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Happy Healthy and Safe Swimming Week 2017 Everyone!

Posted By Thuy Kim, MPH, Friday, May 26, 2017
Updated: Friday, May 26, 2017

As summer approaches, many Americans will be searching for solace from the heat in recreational water. Each year, the week before Memorial Day is designated as Healthy and Safe Swimming Week (May 22-28). This year’s observance marks its 13th anniversary of promoting healthy and safe swimming practices for both swimmers and pool operators.


Whether it be in lakes, rivers, water parks, splash pads or neighborhood swimming pools – epidemiologists know that it is no coincidence there is an uptick of waterborne disease outbreaks during the hot summer months. The last major outbreak I investigated before I left the Alabama Department of Public Health (ADPH) in late 2016 to join the CSTE team happened to be a Cryptosporidum outbreak at a local water park. We were happy to have had cooperation from the water park owners and staff who voluntarily closed their facility for treatment. Unfortunately, we were not able to recover organisms from the water. That summer, other states also experienced waterborne disease outbreaks and our collective stories were published in a recently released MMWR.

 

Pictured: CSTE staff member Thuy Kim, MPH contributed to a CDC MMWR focused on a Crypto outbreak in Alabama, Arizona and Ohio in 2016.

In the spirit of this week, a few CSTE members have also written and created an educational music video on water safety. The video was written by Taishayla Mckitt and stars Miranda Daniels and Allison Roebling – all from ADPH.  Please enjoy, like, comment, share and take some notes!

 

 

Thuy Kim, MPH is an Associate Research Analyst II at CSTE with a focus on Enteric Diseases.

Tags:  cryptosporidiosis  infectious disease 

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Wild Ride for Public Health Funding

Posted By Emily J. Holubowich , Friday, May 19, 2017
Updated: Friday, May 19, 2017

May 5 was filled with ups and downs on the public health funding front. On the upside, federal spending legislation for fiscal year (FY) 2017 was signed into law, bringing long overdue closure to public health funding—eight months into the fiscal year. All things considered, CSTE’s funding priorities fared well given that funding for the Centers for Disease Control and Prevention (CDC) was cut by $13 million. Funding for the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) increased by about $5 million, including a $3 million increase for the antibiotic resistance (AR) initiative and a $2 million increase for food safety. As always, we would expect much of NCEZID’s funding to support core infectious disease surveillance capacity at state and local health departments through Epidemiology and Laboratory Capacity (ELC) grants. This funding would be in addition to $40 million from the mandatory Prevention and Public Health Fund (PPHF) provided to ELC grants for the sixth consecutive year. Other NCEZID initiatives—vectorborne disease, advanced molecular protection, hospital acquired infections, National Healthcare Safety Network—were all flat funded.

On the downside, the Public Health Workforce program, through which the CDC/CSTE Applied Epidemiology Fellowship receives funding, was cut by $2 million. The appropriations bills do not specify how much funding would be dedicated to the Applied Epidemiology Fellowship program per se, but we should expect this cut to have an impact on future fellowships.



Photo credit: Emily J. Holubowich

While many were cheering the passage federal spending legislation and the avoidance of a government shutdown on May 5, the House of Representatives resurrected and passed by one vote the American Health Care Act (AHCA) as part of its efforts to “repeal and replace” the Affordable Care Act (ACA). If enacted, the legislation would terminate the PPHF beginning in FY 2019. The loss of the nearly $1 billion PPHF would result in a 12 percent cut to CDC’s total budget and a significant reduction or elimination of funding to many state and local public health programs—ELC, immunizations and the Preventive Health and Health Services Block Grant among them.

Upon its passage in the House, the Senate almost immediately rejected the AHCA, with leadership announcing their intentions to move forward in drafting their own ACA repeal legislation. A working group of 13 GOP Senators representing centrists and conservatives is working to craft a compromise, and another small group of Republicans and Democrats led by Senators Susan Collins (R-ME) and Bill Cassidy (R-LA) are simultaneously working to craft an ACA “repair” package that can garner support on both sides of the aisle. In sum, as the future of the ACA repeal is murky at best one thing is clear: don’t expect any swift action from the “World’s Greatest Deliberative Body.”

All eyes now turn to FY 2018, and the release of the President’s budget on May 23. The full budget will provide more information about the administration’s specific funding priorities—we’re anticipating cuts and consolidations galore! But of course, it will be up to Congress to ultimately decide how to prioritize spending. The budget resolutions that will emerge from the House and Senate Budget Committees in June will set the tone for ongoing discussions about public health funding and largely determine the fate of spending bills going forward. Deep cuts to spending in the budget resolutions will be rejected by Democrats, making it nearly impossible to move any appropriations legislation—legislation that will require bipartisan support to clear either chamber.

For more information about funding levels for your specific priorities, please click here for a copy of the omnibus spending legislation, and click here for a copy of the accompanying report that provides more detailed instructions about public health funding levels and intended purposes.


Emily Holubowich is Senior Vice President at CRD Associates and serves as CSTE’s Washington representative, leading our advocacy efforts in the nation’s capital.
 

Tags:  epidemiology  infectious disease  surveillance 

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2017 Plenary Speakers & Mann Memorial Lecturer

Posted By CSTE Staff, Friday, May 12, 2017
Updated: Thursday, May 11, 2017
CSTE is pleased to announce an exciting lineup of speakers at this year’s annual conference in Boise, Idaho with diverse professional backgrounds and insightful presentations to share. Our 2017 speakers will share their perspectives on applied public health epidemiology, with a focus on the 2017 conference theme - “Cultivating an Environment for Better Health.”

