Presentation Transcript

1. Epidemiology Applications:Forensic Epidemiologyand Maternal and Child Health Epidemiology

   Session 5, Part 2
2. Learning ObjectivesSession 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
3. Session OverviewSession 5, Part 2 Forensic epidemiology Maternal and child health epidemiology

4. Forensic Epidemiology

5. Forensic Epidemiology Epidemiologic methods applied in a setting of potential criminal investigation Richard A. Goodman, CDC
6. 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
7. 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
8. 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
9. Challenges Using Epidemiology in the Courtroom Epidemiology studies disease in populations, not individuals Science is ever-changing Difficult to prove exposure caused disease
10. 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
11. 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 Field-Based Forensic Epidemiology
12. Public Health Make people safer and healthier Prevent disease outbreaks Conduct disease surveillance and management Law Enforcement Protection of public Prevention of criminal acts Identification, apprehension, and prosecution of perpetrators Safeguarding all involved Public Health and Law Enforcement Goals
13. 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
14. 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
15. 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
16. 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
17. 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
18. 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
19. 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
20. Handling Credible Threat Evidence Handle as evidence and establish a chain of custody Process evidence through an approved Laboratory Response Network (LRN)
21. 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)
22. Confidentiality Public health Confidentiality of patient and medical records Law enforcement Confidentiality of witness or informant
23. 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
24. 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 Classified
25. 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
26. Intentional or Accidental Mass Incidents 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

27. Maternal and Child Health Epidemiology

28. 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
29. MCH Epidemiology Project Areas Surveillance Maternal mortality Perinatal morbidity and mortality Birth defects Newborn screening Maternal / pediatric nutrition Assistance / partnership Women, Infants, and Children program (WIC) Medicaid Program evaluation
30. 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
31. 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
32. References and Resources 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 Bioterrorism-Related 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.
33. References and Resources 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.
34. References and Resources 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;278:389-395. 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.