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):510518.