Epidemiology Practice OfPH

Epidemiology and the Practice of Public Health: 

Epidemiology and the Practice of Public Health WVU Department of Community Medicine October 20, 2004

Robert W. White II, RS, MPH: 

Robert W. White II, RS, MPH Regional Epidemiologist Monongalia County Health Department Morgantown, WV 598-5132

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are: 

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are: 

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are: 

Bureau for Public Health – Infectious Disease Epidemiology Program – Who We Are

BPH Issues - Website: 

BPH Issues - Website http://www.wvdhhr.org/bph/oehp/sdc/a-z/a-z-idep.htm Reporting information What diseases to report How to report (forms / protocols) Disease information Information sheets Protocols Data

BPH Issues - Confidentiality: 

BPH Issues - Confidentiality HIPAA Letter from Commissioner Covered in the Communicable Disease Rule (64 CSR 7) – information cannot be released except under specified circumstances: Section 64-7-14 (pg 13)

BPH Issues – Proposed Reportable Disease Rule: 

BPH Issues – Proposed Reportable Disease Rule Proposed Updated reporting requirements for BT agents, SARS, monkeypox, enterovirus, pediatric death due to influenza Deletion of requirement to report herpes, aseptic meningitis New sections on outbreaks, BT, special surveillance projects Proposed language on the web

Surveillance Issues – Case Definitions: 

Surveillance Issues – Case Definitions National case definitions located at: www.cdc.gov/epo/dphsi/casedef/case_definitions.htm Standard criteria for use by every reporting source and health department in doing surveillance

BPH Issues - AMR: 

BPH Issues - AMR Four outbreaks of CA-MRSA in 2003 Outbreak report Encourage reporting of Outbreaks of CA-MRSA - within 24 hours (required by communicable disease rule) Cases of CA-MRSA (voluntary) Cases of Invasive Streptococcus pneumoniae and antimicrobial resistance profile (required)

BPH Issues – AMR (2): 

BPH Issues – AMR (2) GET SMART campaign CDC-designed information campaign Easy to participate Electronic copies on our website We invite your participation: ICP Laboratory Director Pharmacy Director Medical Staff Director Anyone!

BPH Issues -- Timeliness of Reporting (3): 

BPH Issues -- Timeliness of Reporting (3) Pertussis Contacts must be traced and started on prophylaxis ASAP Symptomatic contacts should be identified, begun on therapy, and isolated during the first 5 days of treatment

BPH Issues -- Timeliness of Reporting (4): 

BPH Issues -- Timeliness of Reporting (4) Foodborne Do not need laboratory confirmation by OLS to report Delayed investigation results in Decreased recall of food history and other risk factors Delayed recognition of clusters and outbreaks Lost opportunities to confirm the etiologic agent

BPH Issues – Completeness of Reporting: 

BPH Issues – Completeness of Reporting PAPER WV BPH Confidential Reportable Disease Case Report Form (Yellow Card) Patient Onset of symptoms Demographic information Full name and address - helps us refer the investigation to the proper county (or state!) Physician Full name, address, phone – facilitates the investigation Attach copy of appropriate labs NEDSS Completely fill out the provider section

BPH Issues – Timeliness of Reporting: 

BPH Issues – Timeliness of Reporting Hepatitis A (24 hours) LHD must offer immune globulin to contacts within 2 weeks after exposure Hepatitis B (24 hours) LHD must offer hepatitis B immune globulin (HBIG) to Sexual contacts within 2 weeks of the last contact and Needle-sharing contacts within 1 week of last exposure

Bacterial Isolates that Should be Referred to OLS: 

Bacterial Isolates that Should be Referred to OLS Bacillis anthracis Clostridium botulinum Corynebacterium diphtheriae Enterhemorrhagic E coli Haemophilus influenzae Listeria monocytogenes Mycobacterium tubersulosis Neisseria meningitidis Salmonella typhi Shigella sp Staphylococcus aureus with glycopeptide-Intermediate (GISA/VISA) or glycopeptide resistant (GRSA/VRSA) susceptibilities CA-MRSA Streptococcus pneumoniae, invasive Tularemia Vibrio cholerae Yersinia pestis

Viral / Serological Specimens that Should be Confirmed by OLS: 

Viral / Serological Specimens that Should be Confirmed by OLS Arboviral encephalitis Hantavirus Mumps (IgM) Poliomyelitis Rabies, animal or human Rubella (IgM) Rubella (IgM) Smallpox

BPH Issues - Foodborne Disease : 

BPH Issues - Foodborne Disease Salmonella, Shigella, Campylobacter, Listeria, Enterotoxigenic E coli Serotyping PFGE Typing of shigatoxin-producing E coli Do not wait for OLS confirmation to report a positive from your laboratory If you report, we begin the epi investigation immediately.

