{"title":"Suspected Intentional Use of Biologic and Toxic Agents","authors":"S. Papagiotas, K. Shannon","doi":"10.1093/OSO/9780190933692.003.0024","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0024","url":null,"abstract":"Exposures, illnesses, or outbreaks involving the suspected intentional use of biological or toxic agents require epidemiologists to work with nontraditional partners, specifically law enforcement. To increase effectiveness, public health and law enforcement must collaborate on timely identification, notification, assessment, and investigation. The process begins by establishing relationships between appropriate public health and law enforcement points of contact. Once an event is recognized, and if that threat involves a biological or toxic agent, public health and law enforcement can conduct a joint criminal–epidemiologic (crim–epi) investigation, which increases the effectiveness of the investigation through the exchange of real-time information. Although instances of bioterrorism are infrequent, the potential use of biological or toxic agents for this purpose by individuals and groups can have enormous consequences and are likely to remain a persistent threat. Only through a productive partnership can public health and law enforcement effectively respond to intentional uses of biological and toxic agents.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"39 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130653301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Suicide, Violence, and Other Forms of Injury","authors":"J. Logan, J. Mercy","doi":"10.1093/OSO/9780190933692.003.0025","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0025","url":null,"abstract":"Fatal and nonfatal self-directed and interpersonal violence and unintentional injuries can spread throughout a community just like infectious diseases. What drives people to attempt suicide, harm others, or place themselves in unsafe situations most often results from complex dynamics between themselves and their social environments. Nevertheless, outbreaks of fatal and nonfatal injuries do occur. Similar to how an infectious disease manifests and spreads, outbreaks of self-inflicted, violent injuries, and even unintentional injuries, such as drug overdoses, also can be precipitated by immediate exposures that public health prevention strategies can best address. At some point, a field epidemiologist will face the challenges and the nuances of these epidemics. This chapter provides case stories of injury-related epidemics and the exposures and circumstances that propagated them. It also reviews the types of investigations conducted to address these epidemics, common challenges, and the short- and long-term strategies used to control such dangerous and deadly outbreaks.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115498452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Community Congregate Settings","authors":"A. Uzicanin, Joanna Gaines","doi":"10.1093/OSO/9780190933692.003.0019","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0019","url":null,"abstract":"Settings and patterns of human congregation are risk factors and determinants for infectious and other diseases in communities because they can modulate the scope and extent of spread through modes of exposure and transmission (e.g., person-to-person, airborne, foodborne, waterborne, and vectorborne). This chapter reviews practical and legal implications for field investigations in four types of community congregate settings: (1) educational institutions, (2) workplaces, (3) mass gatherings, and (4) detention facilities. For each of these, it summarizes one or more illustrative field investigations. Challenges often associated with field investigations in community congregate settings include the potential for interference with normal business processes, data availability and access, and additional legal and confidentiality requirements. Field investigations of congregate settings can therefore be aided by thorough preparation, detailed documentation and close coordination and collaboration.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"49 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114587695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Coordination of Multiple States and Federal Agencies","authors":"T. Jones, C. Hedberg","doi":"10.1093/oso/9780190933692.003.0014","DOIUrl":"https://doi.org/10.1093/oso/9780190933692.003.0014","url":null,"abstract":"Although most outbreaks are confined to a local jurisdiction, the number of multijurisdictional outbreaks (i.e., involving multiple geographic areas, widely distributed contaminated food or pharmaceutical products, or multiple government agencies) is increasing. In such cases, a clear and effective management system for the response must be established promptly. The roles and expectations of all involved responders should be clearly defined and closely monitored. Partners should be in regular communication throughout the response. Procedures and mechanisms for sharing of appropriate data and protecting sensitive information should be established from the onset of the investigation. Public communication about the investigation and response should be closely coordinated among agencies and preferably handled by a single spokesperson. Following the established procedures of the Incident Command System is often appropriate for large-scale or multijurisdictional outbreak responses.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"63 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121456819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Emergency Operations Centers and Incident Management Structure","authors":"J. Bryant, D. Sosin, Tim W. Wiedrich, S. Redd","doi":"10.1093/OSO/9780190933692.003.0016","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0016","url":null,"abstract":"Domestically and internationally, Emergency Operation Centers and Incident Management Systems provide a structure and framework to coordinate preparedness and response activities. This chapter provides a US perspective on emergency response systems, but the concepts have been successfully implemented in other countries. Public health responses are often complex, requiring adaptive leadership and flexible systems to be effective as information is received, analyzed, and shared with response partners and affected populations. Familiarity with the emergency management principles underlying these frameworks can help rapidly integrate field epidemiology expertise into response operations. Emergency Operations Centers typically become activated when an entity (local, regional, district, prefecture, state) responsible for maintaining routine public health and medical systems becomes overwhelmed in a crisis. Preparedness activities, such as preestablished organizational structures, protocols and policies, mutual aid and resource-sharing agreements, trained staff, and mechanisms to procure necessary capabilities can bring resources together for a rapid and effective response.