Keiji Fukuda , MD, MPH– Jonathan M. Mann Memorial Lecture

Keiji Fukuda is the Director and a Clinical Professor at the University of Hong Kong School of Public Health. He previously worked at the World Health Organization (WHO) in several capacities including Assistant Director-General (ADG) and Special Representative of the Director-General for antimicrobial resistance; ADG for the Health Security and Environment Cluster; and Director of the Global Influenza Programme. Before that, he worked at the U.S. Centers for Disease Control and Prevention (CDC) as the Epidemiology Section Chief, Influenza Branch and as a Medical Epidemiologist in the Viral Exanthems and Herpesvirus Branch, National Center for Infectious Diseases. Professor Fukuda has been a global public health leader in many areas including health security; emerging infectious diseases including seasonal, avian and pandemic influenza, SARS, MERS and Ebola; antimicrobial resistance; development of the Pandemic Influenza Preparedness Framework; implementation of the International Health Regulations; food safety; and chronic fatigue syndrome. He has considerable experience in epidemiological research and field investigations, media communications and international diplomatic negotiations including those held to establish a historic Heads of State level meeting on antimicrobial resistance at the United Nations in 2016. He has a BA in Biology, an MD; an MPH; was trained in the Epidemic Intelligence Service at CDC and is certified in internal medicine by the American Board of Internal Medicine.

Caleb Banta-Green, PhD, MPH, MSW

Caleb Banta-Green is a Principal Research Scientist at the Alcohol & Drug Abuse Institute, an Affiliate Associate Professor at the School of Public Health and Affiliate Faculty at the Harborview Injury Prevention & Research Center at the University of Washington. He conducts research and provides community and professional technical assistance on opioid use disorder treatment and opioid overdose interventions. He is currently analyzing data from an NIH funded clinical trial on opioid overdose prevention and has recently started at clinical trial to test an opioid use disorder treatment intervention for those released from prison. He is evaluating a HHS SAMHSA funded community based overdose prevention intervention and working with the Washington Department of Health on developing opioid overdose surveillance systems. He has been the Seattle representative to the NIH NIDA drug epidemiology workgroup since 2001. In 2012, he served as the Senior Science Advisory in the White House drug policy office working on opioid overdose prevention.

CAPT. Martin (Marty) Cetron, MD

Dr. Cetron is director of the Division of Global Migration and Quarantine (DGMQ) at the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). He previously served as director of DGMQ when it was within the National Center for Preparedness, Detection, and Control of Infectious Diseases. DGMQ’s mission is to prevent the introduction and spread of infectious diseases into the U.S. and to prevent morbidity and mortality among immigrants, refugees, migrant workers and international travelers. Dr. Cetron’s primary research interest is international health and global migration with a focus on emerging infections, tropical diseases and vaccine-preventable diseases in mobile populations.

Since coming to CDC in 1992, Dr. Cetron he has led a number of domestic and international outbreak investigations, conducted epidemiologic research and been involved in domestic and international emergency responses to provide medical screening and disease prevention programs to refugees prior to U.S. resettlement. He played a leadership role in CDC responses to intentional and naturally acquired emerging infectious disease outbreaks, including the anthrax bioterrorism incident, the global SARS epidemic, the U.S. monkeypox outbreak and the H1N1 pandemic. Dr. Cetron is also part of CDC’s Pandemic Influenza Planning and Preparedness Team. He holds faculty appointments in the Division of Infectious Diseases at the Emory University School of Medicine and the Department of Epidemiology at Rollins School of Public Health.

Dr. Cetron received his bachelor of arts degree from Dartmouth College in 1981 and his MD from Tufts University in 1985. He trained in internal medicine at the University of Virginia and infectious diseases at the University of Washington before becoming a commissioned officer in the U.S. Public Health Service in 1992.


Jacqueline MacDonald Gibson, PhD, MS

Dr. Gibson is currently an associate professor in the Department of Environmental Sciences and Engineering at the University of North Carolina, Chapel Hill. She had a 13-year career working for public policy research institutions before returning to school to earn a dual Ph.D. and entering academia.

As a senior engineer at the nonprofit RAND Corp., she served as liaison to the White House Office of Science and Technology Policy and conducted technical reviews of risk assessment methods adopted by government agencies. As associate director of the Water Science and Technology Board of the National Research Council, which advises Congress and the federal government on science policy matters, Dr. Gibson led a range of studies of issues at the interface between water science and public policy.

Studies included assessment of options for improving potable water service to small U.S. communities, evaluation of regulatory requirements for the remediation of contaminated groundwater, and assessment of research priorities for new environmental remediation technologies. She has also given briefings on these and other topics to a variety of federal officials, members of Congress and their staffs, and institutional advisory boards.


Christine Hahn, MD

Christine Hahn, MD, known for her common-sense approach to often challenging situations, has wanted to help as many people as possible since she finished her training as an Epidemic Intelligence Service Officer with the Centers for Disease Control and Prevention in 1995. She realized then she enjoys helping people live healthier lives now, as well as in the future. That led her to accept the position as Idaho’s state epidemiologist in 1996, and she continues to be the go-to authority for an array of healthcare professionals in the state, as well as the state’s public health districts. Her favorite part of the job is being able to help busy medical providers get the tools they need so they and their patients are successful. Her work overseeing the Idaho Refugee Health Screening Program has helped to provide better coordination and standardization of screening processes between clinics throughout the state in the last two years. She also has been instrumental in aligning Idaho’s immunization requirements with the CDC’s Advisory Committee on Immunization Practices, meaning that more children are starting school with the recommended panel of vaccines. As the state’s tuberculosis controller, she has advised and supported physicians treating and managing the disease.

