Membership Roadmap: The IH Section is Ready When You Are!

In May 2015, I became a graduate student member of the American Public Health Association so that I could attend the Annual Conference and take advantage of networking opportunities. I applied for and received a travel scholarship from my university later that year.

While at the conference, I attended a variety of Student Assembly, Epidemiology, Maternal and Child Health, Community-based Participatory Research and International Health Section sessions. I also visited the Expo Center and made sure to hand out many copies of my resume as well as business cards at various booths. With my student membership, I was able to join two Sections and selected Epidemiology (my concentration) and International Health as my main groups to plug into.

Shortly after attending the Annual Conference and following up with contacts I met using email and/or LinkedIn, I had to switch my focus to finishing my practicum and graduating within the next month. In addition, I began to close out my involvement with student organizations while balancing the “job search” process. It was a busy time for me.

In February 2016, I was hired to work at a local health department as a High-Consequence Infectious Disease Epidemiologist. Since I was living ~3 hours away from where I was going to begin working, I had to find someone to take over my lease while starting the 45 min- 1.5 hour commute to work from my parents’ house. During this time, Zika virus was declared to be a public health emergency by the World Health Organization and became one of my highest priorities.

Fast forward to the end of May 2016. I received a second notification to renew my APHA membership but was weighing whether or not it would be a worthwhile investment since I wasn’t sure how APHA could benefit me. Thankfully, the Early-Career Professionals group was a great incentive for me to choose to renew my membership. Because the membership fee was reduced, funding was available, and products like the journal and newsletter could be shared within my workplace- my employer was willing to cover the membership renewal fee. These elements also played a role in me being able to attend the Annual Conference for the second time. I made a list of conference sessions that could be beneficial to my health department and solicited feedback from leadership as well as my colleagues to see what information they wanted me to bring back. I also focused on seeking out ways to collaborate and contribute to the broader public health community. This led me to take a leadership position with the International Health Section Communications Committee after seeing a Call for Volunteers in an awesome newsletter that came through my email.

Since joining the IH Communications Committee in October 2016, I have been able to post to the Section blog, create an informational video, utilize new social media outlets, review policy, serve as a proxy for a Governing Councilor at the Annual Conference, create a Membership Roadmap, assist with the Listserv as needed, share professional development opportunities, contribute to strategic planning efforts, review abstracts and much more.

So, what’s the point of me sharing all of this?! It’s never too late to get involved! Even though there were some lapses in my activity due to work and life, when more time became available in my schedule (or my circumstances changed) I was able to fall back on my membership.

If you’re looking for ways to get involved, make sure to check your emails for post-conference opportunities, read the Section blog as well as newsletter, and feel free to use the Membership Roadmap as a flexible guide!

 

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Ready or Not? A Glimpse into How Public Health Responses are Coordinated

Most of us dream of one day working for the Centers for Disease Control and Prevention (CDC) or World Health Organization (WHO). We often envision ourselves responding to public health events around the globe and being placed in the middle of the action- whatever that action may be…

However, have you ever wondered how the response to an infectious disease outbreak or disaster is organized? Do you know how multiple agencies coordinate people and resources during a response? This blog post will provide a brief overview of functions of the National Incident Management System (NIMS), Incident Command System (ICS), Multi-Agency Coordination Systems (MACS), and Emergency Operations Centers (EOC).

Emergency management professionals are tasked at the local, state, and national level with coordinating responses to incidents- also known as events, natural or human-caused, that require a response to protect life or property, according to the Federal Emergency Management Agency (FEMA). Governmental agencies in the United States are required to follow NIMS, a systematic approach that is grounded in preparedness concepts and supports incident management for a diverse range of hazards, in order to receive preparedness grants or funding. NIMS incorporates standard resource management procedures and includes principles for information management. While NIMS is NOT a concrete plan, it supports the development of plans created by various jurisdictional players- one of the benefits of being a flexible, scalable, and dynamic approach.

