Feburary 3, 2005P. Brumund, Chesapeake HD1 Epidemiology Tools Used at the Local Level Common and...
-
date post
21-Dec-2015 -
Category
Documents
-
view
214 -
download
0
Transcript of Feburary 3, 2005P. Brumund, Chesapeake HD1 Epidemiology Tools Used at the Local Level Common and...
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
Feburary 3, 2005 P. Brumund, Chesapeake HD 2
Investigation 1
Tuberculosis
Feburary 3, 2005 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
Feburary 3, 2005 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
Feburary 3, 2005 P. Brumund, Chesapeake HD 5
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
Feburary 3, 2005 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
Feburary 3, 2005 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?
Feburary 3, 2005 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
Feburary 3, 2005 P. Brumund, Chesapeake HD 9
Investigation 2
Foodborne Outbreak
Feburary 3, 2005 P. Brumund, Chesapeake HD 10
Foodborne Outbreak (FBO)
Background• 200 bed residential facility
• Unknown cause of 30 GI illness complaints
• Mentally handicapped population
Feburary 3, 2005 P. Brumund, Chesapeake HD 11
FBO – Tools Required
• Relationships
– Facility staff
– Laboratory
– Media
– Medical Examiner
– Environmental Health program
Feburary 3, 2005 P. Brumund, Chesapeake HD 12
FBO – Tools Required
• Dedicated & Knowledgeable Epidemiology Response Team
• Interviewing skills
• Outbreak Investigation techniques
• Analytic skills
• Reliable references
• Diplomacy & Advocacy
Feburary 3, 2005 P. Brumund, Chesapeake HD 13
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
Feburary 3, 2005 P. Brumund, Chesapeake HD 14
Investigation 3
Severe Acute Respiratory Syndrome
(SARS)
Feburary 3, 2005 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
Feburary 3, 2005 P. Brumund, Chesapeake HD 16
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
Feburary 3, 2005 P. Brumund, Chesapeake HD 17
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
Feburary 3, 2005 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
Feburary 3, 2005 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.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
Feburary 3, 2005 P. Brumund, Chesapeake HD 20
QUESTIONS ?
Paul Brumund
Epidemiologist
Chesapeake Health Department
757-382-8642