Hahn attended Medical School at Michigan State University and completed a residency in Internal Medicine at the Mayo Clinic’s Graduate School of Medicine. She then completed a Fellowship in Infectious Diseases at Duke University Medical Center. After a two-year training program as an Epidemic Intelligence Service Officer with the CDC, she became the Idaho state epidemiologist. Hahn served on the CDC’s Advisory Committee for the Elimination of Tuberculosis until June 2012. She was recently named the Medical Director for the Division of Public Health with oversight of the Bureau of Communicable Disease Prevention and the Idaho Bureau of Laboratories. She served as president of the Council of State and Territorial Epidemiologists from 2004-2005, and remains active in that organization. She is the organization’s liaison to the CDC Advisory Committee on Immunization Practices, which sets national vaccination policy. Locally, Hahn serves on the infection prevention committees of Saint Alphonsus and St. Luke’s regional medical centers in Boise and is on the board of Idaho’s Immunization Policy Commission.


Debra Houry, MD, MPH

Dr. Houry is the Director of the National Center for Injury Prevention and Control (NCIPC) at CDC. In this role, Dr. Houry leads innovative research and science-based programs to prevent injuries and violence and to reduce their consequences. She joined the CDC in October 2014. She has previously served as Vice-Chair and Associate Professor in the Department of Emergency Medicine at Emory University School of Medicine and as Associate Professor in the Departments of Behavioral Science and Health Education and in Environmental Health at the Rollins School of Public Health. Dr. Houry also served as an Attending Physician at Emory University Hospital and Grady Memorial Hospital and as the Director of Emory Center for Injury Control. Her prior research has focused on injury and violence prevention in addition to the interface between emergency medicine and public health, and the utility of preventative health interventions and screening for high-risk health behaviors. She has received several national awards for her work in the field of injury and violence prevention.

Dr. Houry received the first Linda Saltzman Memorial Intimate Partner Violence Researcher Award from the Institute on Violence, Abuse, and Trauma and the Academy of Women in Academic Emergency Medicine’s Researcher Award. She is past president of the Society for Academic Emergency Medicine, Society for Advancement of Violence and Injury Research and Emory University Senate. Dr. Houry has served on numerous other boards and committees within the field of injury and violence prevention. She has authored more than 90 peer-reviewed publications and book chapters on injury prevention and violence. Dr. Houry received her MD and MPH degrees from Tulane University and completed her residency training in emergency medicine at Denver Health Medical Center.


Lyle R. Petersen, MD, MPH

Dr. Petersen is the director of the Division of Vector-Borne Diseases in the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID). The division, located in Fort Collins, Colorado, supports CDC’s mission to protect the American public from exotic and domestic bacterial and viral pathogens transmitted by mosquitoes, ticks, fleas and other vectors.

Dr. Petersen earned his medical degree from the University of California, San Francisco. His career at CDC began in the Epidemic Intelligence Service (EIS) in 1985. During that time, he completed CDC’s Preventive Medicine Residency Program, received a Master of Public Health degree from Emory University, and served in several posts, including the Chief of the HIV Seroepidemiology Branch. In 1996, Dr. Petersen accepted an assignment in Germany, where he helped guide that country’s efforts in creating a new national infectious disease epidemiology program at the Robert Koch Institute in Berlin. In 2000, he returned to the United States to serve as the Deputy Director of Science of the Division of Vector-Borne Diseases, and he became the division’s Director in 2004.


Continuing Education through CDC

This year, CSTE has partnered with CDC to provide continuing education to Annual Conference attendees. We anticipate offering CE for doctors, nurses, health educators, veterinarians, certified in public health and general practitioners. Approval is pending with more details to come.

 

To learn more, visit www.csteconference.org.

Tags:  Annual Conference  epidemiology  infectious disease 

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Mosquito Season is upon us: CDC’s New Vector Control Training can help

Posted By Liljana Baddour, MPH and Martin A. Kalis, MA, Friday, May 5, 2017
Updated: Thursday, May 4, 2017

Mosquitoes are responsible for transmitting diseases to millions of people worldwide, with substantial morbidity and mortality. Epidemiologists know mosquitoes spread diseases such as West Nile virus, dengue, chikungunya and Zika. Preventing and reducing the spread of many of these diseases depends on controlling mosquito vectors or interrupting human-vector contact. Several factors, including the type and timing of mosquito control activities, are critical to reducing mosquito populations.
A new online training is now available for the public health workforce that focuses on vector control and pest management, and incorporates the 10 Essential Environmental Public Health Services and the Environmental Public Health Performance Standards developed by CDC’s National Center for Environmental Health (NCEH).

The online learning series Vector Control for Environmental Health Professionals (VCEHP) provides the knowledge and resources necessary to prevent and control vector-borne illnesses spread by insects, rodents, ticks and more. VCEHP provides resources on using an integrated pest management (IPM) approach.

