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is for Epi

is for Epi. Epidemiology basics for non-epidemiologists. Session II Part I. An Epidemiologist’s Toolkit. Overview. Public health, allied health, and community collaborators Public health laboratories Data, technology, and the media Centers for Disease Control and Prevention

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is for Epi

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  1. is for Epi Epidemiology basics for non-epidemiologists

  2. Session IIPart I An Epidemiologist’s Toolkit

  3. Overview • Public health, allied health, and community collaborators • Public health laboratories • Data, technology, and the media • Centers for Disease Control and Prevention • Universal epidemiological methods

  4. 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

  5. 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

  6. Human “Tools”

  7. Colleagues & Collaborators • Public Health Regional Response Teams • First responders • Environmental health specialists • Public Health Laboratories • Disease investigation specialists

  8. Traditional Fire Department Law Enforcement HazMat Emergency Medical Services Department of Transportation Environmental Protection Agency Non-traditional Hospitals Public Health Laboratories Public Works First Responders

  9. Outbreak Investigation Triad Environmental Health Specialist Public Health Lab Epidemiologist

  10. 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

  11. 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

  12. 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)

  13. 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

  14. 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

  15. 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

  16. 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

  17. 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

  18. Investigation 1 Tuberculosis

  19. 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

  20. 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

  21. 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

  22. 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?

  23. 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

  24. Investigation 2 Foodborne Outbreak

  25. Foodborne Outbreak (FBO) Background • 200 bed residential facility • Unknown cause of 30 GI illness complaints • Mentally handicapped population

  26. FBO – Tools Required • Relationships • Facility staff • Laboratory • Media • Medical Examiner • Environmental Health program

  27. FBO – Tools Required • Dedicated & knowledgeable Epidemiology Response Team • Interviewing skills • Outbreak investigation techniques • Analytic skills • Reliable references • Diplomacy & advocacy

  28. Eat Chopped Pork BBQ Ill Not Ill Total Yes (exposed) 30 28 58 No (not exposed) 1 11 12 Total 31 39 70 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 AR = 51.7; RR = 6.2069; p = 0.000587

  29. 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 Mailwww.promedmail.org • And of course, paper & pen

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