Anatomy and Physiology of an Outbreak Team

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Anatomy and Physiology of an Outbreak Team
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Goals

• The goals of this presentation are to discuss
• Management strategies during an outbreak
  investigation
• Team member roles
• Necessary equipment
• Lines of communication

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In the Beginning

• Successful investigations require a
  multidisciplinary approach, effective
  communication and collaboration
• Steps
• Assemble team members
• Present available information
• Outline plan for investigation and team
  communication
• Assign roles and responsibilities

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Questions to Consider

• What resources, including personnel, are
  available?
• What resources could be provided by outside
  collaborators?
• Who will direct the day-to-day investigation?

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More Questions to Consider

• Who will interact with the media?
• How will data be shared and analyzed?
• Who will write the final report and present the
  information?
• How will the team communicate with each other?

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Team Member Roles

• Team Leader
• Experience in outbreak investigation and
  epidemiology
• Selection can be result of outbreak setting or
  etiologic agent
• Role can be filled by
• County health director,
• Public health nurse,
• Epidemiologist, or
• Environmental health specialist
• Role may change depending on stage of
  investigation

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Team Member Roles

• Epidemiologist
• Develop study design and survey questionnaires
• Create database and conduct data analysis

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Team Member Roles

• Microbiologist
• Verify the diagnosis
• Subtype pathogens to help refine case definition

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Team Member Roles

• Environmental health specialists (EHS)
• Collect food and environmental samples
• Provide guidance on food safety regulations and
  engineering

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Team Member Roles

• Interviewers
• Collect data in person or by telephone
• Role can be filled by health department
  personnel, state or federal personnel, or health
  science students

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Team Member Roles

• Clinicians
• Administer vaccines or prophylaxis
• Collect clinical specimens
• Role can be filled by health department or local
  medical community
• May include veterinarians,
  depending on type of outbreak

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Team Member Roles

• Regulators
• Facilitate identification of the source of
  outbreak and develop prevention strategies
• Role can be filled by state or federal agency
  employees

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Team Member Roles

• Media Spokesperson
• Deliver clear and consistent messages to
  community
• Role can be filled by one outbreak team member or
  representatives from each agency

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Team Equipment

• Computer with access to internet
• Email communication
• Literature searches (PUBMED)
• Data entry and analysis (Epi-Info 2002
  http//www.cdc.gov/epiinfo/epiinfo.htm)
• Written reports

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Team Equipment

• Specimen collection tools
• Rectal swabs or specimen cups
• Phlebotomy equipment
• Cooler to transport specimens

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Communication

• Information flows in both directions
• Leader should update the team during meetings,
  conference calls, or email
• Members provide regular updates to team leader
• Acts as tool for measuring progress
• Enables leader to provide feedback and direction
  to team members

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Communication

• Keep lines of communication open through regular
  meetings or phone
• Include local, state, and federal public health
  agencies
• Document progress
• Allows all members to remain up-to-date
• Assists in drafting final report

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Conclusion

• Working as a team requires
• A wide range of expertise
• Clear communication
• A rapid but careful and systematic approach in
  dealing with outbreaks

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References

• Butler JC, Cohen ML, Friedman CR, Scripp RM, Watz
  CG. Collaboration between public health and law
  enforcement new paradigms and partnerships for
  bioterrorism planning and response. Emerg Infect
  Dis 20028(10)1152-6.
• Frace RM, Jahre JA. Policy for managing a
  community infectious disease outbreak. Infect
  Control Hosp Epidemiol 199112(6)346-7.
• Sobel J, Griffin PM, Slutsker l, Swerdlow DL,
  Tauxe RV. Investigation of multistate foodborne
  disease outbreaks. Public Health Rep
  2002117(1)8-19.