 
The online curriculum of 11 courses geared toward environmental health professionals is:
  • Credible: It includes the latest science and evidence from vector control experts.
  • Practical: It addresses concrete principles, practices and resources for vector control.
  • Free and Flexible: Professionals can take the courses they want, when they want.
  • Available for Continuing Education Units: The National Environmental Health Association offers optional CEUs.


Pictured: VCEHP includes a subset of courses particularly helpful for understanding and addressing Zika virus and other mosquito-borne diseases. Photo credit: CDC/ Prof. Frank Hadley Collins, Dir., Cntr. for Global Health and Infectious Diseases, Univ. of Notre Dame

Course topics include:
  • Vector-borne diseases, IPM basics, pesticide toxicology.
  • Performance assessment and improvement for vector control programs.
  • Biology and control of bedbugs, ticks, rodents, and mosquitoes.
  • Vector control and pest management in specific locations like schools, restaurants, and hotels.
  • Risk communication.
We invite you to access or share VCEHP and get started today to prepare for mosquito season.
 
Texas Health Institute, Tulane University and the National Environmental Health Association.


VCEHP was developed by CDC, the National Network of Public Health Institutes, Liljana Baddour, MPH, is Senior Manager for Workforce and Education Initiatives at the National Network of Public Health Institutes (NNPHI), one of CDC’s core partners for VCEHP. Martin A. Kalis, MA, is a Public Health Advisor with CDC’s Environmental Health Services Branch and is the CDC lead for VCEHP.

Tags:  epidemiology  infectious disease 

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CSTE at the 2017 HIMSS Conference

Posted By Janet Hui , MPH, Friday, April 7, 2017
Updated: Friday, March 31, 2017
This February, CSTE attended the 2017 HIMSS Annual Conference and Exhibition in Orlando, Florida. HIMSS – the Healthcare Information and Management Systems Society – is a global non-profit whose mission is to improve health through information technology. Their annual conference is one of the largest health IT conferences in the world, with over 40,000 representatives from health care and health IT attending this year. The enormous HIMSS exhibit hall featured some of the biggest names in health care and technology, such as Allscripts, Cerner, Epic IBM and many others.


This year, CSTE was invited by CDC to participate in the HIMSS Interoperability Showcase to demonstrate the Reportable Conditions Knowledge Management System (RCKMS). The Interoperability Showcase is a guided exhibit at HIMSS, where companies and organizations partner together and demonstrate how different technologies can work together to address a health problem. For our use case, CSTE partnered with the Association of Public Health Laboratories (APHL), Utah Department of Health, Epic and others to demonstrate how new technologies and standards can be used to enhance public health (PH) surveillance. Together, we demonstrated the electronic case reporting flow for a potential case of Zika virus infection.


During the Showcase, we simulated a patient visiting a clinic in Utah and receiving a positive PCR result for Zika virus, which triggered the process of PH reporting. The clinic’s EHR, represented by Epic, built and sent an initial electronic case report (elCR) to the APHL AIMS platform, which invoked the RCKMS decision support service to determine that this potential case should be reported to Utah Department of Health. AIMS routed the eICR and a Reportability Response (RR) to the Utah Department of Health and a RR to the Epic EHR system. Utah consumed the eICR and RR into their surveillance system, and Epic received and processed the RR.

Pictured: CSTE staff member Janet Hui leads a demonstration of the Reportable Conditions Knowledge Management System (RCKMS) during the 2017 HIMSS Conference in Orlando, FL.

Overall, CSTE’s participation in this year’s HIMSS Conference was very productive in educating attendees on CSTE’s role in the work of public health reporting, RCKMS and other technology currently being developed in the surveillance/reporting realm. The Conference presented a great opportunity to engage fellow public health professionals on the ongoing work of RCKMS, and I look forward to participation in future HIMSS Conferences.
 
Janet Hui is CSTE’s Associate Research Analyst on the RCKMS initiative. For more information about the ongoing RCKMS work or other projects in the Surveillance/Informatics area, contact Janet at jhui@cste.org.

Tags:  cross cutting  infectious disease  informatics  RCKMS  surveillance 

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#CSTE on Capitol Hill

Posted By Jeremy Arieh and Emily Holubowich, Thursday, March 23, 2017
Updated: Thursday, March 23, 2017
Each year, members of CSTE’s executive leadership team visit Washington, DC to meet with key Congressional offices on behalf of the applied epidemiology profession. Advocacy is one of CSTE’s integral functions, and the activity is a key component of the overall CSTE mission. On March 8-9, President Joe McLaughlin of Alaska, President-Elect Janet Hamilton of Florida, Secretary-Treasurer Sarah Y. Park of Hawaii, Senior Board Advisor Tim Jones of Tennessee and Executive Director Jeff Engel attended meetings with members of the U.S. House and Senate, and the Centers for Disease Control and Prevention’s (CDC) Washington office as part of the 2017 “Hill Day.”

Pictured (L-R): Janet Hamilton, Jeff Engel, Tim Jones, Sarah Park, Emily Holubowich and Joe McLaughlin attend CSTE Hill Day at the U.S. Capitol.

 

Led by CSTE’s Washington representative Emily Holubowich, advocacy efforts during this year’s Hill visits hinged upon the preservation of CDC’s Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) funding, which in fiscal year 2016 awarded over $240 million to help states detect, prevent and respond to the growing threats posed by infectious diseases, including foodborne and vaccine-preventable diseases. In particular, CSTE’s meetings focused on proposed cuts to the Prevention and Public Health Fund (PPHF) as part of legislation to repeal and replace the Affordable Care Act (ACA). The loss of the PPHF would deal a $900 million blow to the CDC’s budget, and a $50 million blow to epidemiology capacity at the state and local level. This funding comprises around 12 percent of the CDC’s overall budget, and it is a vital aspect of our nation’s public health infrastructure. Cuts of this magnitude could severely hamper core CDC programs, such as immunization, workforce capacity, vector-borne disease management and more.

