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Student Aid for Field Epidemiology Response SAFER


A group of enthusiastic public health graduate students who are ... Pertussis outbreak in Pima County. Norovirus outbreak at a local assisted care facility ... – PowerPoint PPT presentation

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Title: Student Aid for Field Epidemiology Response SAFER

Student Aid for Field Epidemiology Response
  • Outbreak Response Training
  • (AKA - Will I get to wear one of those cool
    hazard suits?)

Kristen Pogreba-Brown, MPH
What is SAFER??
  • A group of enthusiastic public health graduate
    students who are interested in learning more
    about how local health departments conduct
    outbreak investigations and who are available to
    take part in emerging and continuing disease
    investigations with public health professionals

Background on the Team
  • Needs assessment of local health departments
  • Summary of interview findings
  • Program development
  • Pilot of course with student
  • Establishment of an outbreak response course tied
    to team membership

Program Synopsis
  • Team membership
  • Including eligibility criteria and an application
  • Required training on surveillance and outbreak
    response at ADHS
  • Student participation in outbreak response class
  • ICS 100 and ICS 700 training required
  • Advisory group
  • Steering committee with representatives from all
    partnering agencies
  • Response Notification Systems
  • Request for team participation from health
  • Response from program coordinator to health
  • Evaluations Systems
  • Student training evaluations
  • Agency evaluations of student participations
  • Student evaluation of agency and experience
    following response

Class Description
  • Interactive seminars that bring in public health
    professionals to share their investigation
    experiences with the students
  • Outbreak Activities
  • Short-term projects for returning students
  • Fun, Fun, Fun!

Training Sessions
  • Arizona Department of Health Services (Infectious
    Epidemiology Division)
  • Students must complete a full day training
    session covering the basics of surveillance,
    reporting procedures and how different types of
    outbreak investigations are conducted
  • Maricopa County Health Department
  • Focuses on food borne outbreak investigations and
    interviewing skills
  • Pima County Health Department
  • Introduction to local health department,
    conducting interviews from a call center, and
    Incident Command structures and the EOC

What would I do with SAFER?
  • Interviews
  • Helping to create questionnaires and conducting
    interviews either in person or over the phone
  • Data Management
  • Data entry, analysis and follow-up
  • Communicating with the public
  • Answering questions about the recent outbreak and
    public health in general
  • Sample collection and transportation
  • Conducting case-control studies
  • Taking part in public health preparedness drills
  • Become VERY comfortable discussing peoples
    bathroom experiences

Activation of the Team
What happens when the state calls?
  • Email
  • Calls
  • Response

What has SAFER done in the past?
  • Pertussis outbreak in Pima County
  • Norovirus outbreak at a local assisted care
  • Case-Control of possible food borne outbreaks
    with Maricopa County Health Department
  • Norovirus outbreak at the Grand Canyon
  • Hepatitis A outbreak investigation with ADHS
  • Mass vaccination drill with the University

Can I Join?
  • Do disease outbreaks interest you?
  • Did you see Outbreak? Did you say Do scientists
    really chase monkeys like that?
  • Do you ever wonder what actually takes place at a
    health department during an outbreak?
  • Do you want to get some real world experience?
  • Interviews
  • Show your family one thing you could do with your
    future MPH
  • Impress future dates (because, come on, who isnt
    turned on by learning all about a recent bout of
    Salmonella suffered by the masses)?

What is required to join?
  • Completion of Epi(a) and Biostats(a)
  • OR the permission of the instructor
  • Training sessions at ADHS, Maricopa and Pima

  • If youre interested for next semester
  • We will be having two training sessions a year so
    anyone that would like to join next semester is
    welcome to come then
  • The team will be more formally linked to a 1 unit
    class (tentatively called Public Health
    Experience) so keep your eyes open on your email
  • The first class will be September 8th from 10-12
    (room A122)!

  • Kristen Pogreba-Brown
  • Dr. Robin Harris

Norovirus Investigations with Maricopa County
Health Department
3 Separate Outbreaks
  • Assisted Care Facility X
  • Assisted Care Facility Y
  • School Z

Assisted Care Facility X
  • In late May of 2005 the doctor on call was paged
    by a local fire department who reported
    transporting three ill residents from a senior
    apartment complex to the local hospital. They
    reported that other residents at the complex were
    ill with the same gastrointestinal symptoms.
  • An investigation was initiated, and the apartment
    manager was contacted. A line list of ill
    residents was provided by the facility two days
    later and interviews were conducted by
    Epidemiology staff as well as students from the
    Student Epidemiology Response Team. Over the
    course of the outbreak, 58 residents and 2 staff
    members were reported ill.

