Introduction to North Carolina Epidemiology Teams

Presentation Overview

• What is an Epi Team?

• Who belongs to an Epi Team?

• What are the responsibilities of an Epi Team?

• How does an Epi Team function?

• What is an example of an Epi Team investigation?

Learning Objectives

• List the roles on a local health department Epi Team

• Describe the primary responsibilities of an Epi Team

• Give an example of a successful Epi Team investigation in North Carolina

What is an Epi Team?

• Multi-disciplinary public health response team that exists in a state of readiness to respond to public health threats

Epi Team Roles

• Team Leader• Epidemiologist• Nurse• Environmental Health Specialist• Public Information Officer• Laboratorian• Administrator• IT Specialist

Team Leader

• Description– Experience in outbreak investigation and

epidemiology

– May be different for different outbreaks

– Role can be filled by local health director or designee

Team Leader

• Responsibilities– Convenes Epi Team– Provides oversight for investigation– Assigns tasks to other team members– Serves as contact with other agencies– Conducts regular meetings– Facilitates outbreak interventions– Reports outbreaks

Epidemiologist

• Description

– Expertise in field epidemiology methods

– Experience developing case definitions and

questionnaires

Epidemiologist

• Responsibilities– Monitors surveillance data– Creates case definitions– Maintains line listing of cases– Trains team members on case finding and

follow-up– Provides daily reports on case finding and

case counts– Ensures data quality

Nurse

• Description– Formal nursing training

– Knowledge of disease prevention and treatment

– Health education experience

Nurse

• Responsibilities– Advises providers regarding disease signs

and symptoms, transmission, incubation period, and treatment

– Collects clinical specimens– Educates cases and contacts – Visits health care providers– Monitors contacts for symptoms– Coordinates vaccine supply and distribution

Environmental Health Specialist

• Description– Experience with environmental field

investigations

– Knowledge of food and water safety regulations

– Knowledge of environmental sampling

Environmental Health Specialist

• Responsibilities– Monitors environmental surveillance data– Conducts field investigations and traceback

investigations– Collects environmental samples– Provides guidance on food and water safety

regulations and engineering– Implements facility-related control measures– Communicates with Division of Environmental

Health

Public Information Officer

• Description– Knowledge of risk and crisis communication

– Experience developing media messages

– Role may be filled by Health Educator

Public Information Officer

• Responsibilities– Reviews provider and public alerts, fact

sheets, and reporting reminders– Prepares/reviews press releases– Responds to media inquires– Ensures availability of appropriate educational

materials

Laboratorian

• Description– Expertise in laboratory testing

– Knowledge of proper specimen collection and transport procedures

Laboratorian

• Responsibilities

– Provides information on proper collection and

transport of clinical specimens

– Coordinates submission of specimens to

State Laboratory of Public Health

Administrator

• Description– Knowledge of local health department policies

and procedures

– Experience handling staff expenses

Administrator

• Responsibilities– Distributes meeting agendas– Records minutes and keeps records of

meetings– Tracks staff expenses (overtime, travel

reimbursement)– Assures after hours building and cell phone

access

IT Specialist

• Description– Knowledge of local health department

computer system

– Experience with database development and management

IT Specialist

• Responsibilities– Assists in database development,

modification, and maintenance– Provides technical support– Assists with data entry– Supplies team with necessary equipment

Responsibilities of an Epi Team

• Coordinate disease surveillance activities

• Conduct epidemiologic investigations

• Gather and analyze information from investigations

• Recommend public health control measures

• Educate the public

Coordinate Disease Surveillance

• Monitor routine surveillance data

• Compare expected to observed numbers and rates

• Investigate reports from healthcare providers

• Confirm or refute rumors of outbreaks

Conduct Epidemiologic Investigations

• Verify the diagnosis and confirm the outbreak

• Define and find cases• Collect data• Tabulate and analyze data• Generate hypotheses• Communicate findings• Write final report

Gather and Analyze Information

• Collect data– Interviews– Medical records– Attendance rosters– Business receipts

• Organize data by person, place, and time

• Analyze data

Recommend Public Health Control Measures

• Decide upon appropriate control measures

• Communicate necessity of control measures to health director

• Work with community partners to implement control measures if necessary

Educate the Public

• Provide information about the disease or health condition to the general public or those at risk of infection

• Provide guidance to agencies dealing with outbreaks– Institutional settings (e.g. long-term care

facilities, correctional facilities, schools)– Food service establishments

How Does an Epi Team Function?