With the House’s introduction of the American Health Care Act (ACHA) to repeal the ACA earlier in the week, this year’s Hill visit was very well-timed, as CSTE leaders spoke to the proposed PPHF cut during meetings with Senate and House staff. Our packed March 8th agenda began with an ASTHO briefing at the Capitol Visitors Center. The briefing featured panel discussions on hot topic issues, such as Zika prevention and opioid addiction. CSTE Senior Board Advisor and Tennessee State Epidemiologist Tim Jones joined a panel of state health department experts from Georgia, Florida and Minnesota to convey his experiences during Tennessee’s Zika response.


Pictured: Tim Jones highlights Tennessee’s Zika response during an ASTHO panel, entitled Zika Response: State & Territorial Public Health Acting to Protect America’s Health.

From there, CSTE attended meetings with Senate and House staffers, including the offices of Sen. Lisa Murkowski of Alaska, Sens. Marco Rubio and Bill Nelson of Florida, Sen. Brian Schatz of Hawaii, Sen. Richard Burr of North Carolina, Sens. Lamar Alexander and Bob Corker of Tennessee and Sen. Chris Coons of Delaware. Meetings were held with staff of the Senate Health, Education, Labor & Pensions (HELP) Committee and Senate and House Appropriations Subcommittees on Labor, Health and Human Services, Education & Related Agencies. Our Hill visits concluded with a meeting with staff at the CDC Washington offices on March 9th.

Pictured: CSTE leadership met with staff in the offices of Sens. Richard Burr, Lisa Murkowski, Marco Rubio, Brian Schatz and several others.

As part of our ongoing advocacy efforts, CSTE once again partnered with the Association of Public Health Laboratories (APHL) in co-signing request letters to Senate and House appropriators urging support of CDC’s core epidemiology and laboratory programs in the FY 2018 federal budget. The letters emphasize the need for vital funding of Emerging and Zoonotic Infectious Disease prevention and Public Health Workforce and Career Development.

Our presence on Capitol Hill was more important than ever. Last week, President Trump provided a preview of his FY 2018 budget and proposed an 18 percent cut to HHS. The high-level budget summary does not specify the level of cuts to CDC, but one must assume that the full budget released in May will include deep cuts given the cuts proposed for the Department itself. CSTE will continue to educate lawmakers about the value of disease surveillance activities at the state and local levels, and work with our partners in the public health community to protect CDC from further cuts.

Click HERE to view a table of ELC and HAI funding for each state in FY 2016.

 

Tags:  epidemiology  infectious disease  surveillance 

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Antibiotic Use/Resistance Surveillance through the National Health Care Safety Network: The Key to Data-Driven Interventions

Posted By Erica Washington, MPH, CPH, CIC, CPHQ, Friday, February 17, 2017
Updated: Wednesday, February 15, 2017

When considering the state of antibiotic resistance proliferation in today's health care landscape, the words “The Bugs are Fighting Back!” may come to mind. While this may sound like a D-list ‘80s movie, it succinctly summarizes the rapid pace of antibiotic resistance evolution, and the urgent need for stewardship in prescribing and surveillance practices. Antibiotics are ubiquitous in today's society: they are in foods, prescribed as medicine and at one point were even widely used in soaps. Each of these factors spurned the growth of resistant organisms for which antibiotics have reduced efficacy. Some consequences of antibiotic-resistant infections are longer and more complicated illnesses, increased doctor visits and increased mortality. In light of the vast problem of existing and emerging resistance, I chose to address surveillance of antibiotic prescribing practices and antibiotic threats as my project for my Informatics-Training in Place Program (I-TIPP) fellowship.

I join a myriad of stakeholders who have focused their attention on the need for antibiotic stewardship over the last several years. These efforts to combat antibiotic-resistant bacteria were propelled further by the 2015 White House Report titled National Action Plan for Combating Antibiotic-Resistant Bacteria. The report established several goals to fight “super bugs,” such as reducing the incidence of Clostridium difficile by 50 percent, reducing carbapenem-resistant Enterobacteriaceae infections by 60 percent, and maintaining the prevalence of ceftriaxone-resistant Neisseria gonorrhoeae below two percent (of all of the multi-drug resistant organisms, stating the emergence of Gonorrhoeae as a drug-resistant threat typically gets the biggest gasp from my audiences of infection preventionists and stakeholders).

The need for antibiotic stewardship is readily apparent in Louisiana, where I am pursuing my fellowship in the Louisiana Department of Health. According to Centers for Disease Control and Prevention's (CDC) Healthcare-Associated Infections 2015 Prevention Status Report, only 29.5 percent of acute care hospitals in Louisiana reported having antibiotic stewardship programs that incorporated all seven core elements deemed critical by CDC. These seven core elements include leadership commitment, accountability, drug expertise, action, tracking, reporting and education. Although this data references only acute care hospitals, antibiotic stewardship is needed across the health care spectrum. The seven core elements for antibiotic stewardship are recommended for implementation in all settings where prescribing occurs, including long-term acute care hospitals and nursing homes.

