[show abstract][hide abstract] ABSTRACT: Please cite this paper as: Fowlkes et al. (2012) Estimating influenza incidence and rates of influenza-like illness in the outpatient setting. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12014. Background: Estimating influenza incidence in outpatient settings is challenging. We used outpatient healthcare practice populations as a proxy to estimate community incidence of influenza-like illness (ILI) and laboratory-confirmed influenza-associated ILI. Methods: From October 2009 to July 2010, 38 outpatient practices in seven jurisdictions conducted surveillance for ILI (fever with cough or sore throat for patients ≥2 years; fever with ≥1 respiratory symptom for patients <2 years). From a sample of patients with ILI, respiratory specimens were tested for influenza. Results: During the week of peak influenza activity (October 24, 2009), 13% of outpatient visits were for ILI and influenza was detected in 72% of specimens. For the 10-month surveillance period, ILI and influenza-associated ILI incidence were 20·0 (95% CI: 19·7, 20·4) and 8·7/1000 (95% CI: 8·2, 9·2) persons, respectively. Influenza-associated ILI incidence was highest among children aged 2-17 years. Observed trends were highly correlated with national ILI and virologic surveillance. Conclusions: This is the first multistate surveillance system demonstrating the feasibility of using outpatient practices to estimate the incidence of medically attended influenza at the community level. Surveillance demonstrated the substantial burden of pandemic influenza in outpatient settings and especially in children aged 2-17 years. Observed trends were consistent with established syndromic and virologic systems.
Influenza and Other Respiratory Viruses 09/2012; · 1.47 Impact Factor
[show abstract][hide abstract] ABSTRACT: With nearly one quarter of the combined governmental public health workforce eligible for retirement within the next few years, recruitment and retention of workers is a growing concern. Epidemiology has been identified as a potential workforce shortage area in state health departments.
Understanding strategies for recruiting and retaining epidemiologists may help health departments stabilize their epidemiology workforce. The Council of State and Territorial Epidemiologists conducted a survey, the Epidemiology Capacity Assessment (ECA), of state health departments to identify recruitment and retention factors.
The ECA was distributed to 50 states, the District of Columbia (DC), and four U.S. territories in 2009. The 50 states and DC are included in this analysis. The State Epidemiologist completed the organizational-level assessment; health department epidemiologists completed an individual-level assessment. Data were analyzed in 2010.
All states responded to the ECA, as did 1544 epidemiologists. Seventeen percent of epidemiologists reported intent to retire or change careers in the next 5 years. Ninety percent of states and DC identified state and local government websites, schools of public health, and professional organizations as the most useful recruitment tools. Top recruitment barriers included salary scale, hiring freezes, and ability to offer competitive pay; lack of promotion opportunities and merit raise restrictions were main retention barriers.
Although the proportion of state health department epidemiologists intending to retire or change careers during the next 5 years is lower than the estimate for the total state public health workforce, important recruitment and retention barriers for the employees exist.
American journal of preventive medicine 01/2012; 42(1):76-80. · 4.24 Impact Factor
[show abstract][hide abstract] ABSTRACT: In 2005, a Web-based survey of chief epidemiologists of 50 states, the District of Columbia, 9 large cities, and 8 territories examined the status of US smallpox surveillance after the Council of State and Territorial Epidemiologists recommended that smallpox be reportable. Of 55 respondents, 95% reported state or territory laws or regulations governing smallpox reporting; 70% of states required laboratories to report variola virus. All respondents could investigate reported suspected patients; 70%-89% would investigate initially by telephone or fax. In 2004, 11 states reported 33 patients suspected of having smallpox. Reports were more likely in states that provided >/=2 educational and training sessions (67% vs. 21%; prevalence odds ratio, 7.60; 95% confidence interval, 1.07-60.45). The goal is a public health surveillance system in which all states, cities, and territories can detect and manage suspected smallpox cases urgently and in which overall surveillance for other infectious diseases is strengthened.
[show abstract][hide abstract] ABSTRACT: We reviewed timeline information for a sample of Salmonella spp., Shigella spp., Campylobacter spp., and Escherichia coli O157:H7 cases and all confirmed foodborne outbreaks reported in 6 states during 2002. Increasing the timeliness of case follow-up, molecular subtyping, and linkage of results are critical to reducing delays in the investigation of foodborne outbreaks.
[show abstract][hide abstract] ABSTRACT: We determined the competency of the public health epidemiolOgy workforce within state health agencies based on the Centers for Disease Control and Prevention/Council of State and Territorial Epidemiologists Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs).
The competence level of current state health agency staff and the need for additional training was assessed against 30 mid-level AECs. Respondents used a five-point Likert scale-ranging from "strongly agree" to "strongly disagree"-to designate whether staff was competent in certain areas or whether additional training was needed for each of the competencies.