The five key areas of NIMS are:

  • Preparedness– focused on planning, organizing and equipping, training, exercising, and evaluating/improving readiness to respond to an incident. Preparedness is supported by partnerships that are formed between government agencies, nongovernmental organizations, and the private sector before an incident.
  • Communications/Information Management– based on the concepts of a) Common Operating Picture, b) interoperability, c) reliability, scalability, and portability; and d) resiliency and redundancy. Communications systems should be flexible and adaptable to each incident.
  • Resource Management– serves as an accountability system for establishing current assets, identifying needs, requesting additional resources as well as organizing and tracking materials and personnel. It also allows for critical resources to be shared across jurisdictions.
  • Command and Management- consists of three organizational constructs: 1) Incident Command System (includes a management hierarchy that can be integrated into a common organizational structure), 2) Multi-Agency Coordination System (utilized when multiple agencies are involved) and 3) Public Information (processes for sharing timely, accurate, and relevant information during an incident).
  • Ongoing Management and Maintenance

Emergency Operations Centers (EOC) are used for information collection and evaluation, coordination, and priority setting. These are central locations where officials and personnel from key agencies go to meet, make decisions, and direct response activities.  Resources are coordinated at local EOCs, then at state EOCs when there are not enough resources to support an effective response. If state resources are overwhelmed then assistance from the federal government may be requested.

As stated earlier, this is just a brief overview of how a response is coordinated during an incident such as a public health event. In my next blog post, I will share my recent experience applying NIMS from a regional health department perspective.

 

Watch this video to see how the CDC responds to public health events and sets up its EOC!

 

 

 

The 9th TEPHINET Global Scientific Conference: Ending Pandemics in our Lifetime Initiative

From August 7th-11th, The Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET) held its 9th Global Scientific Conference and the 23rd National Epidemiology Seminar in Chiang Mai, Thailand. I had the opportunity to listen to a panel presentation on Global Influenza Surveillance as well as the following presentation on Ending Pandemics. The overview I have provided below summarizes Mark Smolinski’s (Director of Global Health Threats at Skoll Global Threat Funds) presentation on innovations in surveillance for personal, national, and global health security. Feel free to listen to the entire presentation (1:17:00-2:16:28)!