Similar to the Prevention Status Report's revelation of lack of antibiotic stewardship programs, CDC's 2014 Community Antibiotic Prescriptions Report shows data demonstrating that Louisiana's doctors' offices, emergency departments and hospital clinics administer antibiotics that are unnecessary at a rate of 1,021-1,285 prescriptions per 1,000. Overprescribing can be attributed to a number of factors. One study published in British Journal of General Practice showed that reduced antibiotic prescribing is associated with lower patient satisfaction, which may be why doctors overprescribe unnecessary medications. According to The Pew Charitable Trusts (PCT), common inappropriate uses of antibiotics in health care are for asthma, allergies, bronchitis, middle ear infections, influenza, viral pneumonia and viral upper respiratory infections. PCT has listed reducing inappropriate antibiotic use for all conditions by 50 percent by 2020 as a national goal.

Through my I-TIPP fellowship, I have identified current informatics capacities at acute care hospitals, promoted use of the National Healthcare Safety Network's (NHSN) Antibiotic Use and Resistance Module (AUR), educated facilities about the need for robust antibiotic stewardship activities and notified acute care hospitals about the eligibility of Meaningful Use Stage 3 incentives for participating in both the antibiotic use and antibiotic resistance features of the AUR. In July 2016, I conducted an introductory webinar on the AUR and in September 2016, I conducted a survey among acute care NHSN users to assess their electronic reporting capacities to participate in the AUR. Information administered in the initial webinar on AUR was reinforced at three, in-person workshops that were presented statewide in November 2016. These workshops focused on the NHSN and Emerging Infectious Disease, which are an integral part of Louisiana's health care-associated infections activities. Infection preventionists and patient safety personnel were the target audience for these workshops, however some pharmacists participated as well, in light of the demonstration of the AUR Module.

Effectively intersecting with people to generate outcomes that impact population health has been the key to my success in the fellowship thus far. Understanding the needs of each facility that has indicated an interest in signing up for the AUR Module, determining what their current capacities and barriers to creating competent antibiotic stewardship programs, and showing how Meaningful Use participation can help them has been integral to my project. Through I-TIPP, I have been able to refine my communication skills and problem solving methods to achieve public health goals that will better the health of Louisianans as we fight back against super bugs.



CSTE Fellow Erica Washington presents content on the NHSN Antibiotic Use/Resistance Module at the annual Louisiana National Healthcare Safety Network/Emerging Infectious Diseases Workshops in Bossier City, LA at Willis-Knighton Health Center in November 2016.

Erica Washington is an Informatics-Training in Place Program Fellow at the Louisiana Department of Health. She received her MPH from Tulane University in New Orleans, LA. Ms. Washington's post is the fifth in a series of blogs by CSTE-sponsored fellows.

Tags:  cross cutting  epidemiology  fellowship  informatics  surveillance  workforce development 

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#FoodPoisoning: Using Social Media to Detect Outbreaks

Posted By Katelynn Devinney, Tuesday, February 7, 2017
Updated: Tuesday, February 7, 2017

Foodborne illness is not only an unpleasant experience, but also a major public health concern. Many individuals who acquire foodborne illnesses do not seek medical care and do not report their illness to health departments, which can make complete and timely outbreak detection nearly impossible. With the emergence of social media as a primary form of communication, many individuals do, however, complain to their friends and followers online about their illness, symptoms and possible causes. So, how can we harness the power of social media to stop foodborne outbreaks?

As a fellow with the Project SHINE Informatics Training in Place Program in the New York City Department of Health and Mental Hygiene (DOHMH) – with support from the Alfred P. Sloan Foundation and the National Science Foundation – I have been tasked with developing a system, using data from Twitter, to identify complaints of foodborne illness across the city. The DOHMH has a long history of applying innovative methods to improve foodborne disease surveillance. We utilize the citywide non-emergency information system, “311,” where anyone can submit a food poisoning complaint related to a New York City restaurant. Additionally, in 2011, after identifying reports of illness on the restaurant review website Yelp that were not reported to 311, DOHMH began collaborating with Yelp and Columbia University to obtain a daily feed of Yelp reviews and develop a machine learning program using text mining to identify reviews pertaining to foodborne illness. This project was supported by two former CSTE Applied Epidemiology fellows, Cassandra Harrison, MPH and Kenya Murray, MPH and resulted in the full integration of Yelp into our foodborne illness complaint system. Each year, approximately 4,000 restaurant-associated complaints are received via 311 and Yelp combined, which result in the detection of about 30 outbreaks.

Nevertheless, New York City is a large metropolitan area with more than 8.5 million residents, 78 percent of whom eat food purchased from the city’s approximately 24,000 restaurants and 15,000 food retailers at least once per week. There are ample opportunities for exposure to foodborne pathogens at New York City restaurants. Even with the integration of Yelp and 311, we remain concerned that we are not receiving all reports of restaurant-associated foodborne illness incidents in the city.

Working with Columbia University, we have developed a system very similar to that used for Yelp reviews, which pulls publicly available data from Twitter’s application program interface (API), and uses text mining and machine learning to identify tweets indicating foodborne illness. We have also developed a web-based application, which displays all Yelp reviews and tweets for epidemiologists to review and manually classify, and allows us to track follow up and conduct interviews with complainants.

Using this application, we can respond to Twitter users we believe to be tweeting about a potential food poisoning incident and ask them to complete a brief online survey. The survey asks about the restaurant name and location, date of their visit, details of the incident and contact information for follow-up. DOHMH staff attempt to interview all users who submit surveys to obtain more information about their symptoms, incubation period and a three-day food history.