Most states indicated their epidemiology workforce was competent in most of the AECs subject areas. Subject areas with the greatest number of states reporting competency (82%) are creating and managing databases and applying privacy laws. However, at least one-third of the states reported a need for additional training in all competencies assessed. The greatest reported needs were for additional training in surveillance system evaluation and use of knowledge of environmental and behavioral science in epidemiology practice.
The results indicate that most epidemiologists mastered the traditional discipline-specific competencies. However, it is unclear how this level of competency was achieved and what strategies are in place to sustain and strengthen it. The results indicate that epidemiologists have lower levels of competence in the nontraditional epidemiologic fields of knowledge. Future steps to ensure a well-qualified epidemiology workforce include assessing the full AECs in a subgroup of Tier 2 epidemiologists and implementing competencies in academic curricula to sustain reported competency achievements.
Public Health Reports 02/2008; 123 Suppl 1:128-35. · 1.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: We developed competencies for applied epidemiologic practice by using a process that is based on existing competency frameworks, that engages professionals in academic and applied epidemiology at all governmental levels (local, state, and federal), and that provides ample opportunity for input from practicing epidemiologists throughout the U.S.
The model set of core public health competencies, consisting of eight core domains of public health practice, developed in 2001 by the Council on Linkages Between Academia and Public Health Practice, were adopted as the foundation of the Competencies for Applied Epidemiologists in Governmental Public Health Agencies (AECs). A panel of experts was convened and met over a period of 20 months to develop a draft set of AECs. Drafts were presented at the annual meetings of the Council of State and Territorial Epidemiologists (CSTE) and the American Public Health Association. Input and comments were also solicited from practicing epidemiologists and 14 national organizations representing epidemiology and public health.
In all, we developed 149 competency statements across the eight domains of public health practice and four tiers of applied epidemiologic practice. In addition, sub- and sub-subcompetency statements were developed to increase the document's specificity. During the process, >800 comments from all governmental and academic levels and tiers of epidemiology practice were considered for the final statements.
The AECs are available for use in improving the training for and skill levels of practicing applied epidemiologists and should also be useful for educators, employers, and supervisors. Both CDC and CSTE plan to evaluate their implementation and usefulness in providing information for future competency development.
Public Health Reports 01/2008; 123 Suppl 1:67-118. · 1.42 Impact Factor
[show abstract][hide abstract] ABSTRACT: In June 1987, nearly 10 years after the World Health Organization (WHO) declared smallpox eradicated, the Council of State and Territorial Epidemiologists (CSTE) recommended removal of smallpox, a highly contagious viral disease, from the National Notifiable Diseases Surveillance System (NNDSS). However, the attacks of September 11, 2001, raised concern that smallpox (variola) virus, might exist in laboratories other than two WHO-designated repositories and could be used as an agent of biologic terrorism. In response to this concern, CSTE and CDC recommended in June 2003 that smallpox again be made reportable through NNDSS and that all states, territories, and cities add smallpox to their lists of reportable diseases. In 2005, CSTE conducted a cross-sectional survey in the United States and its territories to assess key components for surveillance of suspected smallpox disease, including legal reporting requirements, laboratory testing, and training and education (e.g., oral presentations and guides). This report summarizes the results of that survey, which indicated that 100% had the capacity to receive and investigate reports, 94% of states had legal requirements to report suspected smallpox disease, 70% had mandatory laboratory reporting of results indicative of smallpox disease, and 68% were providing ongoing training and education of health-care providers and public health staff.
MMWR. Morbidity and mortality weekly report 01/2007; 55(49):1325-7.
[show abstract][hide abstract] ABSTRACT: To assess the number of epidemiologists and national epidemiology capacity, the Council of State and Territorial Epidemiologists surveyed state health departments in 2001, 2004, and 2006. This article summarizes findings of the 2006 assessment, analyzes trends in epidemiology workforce, and examines statistical associations between the number of epidemiologists and measures of capacity.
The on-line surveys collected information from 50 states and the District of Columbia about the number of epidemiologists employed, their training and educational background, program capacity, organizational structure, and funding sources. The State Epidemiologists and/or their designees answered the questionnaire.
The number of epidemiologists in state health departments increased approximately 40 percent from 2001 to 2006. All programs except occupational health experienced increase in the number of epidemiologists; the greatest increase occurred in bioterrorism programs. Estimated epidemiology capacity increased in all programs except environmental health and occupational health. The Epidemiology Capacity Assessment survey indicates that state health departments need 30 percent more epidemiologists. A linear correlation existed between the number of epidemiologists and state population.
Federal emergency preparedness funding supported most of the increase in epidemiologists, which could fall as funding decreases. To function at full capacity, states need approximately one epidemiologist per 100 000 population for all program areas. Current estimates of workforce capacity need to be refined.
Journal of public health management and practice: JPHMP 15(4):328-36. · 0.96 Impact Factor