  • Epi curves generally focus on human disease but human disease and animal outbreaks coincide or trigger one another. Additionally, bioterrorism can play a role in outbreaks and should be included in epi curves.
  • There are six main opportunities for epidemiologists/public health practitioners to intervene and reduce risk from pandemic threat:
    • Stop the threat in the animal population
    • Reduce the epi curve in the animal population
    • Find the first human cases (quickly)
    • Limit human infections and stop the epi curve in the animal population
    • Ensure strong surveillance/warning systems are in every country so disease doesn’t spread beyond country borders
    • Know and work directly with neighbors across borders so that regional security exists to stop any outbreak/prevent pandemics
  • It costs 3.4 billion dollars to prevent a pandemic by ensuring that developing countries have baseline capacity/public health systems that meet international standards. The return of investment is 10 fold. We are currently at ~450 million dollars.
  • Innovations in Surveillance – Researchers in tech as well as universities are involved in innovative surveillance methods, not necessarily epidemiologists/public health practitioners:
    • Google Flu Trends –predictive of flu and comparable to CDC flu reports (visits to providers), which were delayed by two weeks (80% of ill individuals did not visit a provider)
    • Twitter – University of Rochester developed an algorithm that can predict flu with 90% accuracy and gives an 8-day notice of when someone will get the flu (based off of tweets of others in your community/social circle)
    • HealthMap/Flu Near You – Participatory surveillance system that allows people to check off symptoms, see results on a map, and find where the closest vaccines are; correlates very well with the CDC influenza-like illness surveillance (over 5 years)
    • Epi Hacks – the idea is to bring together human, animal, and environmental health experts for one week to work with developers to come up with open source products for countries to use (for surveillance purposes); at least one has been conducted on each continent
    • PODD – uses a One Health approach as people in villages are tasked with helping find outbreaks quickly and reporting animal morbidity/mortality in real-time
    • KIDENGA – CDC and the University of Arizona are working together on vector-borne surveillance on the U.S/Mexico border, an epi hack will take place to see if they can create a sustainable way to address vector-borne diseases
    • Guardians of Health app – asked attendees to report health issues or symptoms during the World Cup, attendees received health information and program updates/information in return
    • EPICORE – retrospective analysis of public health information related to outbreaks; an automated system that epidemiologists follow-up on (after requests for information have been sent out)
  • When there are no outbreaks, public health gets no credit…
  • All countries cannot meet the International Health Regulations, even if they agree that they SHOULD be met
  • Skoll Global Threats Fund teamed up with Google and examined publicly available data at the World Health Organization (WHO) to determine how long it takes to detect, report, and respond to outbreaks; found that the global community is improving but has plateaued (due to limited data)
  • Research Paper – Finding Outbreaks Faster – Smolinski MS, Crawley AW, Olsen JM. Finding Outbreaks Faster. Health Security. 2017;15(2):215-220. doi:10.1089/hs.2016.0069.
    • There are epidemiologists in 28 countries looking at data from each outbreak to determine 6 metrics that all countries can follow (over past 5-10 years)
    • Countries had never looked closely at this issue and were able to see their strengths and weaknesses in investigating different types of outbreaks
    • Hot Spots of Emerging Infectious Disease – CORDS
      • Build friendship and trust across borders
      • Helps regional disease investigation networks share best practices, scale innovations, optimize informal networks
      • South Asia and West Africa are the most concerning for emerging infectious diseases, in a few years they may have stronger regional networks
  • Ending Pandemics Collective
    • 14 foundations and leaders of companies concerned about social responsibility want to invest in global health, share ideas, coordinate funding for projects, break down barriers in the foundation world
      • Smithsonian Museum of Natural History wants to do a 2-year exhibit called outbreaks, collectively a great chance to improve the knowledge base of people that visit the exhibit (~7 million people)
      • In 10 years the collective sees a world where:
        • Every outbreak is detected within 3 incubations periods of the index case or cluster
        • Every country’s Emergency Operations Center is utilizing an integrated, event-based detection system being used simultaneously by the WHO and G20
        • Human, animal, and environmental health volunteers are verifying rumors or suspected threats within 24 -48 hours through EpiCore
        • Participatory surveillance is engaging communities directly to detect and respond to outbreaks in every disease hotspot across the globe
        • Field epidemiologists in every country are using the latest technology to detect, verify, and respond to outbreaks faster
  • At the end of the day, pandemics can be prevented because “no community is too hard to reach, no community is too poor to innovate, and curiosity outshines fear!” 

13 Years to Eliminate Morbidity and Mortality due to Viral Hepatitis- Global Partners Believe It Can Be Done!

The liver processes nutrients, helps to fight against infection, and aids in cleaning the blood in our bodies. Inflammation of the liver is generally known as hepatitis. Although hepatitis can be caused by autoimmune disorders, occur as a result of excessive alcohol consumption, or become induced after a toxin is introduced into the liver, the hepatitis of most concern has a viral origin. While there are 5 main viruses (Hepatitis A-E), Hepatitis C Virus (HCV) and Hepatitis B Virus (HBV) are responsible for the majority of morbidity and mortality cases associated with viral hepatitis infections globally- this is comparable to HIV/AIDS and TB, killing 1.34 million people a year. Hepatitis can either be acute (i.e. a short-term illness within 6 months of infection) or chronic. 75-80% of individuals infected with HCV will develop a chronic infection. The likelihood of HBV becoming chronic largely depends on the age at which infection occurs. According to the Centers for Disease Control and Prevention (CDC), 90% of infants, 25-50% of children between 1-5 years of age, and 6-10% of individuals over 5 years of age will develop chronic HBV. Although the majority of individuals are diagnosed at a young age, younger age groups are less likely to show symptoms.

Currently, there are 240 million people living with chronic HBV and 130-150 million people with chronic HCV around the world.

