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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

  • Common and uncommon tools used in investigations and response

  • How partnerships enhance outcomes

    • Within Public Health

    • Outside Public health

P. Brumund, Chesapeake HD


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Investigation 1

Tuberculosis

P. Brumund, Chesapeake HD


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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


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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


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TB – Game Plan

  • Create a team (ICS)

P. Brumund, Chesapeake HD


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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


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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


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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


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Investigation 2

Foodborne Outbreak

P. Brumund, Chesapeake HD


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Foodborne Outbreak (FBO)

Background

  • 200 bed residential facility

  • Unknown cause of 30 GI illness complaints

  • Mentally handicapped population

P. Brumund, Chesapeake HD


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FBO – Tools Required

  • Relationships

    • Facility staff

    • Laboratory

    • Media

    • Medical Examiner

    • Environmental Health program

P. Brumund, Chesapeake HD


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FBO – Tools Required

  • Dedicated & Knowledgeable Epidemiology Response Team

  • Interviewing skills

  • Outbreak Investigation techniques

  • Analytic skills

  • Reliable references

  • Diplomacy & Advocacy

P. Brumund, Chesapeake HD


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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


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Investigation 3

Severe Acute Respiratory Syndrome

(SARS)

P. Brumund, Chesapeake HD


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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


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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


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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


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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


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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


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QUESTIONS ?

Paul Brumund

Epidemiologist

Chesapeake Health Department

757-382-8642

[email protected]

P. Brumund, Chesapeake HD


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