10 Things I Didn't Learn in School or Real Life Epidemiology: 

10 Things I Didn't Learn in School or Real Life Epidemiology

Introduction: 

Introduction How my education prepared me for this job How real life differs from the model How things can really go wrong (even when you have good intentions)

1. When is information not that necessary?: 

1. When is information not that necessary? 1977 Halloween Party Outbreak 23 sick students Allergic reaction to hay CDC advised blood samples on all 23 ill patients Science Doesn’t Overcome 23 Crying Children

2. Just What is Swine Flu?: 

2. Just What is Swine Flu? Mass immunization clinics held throughout the county Marion County Armory was the site But what does a Sanitarian do ? Register patients and run for coffee Be ready to do whatever is needed

3. Are you ever off the record?: 

3. Are you ever off the record? Superfund Clean-up site in Marion County Public meeting on testing and remediation Spoke to some individuals in the hallway prior meeting (one was a reporter) Headlines the following day- “Sanitarian says It’s All Just Part of the Plan” Know Your Audience

4. How do you get away from the rioting crowd?: 

4. How do you get away from the rioting crowd? Community sewage problems in South Fairmont Public hearing set Another Sanitarian and I didn’t think the meeting would be well attended - we put out maps showing the problem locations Help- 250 angry residents

5. How gross can it get?: 

5. How gross can it get? Family with recurring diarrhea Physician asked if HD would collect water sample 37 miles and 4 dirt roads one way Opened the hand dug well- a family of mice had drowned Excuse me while I …..

6. Should you always do what the boss says?: 

6. Should you always do what the boss says? Shigella outbreak in Morgantown I had been a Regional Epi for 1 week News station wanted to go with a live outdoor remote broadcast 15 seconds before broadcast the wind and rain started Reporter looked at me and said, “Tell me everything you know, you have 2 minutes live.” The boss isn’t always right

7. How long does it take to wrap up an investigation?: 

7. How long does it take to wrap up an investigation? Food borne outbreak at a Christmas party at a medical center Outbreak team responded well and had under control within 1 day B. Cereus as the culprit but couldn’t find the source- six months later employee volunteered information It’s not over till it’s over

8. Is the Doctor Always Right?: 

8. Is the Doctor Always Right? Meningitis outbreak in jail Set up a meeting with the corrections officers- I got there first and began giving handouts from CDC website Physician showed 30 minutes late and wanted to go on TV with his message. You may know more but…don’t show up the Doctor—Still have him stick to the script

9. What is Validity (and will I ever use it in real life)?: 

9. What is Validity (and will I ever use it in real life)? Working on a major food borne outbreak at an elementary school Surveyed 4th and 6th graders as to what they ate for lunch for the week One student answered that he ate lunch every day at school, then said he had been sick all week and hadn’t been to class Now I know what Validity is

10. How far will you go to complete the job?: 

10. How far will you go to complete the job? Food borne outbreak at a medical center luncheon (Mardi Gras) Completed surveys, sampled leftovers, and wrapped most of the investigation Evidence pointed to drinks, particularly ice rings made in Pennsylvania In the darkness of night I was invited into a PA home, sampled the well and snuck back into WV for lab testing (Whatever it takes)

In Conclusion: 

In Conclusion Make sure the information is worth the effort Be ready to do what is necessary Know your audience and adjust the message Don’t cause undo hardship on yourself Don’t bring in notions of what’s right and wrong Realize that orders can be changed It takes time to solve problems Everybody makes mistakes Text books don’t tell the whole story It’s sometimes better to beg forgiveness than to ask for permission

Mark Twain (1835 - 1910) : 

Mark Twain (1835 - 1910) I have never let my schooling interfere with my education. Mark Twain (1835 - 1910)