• Meetings

• Communication

• Incident Command System

• Coordination with Public Health Regional Surveillance Teams and Division of Public Health

Regular Meetings

• Review routine surveillance data

• Discuss notification procedures

• Develop procedures for disseminating information to general public

• Provide Epi Team members with training opportunities

Daily Meetings

• Provide updates about investigation progress

• Make decisions about next steps

• Assign people to each action

After-Action Review

• What methods worked well?• What mistakes were made and how to

prevent these in the future?• What changes to the process of outbreak

investigation should be made?• Who will be responsible for seeing these

changes implemented? • Was communication flow maintained?• How did the media affect the outbreak?

Epi Team Contact Information

• Maintain database of all team members– Name, specialty, best way to contact– Phone numbers (work, home, cell)– Pager number– Email address– Emergency contact

• Distribute to all team members

• Update regularly

External Communication

• Provide regular updates to external partners– NC Division of Public Health– Other state agencies (e.g. Div of Env Health)– Public Health Regional Surveillance Team– Local stakeholders – hospitals, healthcare

providers, other government leaders/agencies, community organizations

– General public

• Maintain routine communication

Documentation

• Regular meeting minutes

• Daily investigation log– All steps taken in the investigation– Decisions made and rationale– Contacts: name, position, contact info– Meeting minutes– Photographs

Outbreak Report

• Outbreak detection

• Case definition and epi curve

• Epidemiologic, environmental, and laboratory methods

• Results of epidemiologic, environmental and laboratory studies

• Conclusion

• Recommendations

Outbreak Report Timeline

• First clinical observation• Accurate diagnosis• Laboratory confirmation• Identification of exposure

source• Report to public health

authority• Report to law

enforcement authority

• Initiation of emergency operations plan

• Initiation of control measures

• Initiation of post-exposure prophylaxis

• Initiation of public education

• Initiation of risk advice to health care workers

• Last reported case

Potter et al., 2007

Incident Command System

• ICS provides a structure to manage projects or events efficiently and effectively

• Epi Team members should take ICS training

• Practice ICS during routine activities

Coordination with DPH and PHRST

• Communicate with appropriate DPH branch from the outset and at regular intervals

• Contact Public Health Regional Surveillance Team (PHRST)

• Define the role of each agency in an investigation

Other Partners

• Media• Emergency Management / EMS• Law enforcement• NC Department of Agriculture• NC Division of Environmental Health • Hospitals and health care providers• Veterinarians• Universities / schools• NC State Laboratory of Public Health• Community organizations

Tips for Success

• Assure staff is well-trained• Maintain open communication• Keep NC DPH and State Lab informed

about outbreak events• Collect samples• Plan data analysis• Use Epi Info for data entry and analysis• Monitor status of supplies• WORK AS A TEAM!

Example of NC Epi Team Investigation

Nash County Epi Team Investigation

• 29 people with nausea, vomiting, diarrhea, and stomach cramps present to Nash General Hospital over 2 days

• Nash County Epi Team– Starts line listing– Interviews patients to identify epi link– Advises testing for norovirus– Works with hospital for infection control

measures

Nash County Epi Team Investigation

• Epi Team sends letter to child care centers, nursing homes, schools, and restaurants about infection control

• 5 laboratory specimens positive for norovirus

• Over 200 Emergency Room patients, 2 deaths

Nash County Epi Team Investigation

• Having an Epi Team that met regularly was helpful– Team responded quickly– Each team member understood his/her role– Response was coordinated

Importance of Epi Teams

• Increase capacity of LHD

• Provide structure and organization to LHD response

• Provide venue for continuing training

Conclusion

• Working as a team requires:– A wide range of expertise

– Clear communication

– A rapid but careful and systematic approach to disease outbreaks and other public health emergencies

References

• NC Division of Public Health. North Carolina Communicable Disease Control Manual. http://www.epi.state.nc.us/epi/gcdc/manual/toc.html. Accessed April 29, 2008.

• Potter MA, Sweeney P, Iuliano AD, Allswede MP. Performance indicators for response to selected infectious disease outbreaks: a review of the published record. J Public Health Manag Pract 2007;13(5):510-518.