)
Working with the Media
• Public health
– Open with media
– Rely on media to get information to the public
for their protection
• Law enforcement
– Not as open about ongoing investigations
– Must preserve integrity of the case
• Joint Information Center (JIC)
Confidentiality
• Public health
– Confidentiality of patient and medical records
• Law enforcement
– Confidentiality of witness or informant
HIPAA
• Protected health information can be
disclosed:
– When a person is exposed or at risk of
contracting or spreading a disease created or
caused by a terrorist act
– When a weapons of mass destruction event
causes public health issues
– Pursuant to court order, subpoena, or
administrative request form
– To identify or locate a suspect, fugitive or
missing person
Classified / Sensitive
Information
• Some public health officials should hold
clearances to communicate with law
enforcement when necessary
• Secure equipment should be available
– Phone lines
– Fax machines
Joint Interviewing
• Joint interviews with victims and
witnesses
• Each discipline should be
aware of the information
counterparts seek
– Law enforcement: personal,
travel, incident, safety,
criminal investigation
– Public health: personal,
exposure, travel, medical
history
Intentional or Accidental Mass
Incidents
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High concentrations of agent dispersed
Large primary cohort exposed
Agent distributed in a well-traveled area
People present to different hospitals
May be second deliberate attack
Widespread panic
Hospitals may become flooded
Maternal and Child Health
Epidemiology
Maternal and Child Health
Epidemiology (MCH) Defined
• Collection, surveillance,
analysis, and effective use of
health data as it relates to the
health of families
• Structure
– Part of women’s / children’s
health division
– Part of epidemiology division
MCH Epidemiology Project
Areas
• Surveillance
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Maternal mortality
Perinatal morbidity and mortality
Birth defects
Newborn screening
Maternal / pediatric nutrition
• Assistance / partnership
– Women, Infants, and Children program (WIC)
– Medicaid
– Program evaluation
PRAMS
• The Pregnancy Risk Assessment System
• Partnership between CDC and state
health departments
• Improve health by reducing
– Low birth weights
– Infant morbidity and mortality
– Maternal mortality
• Data used within the state and at the
national level
Summary
• Forensic epidemiology is the use of
epidemiologic methods in law enforcement
investigations in the setting of a potential
criminal investigation
• Maternal and child health epidemiology uses
epidemiologic methods to monitor trends in
pregnancy and birth outcomes
• Epidemiologic methods can be applied to
identify trends and risk factors in a variety of
different topic areas
References and Resources
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Carus WS. Bioterrorism and Biocrimes: The Illicit Use of Biological Agents
Since 1900. Washington, DC: Center for Counterproliferation Research,
National Defense University; 2001. Available at:
http://www.ndu.edu/centercounter/Full_Doc.pdf. Accessed March 1, 2012.
Mobilia MA, Rossignol AM. The Role of Epidemiology in Determining
Causation in Toxic Shock Syndrome. Jurimetrics J. 1983;24:78.
Koehler SA, Brown PA. Forensic Epidemiology. Boca Raton, Fla: CRC
Press; 2010:13-18.
Loue S. Forensic Epidemiology: Integrating Public Health and Law
Enforcement. Sudbury, Mass: Jones & Bartlett Publishing; 2010.
Jernigan DB, Raghunathan PL, Bell BP, et al. Investigation of BioterrorismRelated Anthrax, United States, 2001: Epidemiologic Findings. Emerg Infect
Dis [serial online]. 2002;8:1019-1028. Available at:
http://wwwnc.cdc.gov/eid/article/8/10/02-0353.htm. Accessed March 1,
2012.
References and Resources
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Martinez D. Law Enforcement and Forensic Epidemiology. Presented at:
Forensic Epidemiology Training Course; November 2-5, 2002; Chapel Hill,
NC.
Moore J. Responding to Biological Threats: The Public Health System's
Communicable Disease Control Authority. Health Law Bull. 2001;78:1-10.
Available at:
http://sogpubs.unc.edu/electronicversions/pdfs/hlb78.pdf.Accessed March
1, 2012.
Technical Working Group on Crime Scene Investigation. Crime Scene
Investigation: A Guide for Law Enforcement. January 2000. Washington,
DC: US Department of Justice. Available at
https://www.ncjrs.gov/pdffiles1/nij/178280.pdf. Accessed March 1, 2012.
Interviewing Techniques. Public Health Training and Information Network
Broadcast. North Carolina Center for Public Health Preparedness,
University of North Carolina at Chapel Hill School of Public Health; August
17, 2004.
References and Resources
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Inglesby, T. Anthrax as a biological weapon. JAMA. 1999;281:1735-1745.
Torok, T. A large community outbreak of Salmonellosis caused by
intentional contamination of restaurant salad bars. JAMA. 1997;278:389395.
Treadwell, T. Epidemiologic clues to bioterrorism. Public Health Rep. 2003;
118:92-98.
What is PRAMS? [Web page]. Pregnancy Risk Assessment Monitoring
System, Centers for Disease Control and Prevention. Available at:
http://www.cdc.gov/prams/. Accessed March 1, 2012.