Risk factors for HBV and HCV include:

According to the World Health Organization (WHO), there are differences in global burden of disease trends for HCV and HBV:

  • HCV: Affects all regions although there are significant differences between and within countries. The WHO Eastern Mediterranean Region and the European Region have the highest reported prevalence of HCV.
  • HBV: Mostly affects the WHO African Region and the Western Pacific Region

The number of cases of hepatitis that are diagnosed increases every year as well as deaths, which have increased by 50% over the past 20 years. Even worse, most people with hepatitis are asymptomatic in the acute stage and the beginning of the chronic stage- those with symptoms may have fever, jaundice, loss of appetite, grey stools, dark urine, and abdominal pain.  Although a vaccine is only available to protect against HBV, effective treatment options exist for both chronic HBV and HCV. This is an important reality since therapy and proper case management can reduce the risk of complications such as cirrhosis, liver cancer, and premature death that are caused by chronic hepatitis infection. Access strategies supported by the WHO in 13 countries have helped more middle-income countries receive necessary medications such as Directing Acting Antirals (DAA). These drugs have a cure rate of over 95% within a 3-month timeframe, for HCV, and less side effects than other drugs- but 80% of HCV cases still have difficulties accessing the treatment and case management they need because it can be expensive. The WHO released the report, “Global Report on Access to Hepatitis C Treatment: Focus on Overcoming Barriers,” which discussed the importance of political mobilization, advocacy, and pricing negotiations on increasing access to necessary medications in low-middle income countries. Local, more cost-effective medications have even been manufactured in a few countries. In order to address the 80% of people still in need of help, in May 2016, at the World Health Assembly, 194 countries adopted the Global Health Sector Strategy on Viral Hepatitis with the goal of eliminating hepatitis by 2030. DAAs were also added to the List of Essential Medicines.

Information from the global strategy is incorporated into World Hepatitis Day activities. World Hepatitis Day occurs on July 28th every year and is focused on raising awareness about the global burden of viral hepatitis as well as the prevention and treatment options that exist. Watch these short videos to learn more about the WHO’s global strategy and the theme for this year!

International Group B Strep Awareness Month: What Should I Know About GBS Disease?

July is International Group B Strep Month. This blog post gives an overview of the illness and its impact on pregnant women around the globe.

Group B Streptococcus bacteria (GBS), also known as Streptococcus agalactiae, typically colonize the gastrointestinal and genitourinary tracts, the throat, and the skin. GBS disease is caused when bacteria enter a normally sterile site such as the blood, bone, or spinal fluid. Both children and adults can develop GBS disease. The disease usually develops in infants that are 0-90 days old and adults that are 60 years of age and older with underlying chronic illnesses. There is currently no vaccine for GBS disease.

Although GBS may come from unknown sources, one out of four pregnant women are carrying the bacteria in their vagina or rectum and can vertically transmit an infection to their newborns. Infections occur during labor (“early-onset disease” or EOD) or within the first week of life through three months of age (“late-onset disease” or LOD). Symptoms can be difficult to distinguish from other infections and range from fever, difficulty breathing, lethargy, and “blue” skin. Severe symptoms that can develop in newborns and infants include sepsis and pneumonia. Meningitis is more likely to occur in infants or newborns with LOD. Complications from GBS disease may result in preterm delivery and lead to developmental disabilities or death. According to the Centers for Disease Control and Prevention (CDC), risk factors for pregnant women include:

  • Testing positive for group B strep bacteria late in the current pregnancy (35-37 weeks pregnant)
  • Detecting group B strep bacteria in urine (pee) during the current pregnancy
  • Delivering early (before 37 weeks of pregnancy) 
  • Developing a fever during labor
  • Having a long time between water breaking and delivering (18 hours or more)
  • Having a previous baby who developed early-onset disease

