Slide 1

Report
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
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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
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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
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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):510518.

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