The process of developing and launching the application was extensive; we encountered many roadblocks, such as accessing data through firewalls and obtaining secure public facing servers to allow survey data collection. We have only recently started tweeting and sending surveys; so far, the survey completion rate has been low (roughly two percent), but we have observed an overall positive reaction from the public to our tweets. We hope the response rate increases over time and the application is successful, so we can share our work and lessons learned with other health departments who want to incorporate social media into their surveillance and outbreak detection efforts.

Already, our project was recognized at the 2016 New York City Technology Forum as the Most Innovative Use of Social Media/Citizen Engagement. Since then, we’ve enhanced the application to allow us to automate processes and increase the sustainability of the project over time. We have also evaluated different data sources and aim to incorporate those that will increase both the timeliness and completeness of foodborne illness outbreak detection in New York City.



Pictured: New York City Social Media Foodborne Team accepting the award for
Most Innovative Use of Social Media/Citizen Engagement on November 14, 2016.

This project has been an incredible learning experience. I am very thankful to DOHMH, my mentors and Project SHINE for their continued support and guidance. None of this would have been possible without the work of Communicable Disease, Environmental Health and Information Technology staff at DOHMH, our partners at Columbia, our grant administrators at the Fund for Public Health New York and our funders. This collaboration provided me with an amazing opportunity to learn how to effectively communicate and coordinate between groups to promote innovation in informatics, which I will continue to apply throughout my public health career.
Katelynn Devinney, MPH, is an Informatics-Training in Place fellow at the New York City Department of Health and Mental Hygiene. She received her MPH from Columbia University Mailman School of Public Health. Ms. Devinney’s post is the fourth in a series of blogs by CSTE-sponsored fellows.

Tags:  cross cutting  epidemiology  fellowship  food safety  surveillance  workforce development 

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IT’S A NEW YEAR…MEET CSTE’S NEW STAFF

Posted By Jeremy Arieh, Friday, February 3, 2017
Updated: Thursday, February 2, 2017
It is hard to believe that January is already over, and we’re well on our way into 2017. In the last few months, CSTE’s national office staff has grown to accommodate new public health endeavors and support our ongoing work. Please be sure to welcome the new members of our team as we move forward and prep for the 2017 Annual Conference in Boise, Idaho!
 
Jeremy Arieh
Jeremy Arieh joined CSTE in January as new Director of Communications with a focus on strategic internal and external communications that will increase CSTE’s visibility and recognition as the applied epidemiology resource. With nearly a decade of experience in health care communications, marketing and media relations, Jeremy comes to CSTE from the Georgia Department of Community Health (DCH), where he created and implemented strategic communications and marketing plans in the Department's key programmatic areas. Prior to his role at DCH, Jeremy spent five years as Director of Marketing & Communications for the Georgia Nurses Association and Foundation. Jeremy holds a bachelor of arts in journalism from Georgia State University. When he’s not dreaming up new communications for CSTE, Jeremy enjoys reading, writing, watching English Premier League soccer, NFL football and spending time with his family and black lab Rocky.
 
Derwin Henderson
Last September, Derwin Henderson joined CSTE as a new member of our accounting team. He previously held an accounting role at Clark Atlanta University, where he advised students how to manage debt and stick their goal of completing college and earning a degree. Prior to this, Derwin spent time as an asset analyst for Capitol City Bank & Trust Company. In this role, he managed of all the bank’s foreclosed properties. Derwin also worked for five years in an accounting capacity with Enterprise Rent-a-Car. Derwin holds a Bachelor’s degree in accounting from Morehouse College in Atlanta. He enjoys reading books on politics and history, and in his free time, he enjoys listening to jazz artists like Shirley Horn, Miles Davis, John Coltrane and Ella Fitzgerald. Derwin grew up in Los Angeles, California.
 
Thuy Kim
Thuy Kim is a two-time alumna of the University of Alabama at Birmingham, holding a Bachelor of Science in Biology, a Master of Public Health in Epidemiology and a Certificate in Global Health through the Sparkman Center for Global Health. Thuy was an epidemiologist in the Bureau of Communicable Disease at the Alabama Department of Public Health before joining the CSTE team in October 2016. Currently, she is an Associate Research Analyst focusing on CSTE’s food safety portfolio and CIFOR projects.
 
Meri Phillips
Meredith (Meri) Phillips has joined CSTE as an Associate Research Analyst on the ID Team, primarily supporting our vector-borne diseases and public health preparedness portfolios. She will also support efforts of the Public Health Law and Border/International Health subcommittees.

Meri attended Georgia Southern University where she obtained her Master of Public Health with a concentration in Environmental Health Sciences. She began her career in public health as a Florida Epidemic Intelligence Service fellow where she gained hands-on experience in applied epidemiology. Here in Georgia, she has worked at both the state (Georgia Emerging Infections Program) and local levels (Gwinnett, Newton, and Rockdale County Health Departments) as an Epidemiologist. Most recently, she was the lead for Zika response activities in GNR Counties by facilitating testing through the Georgia Public Health Laboratory (GPHL), interviewing positive travel-associated Zika cases and couriering specimens to GPHL. Her experience in infectious disease epidemiology with an emphasis on vector-borne diseases and public health preparedness will be invaluable to her new role at CSTE.

