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Epidemiology Tools Used at the Local Level

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

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Epidemiology Tools Used at the Local Level

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  1. 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 P. Brumund, Chesapeake HD

  2. Investigation 1 Tuberculosis P. Brumund, Chesapeake HD

  3. TB Exposure Investigation Background • Hospital Nurse with active TB died • Unknown duration of infectiousness • Unknown number of patients exposed • Unknown number of hospital visitors exposed or their identity • No base-line data to compare screening findings P. Brumund, Chesapeake HD

  4. 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 P. Brumund, Chesapeake HD

  5. TB – Game Plan • Create a team (ICS) P. Brumund, Chesapeake HD

  6. TB – Investigation & Response • Social & Professional Contacts • Coordinating three districts • Hospital employee and staff screening • Screening and testing patients and visitors • Approx. 900 patients • Approx. 1500 visitors • Outside help needed P. Brumund, Chesapeake HD

  7. 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? P. Brumund, Chesapeake HD

  8. TB - Outcomes • 2500 people screened • 2300 TSTs • 2100 (92%) read • 128 positive TST • > 350 x-rays • 120+ hours of clinic time • New TB testing policy and employee illness monitoring at the hospital P. Brumund, Chesapeake HD

  9. Investigation 2 Foodborne Outbreak P. Brumund, Chesapeake HD

  10. Foodborne Outbreak (FBO) Background • 200 bed residential facility • Unknown cause of 30 GI illness complaints • Mentally handicapped population P. Brumund, Chesapeake HD

  11. FBO – Tools Required • Relationships • Facility staff • Laboratory • Media • Medical Examiner • Environmental Health program P. Brumund, Chesapeake HD

  12. FBO – Tools Required • Dedicated & Knowledgeable Epidemiology Response Team • Interviewing skills • Outbreak Investigation techniques • Analytic skills • Reliable references • Diplomacy & Advocacy P. Brumund, Chesapeake HD

  13. 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 AR = 51.7; RR = 6.2069; p = 0.000587 P. Brumund, Chesapeake HD

  14. Investigation 3 Severe Acute Respiratory Syndrome (SARS) P. Brumund, Chesapeake HD

  15. Severe Acute Respiratory Syndrome (SARS) Background • March 2003 E.D. patient has flu- like symptoms • ED physician recognizes travel history • New Disease = lack of information, diagnostics • Concerned about exposure: • Hospital staff • Community • Family P. Brumund, Chesapeake HD

  16. SARS – Tools Used Date: 10 Feb 2003 From: Stephen O. Cunnion, MD, PhD, MPH This morning I received this e-mail and then searched your archives and found nothing that pertained to it. Does anyone know anything about this problem? Have you heard of an epidemic in Guangzhou? “An acquaintance of mine from a teacher's chat room lives there and reports that the hospitals there have been closed and people are dying.“ A ProMED-mail post Relationships • Hospital • Infection Control • Emergency Department • Administration • Public Relations • Attending Physician • Media • Community • Patient & Family P. Brumund, Chesapeake HD

  17. Communication Hot line Mass communication Internet / email Pro-Med email Public Health Regulations Isolation & Quarantine Reportable condition Tools Not Available Diagnostic to confirm illness Reference materials and investigation tools Confidence infection control is working Additional surveillance required SARS – Tools cont’d P. Brumund, Chesapeake HD

  18. SARS - Results • Patient survived • One of nine confirmed US cases • Source patient survived • Other exposed contacts died • Tools for future use • CDC Studies • Employee exposure • Household contacts • Long-term effects of SARS P. Brumund, Chesapeake HD

  19. 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 P. Brumund, Chesapeake HD

  20. QUESTIONS ? Paul Brumund Epidemiologist Chesapeake Health Department 757-382-8642 Paul.brumund@vdh.Virginia.gov P. Brumund, Chesapeake HD

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