Feburary 3, 2005P. Brumund, Chesapeake HD1 Epidemiology Tools Used at the Local Level Common and uncommon tools used in investigations and response How

Feburary 3, 2005 P. Brumund, Chesapeake HD 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


Investigation 1

Tuberculosis


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


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 – Game Plan • Create a team (ICS)

TB Incident Command Structure (ICS)

Incident CommanderDr. N. Welch

LiaisonR. Rendin

PlanningR. Rendin

OperationsM. Vollmer

LogisticsR. Witwer

AdministrationR. Witwer

InvestigationsS. Ward-Thom

Call CenterD. Rorrer

ClinicL. Boyette/J. Saunders

EPIP. Brumund/B. Rouse

ClinicalN. Welch/B. Rouse

DataP. Brumund

PIOL. Hill


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


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 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


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

AR = 51.7; RR = 6.2069; p = 0.000587


Investigation 3

Severe Acute Respiratory Syndrome

(SARS)


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


SARS – Tools Used

Relationships• Hospital

– Infection Control– Emergency Department– Administration– Public Relations

• Attending Physician• Media• Community• Patient & Family

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


SARS – Tools cont’d

• 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 - 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


Common Toolbox Items

• Control of Communicable Disease Manual• VDH Communicable Disease Manual• VDH Epidemiology web site

www.vdh.state.va.us/epi/regs.aspwww.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

http://www.vdh.state.va.us/epi/regs.asp

http://www.cdc.gov/

http://www.who.int/en/


QUESTIONS ?

Paul Brumund

Epidemiologist

Chesapeake Health Department

757-382-8642

[email protected]

Documents

Feburary 3, 2005P. Brumund, Chesapeake HD1 Epidemiology Tools Used at the Local Level Common and uncommon tools used in investigations and response How