 
Nikka Sorrells
Nikka Sorrells attended the University of Louisville where she received a Master of Public Health with a concentration in Epidemiology. She has recently joined the Non-Infectious Disease team as an Associate Research Analyst at CSTE and is the staff lead for the Chronic Disease/Maternal Child Health/Oral Health track. In addition, she is also the staff lead for the Tribal Health Epidemiology, Health Disparities, WestON, and SouthON Subcommittees and/or Workgroups.

Prior to CSTE, Nikka worked at the Tennessee Department of Health as a Public Health Educator in the Health Promotion Department. During that time, she worked with community county health councils, subcommittees and workgroups on various county-wide health initiatives, projects and grants, which were primarily focused on Chronic Diseases, Maternal Child Health and Minority Health. In addition, Nikka worked with the Primary Prevention Initiative teams at the local health departments to facilitate trainings for staff and develop SMART objectives. Nikka has valuable experience in project management, meeting facilitation and budget management, and will be an asset to the CSTE team.


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Putting People First in Public Health Informatics

Posted By Juliet Sheridan, MPH, Monday, January 23, 2017
Updated: Monday, January 23, 2017

As a self-proclaimed data nerd, I was initially excited about being accepted into the Applied Public Health Informatics Fellowship (APHIF) because I’d have the chance to improve my technical skills in a real-world setting. Supported by CDC, the Council of State and Territorial Epidemiologists (CSTE) and the National Association of County and City Health Officials (NACCHO), my APHIF work is part of the “Project SHINE” professional development collaboration. Imagine my surprise when my main fellowship project for the Family Success Alliance turned out to be more about people than the technical specs.

The Family Success Alliance (FSA) is a collective impact initiative developed to ensure that children whose families struggle to make ends meet have the educational and economic opportunities to succeed in Orange County, NC. Modeled after the Harlem Children’s Zone, FSA works in two neighborhoods called ‘Zones’ to provide a “pipeline” of evidence-based programs, services and supports from cradle to career. With over 200 participants in the first two years and yearly expansion planned, FSA needed a way to keep track of demographic, program and outcome information for each participant and their family.


The Family Success Alliance (FSA) is a collective impact initiative developed to ensure that children whose families struggle to make ends meet have the educational and economic opportunities to succeed in Orange County, NC.

Because the collaborative spans many sectors, including local government, school districts, non-profit organizations and funders, we couldn’t just set up a regular database. It was important to track not only what was happening, e.g., tracking participation in programming, but also how partners were interacting, e.g., whether the afterschool tutoring organization also referred participants to our mental health partners. We needed this tracking to occur in real-time across 13 different organizations, while also being HIPAA and FERPA compliant.

To this end, I was selected to implement a shared measurement system that all our partners could access and utilize. The United Way, one of our funders, uses a web-based case management system called Efforts to Outcomes (ETO), created by Social Solutions, Inc., which we decided to adopt for FSA. I focused first on the technical components necessary for success, such as gathering requirements, managing permissions and building reports. However, I realized that the most important pieces of this project were non-technical. How do you build trust among partners? Maintain common goals and accountability? Allow for unique organizational needs? Prioritize equity? These questions ultimately informed most of my work during my fellowship experience.



Pictured: FSA partners are pictured here during a working meeting.

Before I could begin setting up ETO, we had to create and sign a Master Data Sharing Agreement that outlined the appropriate use, storage, analysis and security for the data we would enter into our system. We found that this agreement could not move forward without numerous conversations about each partners’ experience with similar data, capacity for data management and expectations for security, confidentiality and privacy. Fundamentally, these conversations were about building trust. Do you and your partners trust each other to be good stewards of the data? Do your clients trust you to maintain their information in a secure way? The Data Sharing Agreement is just the first step in a continuing conversation about data use and practices; my role is to accompany our partners in that discussion.

Now that the Master Data Sharing Agreement is almost complete, I’ve turned my attention to getting the system set up for our community partners. In designing the forms and user interface on the website, it is crucial to keep the end goals of the collaborative in mind, so that we can measure the impact on the community. One of the guiding principles of the Alliance is equity, and that is no less true when it comes to data. This principle informs both logistical and measurement questions about our data, including who enters the data, how we train staff, if we are capturing community strengths, and whether we’re contributing to a “fixing systems” mentality instead of “fixing people”. The real questions we want to answer using this database are about families living in Orange County and whether their children are ready for kindergarten; if they have appropriate, stable housing; and if there more families living above the poverty line as a result of our work. If I focused only on the technical requirements of the database, I’d lose sight of what is truly important about the work we’re doing.



Pictured: Here, a teacher reads to children in the Kindergarten Readiness Program.

Through my APHIF experience, I’ve found that informatics is about so much more than just technical skills. Systems like ETO improve our processes and contribute to data-driven decision making, but they must also be designed with human “requirements” in mind, like trust, accountability and equity in order to be truly successful. I am so grateful to my mentors, our community partners, Family Success Alliance staff and funders for their continued support and assistance. The Orange County Health Department and the APHIF program have afforded me this unique opportunity that has changed the way I will approach public health informatics throughout my career.

Juliet Sheridan is an Applied Public Health Informatics Fellow at the Orange County Health Department in North Carolina. She received her MPH from the University of North Carolina at Chapel Hill. Ms. Sheridan’s post is the third in a series of blogs by CSTE-sponsored fellows.

Tags:  Cross cutting  Epidemiology  Fellowship  Informatics  Surveillance  Workforce Development 

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