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125088958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Acute Enteric Disease Outbreaks","authors":"I. Williams, L. Whitlock, M. Wise","doi":"10.1093/oso/9780190933692.003.0023","DOIUrl":"https://doi.org/10.1093/oso/9780190933692.003.0023","url":null,"abstract":"Public health officials investigate outbreaks to control them, to prevent additional illnesses, and to learn how to prevent similar outbreaks in the future. The process the public health community uses to detect, investigate, and control enteric (intestinal) disease outbreaks from food, water, and other sources involves certain procedural steps. These include detecting a possible outbreak, defining and finding cases, generating hypotheses about likely sources, testing the hypotheses and evaluating evidence, finding contamination sources, controlling the outbreak, and determining when the outbreak is over. Investigating outbreaks of acute enteric diseases can be a dynamic and complex undertaking involving multiple public health and regulatory partners in different jurisdictions. This chapter provides an overview of the investigation process with an emphasis on multijurisdictional foodborne illness investigations in the United States.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"67 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121456162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael E. King, D. Bensyl, R. Goodman, S. Rasmussen
{"title":"Conducting a Field Investigation","authors":"Michael E. King, D. Bensyl, R. Goodman, S. Rasmussen","doi":"10.1093/OSO/9780190933692.003.0003","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0003","url":null,"abstract":"Performing field investigations is a core function of epidemiology in public health. When a threat to the public’s health occurs, epidemiologists investigate to describe the problem and identify causes, recommend immediate prevention and control measures, and provide a foundation for communicating information quickly to those who need to know to save lives and protect people from future illness. Although diseases and evaluative technologies evolve continually, the approach to conducting an epidemiologic field investigation remains relatively constant. Investigating an outbreak requires both a speedy and accurate response, necessitating a systematic approach that results in action. This chapter describes the basic 10-step approach for conducting an epidemiologic field investigation. Although the steps in this chapter are presented in a numeric and conceptual order, the order sometimes changes in practice. Ultimately, the goal of any epidemiologic field investigation is to use the science of epidemiology to rapidly ensure public health and safety.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116293458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Occupational Disease and Injury","authors":"K. Kreiss, Kristin J Cummings","doi":"10.1093/OSO/9780190933692.003.0021","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0021","url":null,"abstract":"Occupational diseases and injuries continue to exact a societal burden on productivity, acute and chronic disease, and preventable medical costs. Occupational problems require collaboration from employers, labor, and government both for investigation and for preventive intervention. A key characteristic is the need for exposure assessment with a multidisciplinary investigative team that includes environmental scientists or industrial hygienists who can evaluate workplace characteristics needed for design, questionnaire development, quantitative assessment of exposure, interpretation of findings, and guidance for prevention. A field epidemiologic investigation often is triggered by worker or physician recognition of clusters of disease or injury. The relatively few field investigators working on occupational disease and injury provide room for many contributions. Occupational health field investigations are exciting because of the opportunity they provide to learn from other disciplines and collaborators in other agencies and because of impact.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127393099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Communicating During an Outbreak or Public Health Investigation","authors":"Abbigail J Tumpey, David Daigle, Glen J. Nowak","doi":"10.1093/OSO/9780190933692.003.0012","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0012","url":null,"abstract":"Effective communication during an outbreak or public health investigation is crucial for fostering adoption of public health recommendations and minimizing or preventing harm. During outbreaks, a comprehensive communication strategy integrating news media, social media, and partner engagement is essential for reaching affected persons and for keeping everyone informed about public health actions and recommendations. The strategies outlined in this chapter are the foundation for rapidly and effectively conveying information and public health recommendations to the persons at risk, the media, and the different entities involved in the response. Regardless of the public health event’s cause, core communication actions and steps will be similar; however, in every outbreak or public health investigation, perceptions and needs will vary among target audiences, partners (i.e., persons or organizations that can play a role in the crisis response), and persons or organizations with a connection or interest in the outbreak (stakeholders).","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133865891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Multinational Outbreak Investigations","authors":"F. Mahoney, J. Duc","doi":"10.1093/OSO/9780190933692.003.0015","DOIUrl":"https://doi.org/10.1093/OSO/9780190933692.003.0015","url":null,"abstract":"Multinational collaborations on international outbreak investigations and response have a long history. Development of the World Health Organization (WHO) in 1948 was closely linked to efforts by the global community to prevent, detect, and respond to outbreaks of international concern. Through the International Health Regulations (IHR) of 2005, a legally binding instrument requiring countries to report certain outbreaks and public health events, WHO outlined a strategy for disease threat response. Efforts by global partners to strengthen cooperation have evolved over the years, including roles and responsibilities of WHO, its Member States, and other partners. Among the challenges faced by Member State and WHO in implementing the IHRs are limited funding to support staffing and operational support as well as sometimes conflicting multijurisdictional decision-making. The response to recent outbreaks provides evidence that much work remains to be done to strengthen IHR mechanisms.","PeriodicalId":371391,"journal":{"name":"The CDC Field Epidemiology Manual","volume":"111 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117183601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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