Transcript Gastroenteritis at a University in Texas

is for Epi
Epidemiology basics
for non-epidemiologists
Session II
Part I
An Epidemiologist’s Toolkit
Overview
1. Public health, allied health, and
community collaborators
2. Public health laboratories
3. Data, technology, and the media
4. Centers for Disease Control and
Prevention
5. Universal epidemiological methods
Learning Objectives
• Understand the significant roles of both
the human and technological elements of
epidemiological practice
• Recognize the diverse professionals within
and beyond public health that contribute to
the success of epidemiological
surveillance and investigations
Learning Objectives
• Recognize key sources of epidemiological
data
• Recognize ways in which epidemiologists
work with the media
• Understand how the Centers for Disease
Control and Prevention serves as a
resource for training, technical support,
and surveillance and reporting of
epidemiological data
Human “Tools”
Colleagues & Collaborators
• Public Health Regional Response Teams
• First responders
• Environmental health specialists
• Public Health Laboratories
• Disease investigation specialists
First Responders
Traditional
•
•
•
•
Fire Department
Law Enforcement
HazMat
Emergency Medical
Services
• Department of
Transportation
• Environmental
Protection Agency
Non-traditional
• Hospitals
• Public Health
Laboratories
• Public Works
Outbreak Investigation
Triad
Outbreak Investigation Triad
Roles of an epidemiologist
• Determines existence of an outbreak
• Determines a case definition,
– e.g., “Onset of illness on or after February 1, 2005,
with at least 2 of the following: diarrhea, fever, and
vomiting”
• Conducts interviews with cases, family
members, contacts and controls
• Generates a research hypothesis
• Chooses an appropriate study design if an
analytic study is conducted
• Reviews, analyzes, and interprets interview,
analytic study, and laboratory data
Outbreak Investigation Triad
Roles of an environmental health
specialist
• Collects and tests food, water, or other
environmental elements of interest
• Inspects food service establishments for
sanitation violations or deficiencies
Outbreak Investigation Triad
Roles of a public health laboratorian
• Cultures blood and / or stool samples
• Identifies a pathogen and even the strain
of pathogen via DNA fingerprinting (known
as Pulse Field Gel Electrophoresis)
What Do Public Health
Laboratories Do?
• Confirm a situation that an epidemiologist is
investigating
– Everyday food borne illnesses
– Bioterrorism biological threats
• Serve as a liaison between the public and the
public health system
– Surveillance, monitoring, reporting
• Essential to public health practice
– Part of the public health infrastructure
– Protect community health
Surveillance, Monitoring, Reporting
• Surveillance
– Vector borne diseases
– Communicable diseases
– Food borne and waterborne diseases
• Monitoring
– Newborn screening and genetics
– Radiation monitoring and detection
– Food safety or other environmental issues
• Reporting
– Two-way with state health departments
Association of Public Health
Laboratories
• National non-profit promoting policy and
supporting practice at state and local
levels
• Has an Emergency Preparedness and
Response initiative
• Working relationship with CDC, EPA, FBI,
Department of Homeland Security
CDC Division of Laboratory
Systems
Goal: “Assure availability of consistent
laboratory capacity for public health across
the nation.”
• Demonstration Projects in four states
(WA, NE, MN, MI)
• Partnership
• Assessment
• Training
• Standards
Epidemiology Tools Used at the
Local Level
• Common and uncommon tools used in
investigations and response
• How partnerships enhance outcomes
- Within Public Health
- Outside Public health
Investigation 1
Tuberculosis
TB Exposure Investigation
Background
• Hospital Nurse with active TB died
• Several unknowns:
– duration of infectiousness
– number of patients exposed
– number of hospital visitors exposed
– identity of hospital visitors
• No base-line data to compare screening
findings
TB -Tools to Answer the Unknowns
• Need strong relationships & diplomacy
–
–
–
–
–
–
–
Hospital staff (clinical & administration)
Neighboring health districts
State health department
Laboratory
Media
Community
Local health department staff
TB – Investigation & Response
• Social & Professional
Contacts
– Coordinating three districts
– Hospital employee and staff
screening
• Screening and testing
patients and visitors
– Approx. 900 patients & 1500
visitors
• Outside help needed
TB: Evidence Based Decisions
• Time to answer the unknowns
– Period of infectiousness
• Patient Reaction Rates over time of exposure
– What patients were exposed?
• Social & Professions infection rates
• Do we expand time of exposure period?
TB - Outcomes
• 2500 people screened
– 2300 tuberculin skin tests
• 2100 (92%) read
– 128 positives
– > 350 x-rays
• 120+ hours of clinic time
• New TB testing policy and
employee illness monitoring at the
hospital
Investigation 2
Foodborne Outbreak
Foodborne Outbreak (FBO)
Background
• 200 bed residential
facility
• Unknown cause of 30 GI
illness complaints
• Mentally handicapped
population
FBO – Tools Required
• Relationships
– Facility staff
– Laboratory
– Media
– Medical Examiner
– Environmental Health program
FBO – Tools Required
• Dedicated & knowledgeable
Epidemiology Response Team
• Interviewing skills
• Outbreak investigation techniques
• Analytic skills
• Reliable references
• Diplomacy & advocacy
FBO - Results
• Cause of illness –
Clostridium perfringens
• 30 ill residents, 1
associated death
• Improved food preparation
and monitoring
• Additional staff
• Legislative measures for
more funding
Eat Chopped
Pork BBQ
Ill
Not
Ill
Total
Yes (exposed)
30
28
58
No (not exposed)
1
11
12
Total
31
39
70
AR = 51.7; RR = 6.2069; p = 0.000587
Common Toolbox Items
• Control of Communicable Disease Manual
• VDH Communicable Disease Manual
• VDH Epidemiology web site
www.vdh.state.va.us/epi/regs.asp
www.vdh.state.va.us/epi/bulletin.asp
• CDC web site www.cdc.gov
• World Health Organization
www.who.int/en/
• Pro-Med Mail www.promedmail.org
• And of course, paper & pen