Enhancing Epidemiology Capacity During the 2014-15 West Africa Ebola Outbreak: An Assessment of the Role of Applied Public Health Epidemiologists.

CONTEXT: In late 2014, the Centers for Disease Control and Prevention requested the support of the Council of State and Territorial Epidemiologists to enhance epidemiologic capacity in the West African countries impacted or threatened by an outbreak of Ebola virus disease. In response, the Council of State and Territorial Epidemiologists recruited 36 senior epidemiologists who, collectively, made 45 deployments to West Africa, averaging 42 days each. OBJECTIVE: To assess the self-reported experiences and contributions of the deployed epidemiologists, as well as the role of nonprofit public health organizations in large-scale emergency response. DESIGN: Electronic assessment of the deployed epidemiologists. PARTICIPANTS: Experienced applied public health epidemiologists who volunteered to participate in the response to the West Africa Ebola virus disease emergency. MAIN OUTCOME MEASURES: Descriptive data. RESULTS: The chief, reported functional contributions made during deployments include improving surveillance processes (reported by 73.3% of respondents), building meaningful relationships to facilitate response activities (66.7%), improving data quality (53.3%), and improving understanding of the disease/outbreak (40.0%). Among the professional benefits of deployment to West Africa to assist with Ebola virus disease outbreak response are stimulating enthusiasm for public health work (93.3%, n = 30), broadened perspective of global health (86.7%), and sharpened epidemiological skills (56.7%). CONCLUSIONS: Owing to their ability to access experienced, senior professionals, the Council of State and Territorial Epidemiologists and other nonprofit public health associations can play a meaningful role boosting surge capacity in a sustained, large-scale emergency response.

Assessment of epidemiology capacity in state health departments - United States, 2013.

Since 2001, the Council of State and Territorial Epidemiologists (CSTE) periodically has conducted a standardized national assessment of state health departments' core epidemiology capacity (1-4). During August-September 2013, CSTE sent a web-based questionnaire to state epidemiologists in the 50 states and the District of Columbia. The questionnaire inquired into workforce capacity and technology advancements to support public health surveillance. Measures of capacity included the total number of epidemiologists, a self-assessment of the state's ability to carry out four of the 10 essential public health services* most relevant to epidemiologists, and program-specific epidemiology capacity. This report summarizes the results, which indicated that in 2013, most of these measures were at their highest level since assessments began in 2001, including the number of epidemiologists, the percentage of state health departments with substantial-to-full (>50%) capacity for three of the 10 essential public health services, and the percentage with substantial-to-full epidemiology capacity for eight of 10 program areas. However, >50% of states reported minimal-to-no (<25%) epidemiology capacity for four of 10 program areas, including occupational health (55%), oral health (59%), substance abuse (73%), and mental health (80%). Federal, state, and local agencies should work together to develop a strategy to address continued outstanding gaps in epidemiology capacity.

Assessment of epidemiology capacity in state health departments, 2001-2006.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Public health surveillance for suspected smallpox in the United States, 2003-2005: results of a national survey.

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.

From competencies to capacity: assessing the national epidemiology workforce.

OBJECTIVES: 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). METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Developing competencies for applied epidemiology: from process to product.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Estimating influenza incidence and rates of influenza-like illness in the outpatient setting.

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.

Challenges to recruitment and retention of the state health department epidemiology workforce.

BACKGROUND: 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. PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Timeliness of enteric disease surveillance in 6 US states.

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.