Since 1970, GBS disease has been a topic of concern in health care, research, and public health circles. In 1989, the death of three newborns from GBS disease led to the development of public awareness campaigns that called for improved education, detection, and preventive resources in the U.S. Furthermore, around this time, data collected by the CDC revealed that GBS disease was the leading cause of death in newborns. Parents and advocacy groups actively demanded guidance that would allow for routine screening and the development of an effective vaccine for pregnant moms, globally. Below is a timeline of how advocacy efforts led to research, policy change, and the implementation of effective interventions:

Brief Timeline of GBS Disease Awareness, Education, and Prevention Efforts

  • 1990 Group B Strep Association US/International is created. Its primary goals are to:
    • Educate the public about GBS infections.
    • Promote prevention of neonatal GBS infections through routine prenatal screening.
    • Promote the development of a GBS vaccine.
  • 1991 GBS researchers awarded a 5-year grant to begin research on a vaccine for  GBD disease
  • 1992 American College of Obstetrics and Gynecology and American Academy of Pediatrics publish position papers for members
  • 1996 CDC Call for Content on GBS Prevention Protocol in (January MMWR)
  • 1996 CDC, ACOG, AAP published first consensus statement on GBS National Prevention Guideline in June
  • 1997 Group B Strep Association launches its first website
  • 2002 The National Consensus Guidelines recommending routine screening for all pregnant woman was published
  • 2008 The CDC Active Bacterial Surveillance Core published data that showed an 80% drop in GBS neonatal morbidity and mortality
  • 2014 WHO convened the first meeting of the Product Development for Vaccines Advisory Committee (PDVAC); GBS and RSV identified as pathogens that cause a large burden of disease

Globally, it is estimated that EOD makes up 60-90% of GBS disease cases. The mean incidence of GBS disease in infants 0-89 days old is estimated to be .53 cases of GBS infection/1000 live births. The highest incidence of cases is reported to be in the continent of Africa, however, additional studies need to be conducted in low-income countries to better assess the true burden of disease. Prevention methods worldwide include providing prophylactic treatment (antibiotics) to women that are either high-risk or have tested positive for GBS, during labor. With treatment, there is only a 1/4000 chance of the baby becoming infected compared to a 1/200 chance if no treatment is given. In order to identify those who qualify for treatment, a culture-based method can be used to screen all pregnant women between 35-37 weeks for vaginal or rectal colonization of GBS. On the other hand, a risk-based method identifies pregnant women with risk factors for EOD such as fever, preterm delivery, and being in labor for 18 or more hours.

Although the administration of antibiotics during labor reduced EOD from .75 cases of GBS infection/100 live births to .23 cases of GBS infection/100 live births, GBS disease morbidity in infants and mothers is still significant and likely underreported. Antibiotic treatment and GBS disease education are more accessible to pregnant women in high-income countries than those in low-middle income countries. It is likely that challenges related to access to care and health system deficiencies limit the use of antibiotic treatment in low-middle income countries. As a result, the development of a cost-effective vaccine may be able to help bridge an awareness gap.

According to the World Health Organization (WHO), developing a vaccine for maternal immunization is a priority when it comes to GBS disease. In 2016, the WHO Product Development for Vaccines Advisory Committee held a technical consultation to discuss vaccine development. Ultimately, the committee determined that the global burden of GBS disease cases that result in stillbirths needs to be assessed. In addition, standardized antibody assays need to be developed in order to find correlates of protection. Vaccine targets such as the type III capsular polysaccharide (CPS) and proteins on the GBS bacterial surface have also been identified. As new vaccine development ideas for GBS disease are being discussed, here are some foundational components that the Group B Strep Association (US/International) and Group B Strep Support (UK/EU) groups feel have an important role to play in the introduction of the vaccine to pregnant women across the globe:

  • Standardized definition of disease worldwide.
  • Standardized monitoring of disease worldwide.
  • Routine prenatal care widely available in which a vaccine can be delivered.
  • Education of health professionals and parents and expectant parents about group B Strep and the vaccine.

Check out these CDC podcasts, if you want to learn additional information about GBS disease during International GBS Awareness Month!