Assisted Care Facility X
  • Cases (15 Interviews)
  • 5 Confirmed
  • 15 Probable
  • 42 Suspect
  • 10 of the cases were hospitalized with no deaths
  • Demographics
  • Age Range 18-97 (Median 80 years old)
  • 27 Male/73 Female

Outbreak Details
  • Attack Rate 52 (62/120)
  • Illness Duration
  • Median 30 hours
  • Mean 47 hours
  • Range 2-184 hours
  • Symptoms
  • Diarrhea, cramps, vomiting, malaise, nausea,
    chills, body aches, weakness, fever, headache,

What SAFER did?
  • Conducted a case-control study
  • Interviewed cases
  • Interviewed controls
  • We were able to make phone calls from Tucson,
    which made responding to the outbreak much easier
  • Lots of faxes!

What happened next?
  • The infection control practitioner (ICP) at the
    local hospital was contacted and provided
    information on the residents seen in the
    emergency department (ED) and admitted to the
    hospital. A total of ten residents were admitted
    to the hospital during the outbreak, another
    three residents were seen in the ED.
  • Environmental Services (ES) inspected the complex
    kitchen. They noted that at that time the dining
    room had been closed and all meals were being
    delivered to residents in their rooms. ES
    advised that all kitchen and dining room contact
    services be sanitized with bleach solution, this
    was done. The inspector was also informed that
    the head chef had been ill with gastrointestinal
    symptoms on the day before the outbreak and one
    server had called into work ill on the same day
    with similar symptoms. The chef did come to
    work, but was restricted to doing paperwork that
    day and did not handle any food in the kitchen.

  • The outbreak was attributed to Norovirus
    (laboratory confirmed with 5/9 samples sent to
    state lab)
  • Exact route of transmission could not be
    determined from the available data
  • Kitchen staff were reported ill the day before
    the residents became ill, but person-to-person
    transmission among the residents can not be ruled

Assisted Care Facility Y
  • Three days before the earlier outbreak at
    Facility X, a social worker from the local
    hospital reported that eight residents of a
    senior living apartment complex were seen at the
    emergency department (ED) for gastrointestinal
    illness. The manager of the apartment complex
    was contacted by Epidemiology staff who
    discovered that the facility was an independent
    senior apartment complex that had an on-site
    dining room and an activities area.

Investigation continues
  • The staff stated they had surveyed the complex
    (n197 apartments) and identified eight residents
    with gastrointestinal illness, of those, four
    were seen at the local ED and one had been
  • The dining room had been closed to be thoroughly
    cleaned and sanitized meanwhile all meals were to
    be delivered to residents rooms. The complex
    initiated the meal deliveries before being
    contacted by Epidemiology staff. Activities were
    also temporarily suspended, with staff instructed
    to clean and sanitize all common areas. Ill
    residents were instructed to remain in their
  • The next day, a line listing was provided from
    the facility with 31 residents and 3 staff
    reported ill. This line list was faxed to the
    University of Arizona where Student Epidemiology
    Response Team and team members interviewed 14
    cases and 11 controls. The team also requested
    stool specimens from cases interviewed, but none
    were obtained.
  • Residents from both facilities were known to
    interact with one another.

Assisted Care Facility X
  • Cases (14 Interviews)
  • 0 Confirmed
  • 14 Probable (7 went to ED, 1 hospitalized)
  • 43 Suspect
  • 1 of the cases were hospitalized with no deaths
  • Demographics
  • Age Range 74-94 (Median 85 years old)
  • 43 Male/57 Female

  • Case control was done, however no food was able
    to be isolated as the causative agent
  • The etiology of the outbreak was not confirmed
    because no stool samples were collected, however,
    the transmission and symptoms were consistent
    with Norovirus.

School Z
  • Again, in late May 2005 a report was received
    from a Gilbert school nurse who reported an
    outbreak of gastrointestinal illness among a
    group of 6th grade children who had taken an
    overnight field trip to a science camp in
  • A line listing of the ill children was received
    and the school nurse stated that all ill children
    would be excluded from school for at least 24
    hours. One child was reportedly ill almost as
    soon as the camp was reached and the other
    children became ill the next day.
  • A total of 32 children were reported ill.
  • Yavapai county Environmental Services (ES) was
    notified, and they inspected the camp. No other
    illnesses had been reported at the camp. The
    camp provided food, however the parent/chaperones
    were in charge of preparing the meals. The
    Student Epidemiology Response Team was contacted
    and conducted interviews with a sample of the ill
    childrens parents.
  • In all fifteen questionnaires were completed.

School Z
  • Cases (15 Interviews)
  • 1 Confirmed
  • 15 Probable
  • 13 Suspect
  • Demographics
  • Age Range 11-13 (Median 12 years old)
  • 66 Male/34 Female

  • Three stool specimens were sent to the state lab
    for analysis. Two were negative but one was
    positive for Norovirus, Miami Beach strain.
  • One child was sick upon reaching the camp and it
    is highly likely that the illness was spread