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Fiore A.E.,Centers for Disease Control and Prevention | Epperson S.,Centers for Disease Control and Prevention | Perrotta D.,Council of State and Territorial Epidemiologists | Perrotta D.,Texas A&M University | And 2 more authors.
Pediatrics | Year: 2012

BACKGROUND: Despite long-standing recommendations to vaccinate children who have underlying chronic medical conditions or who are contacts of high-risk persons, vaccination coverage among school-age children remains low. Community studies have indicated that school-age children have the highest incidence of influenza and are an important source of amplifying and sustaining community transmission that affects all age groups. METHODS: A consultation to discuss the advantages and disadvantages of a universal recommendation for annual influenza vaccination of all children age ≥6 months was held in Atlanta, Georgia, in September 2007. Consultants provided summaries of current data on vaccine effectiveness, safety, supply, successful program implementation, and economics studies and discussed challenges associated with continuing a risk- and contact-based vaccination strategy compared with a universal vaccination recommendation. RESULTS: Consultants noted that school-age children had a substantial illness burden caused by influenza, that vaccine was safe and effective for children aged 6 months through 18 years, and that evidence suggested that vaccinating school-age children would provide benefits to both the vaccinated children and their unvaccinated household and community contacts. However, implementation of an annual recommendation for all school-age children would pose major challenges to parents, medical providers and health care systems. Alternative vaccination venues were needed, and of these school-located vaccination programs might offer the most promise as an alternative vaccination site for school-age children. CONCLUSIONS: Expansion of recommendations to include all school-age children will require additional development of an infrastructure to support implementation and methods to adequately evaluate impact. Copyright © 2012 by the American Academy of Pediatrics.


Dick V.R.,Council of State and Territorial Epidemiologists | Masters A.E.,Council of State and Territorial Epidemiologists | McConnon P.J.,Council of State and Territorial Epidemiologists | Engel J.P.,Council of State and Territorial Epidemiologists | And 2 more authors.
American Journal of Preventive Medicine | Year: 2014

Results More than half the alumni (67%) indicated the fellowship was essential to their long-term career. In addition, 79% of the mentors indicated that participating in the fellowship had a positive impact on their career. Mentors also indicated significant impacts on host site capacity. A majority (88%) of alumni had worked for at least 1 year or more in government public health environments after the fellowship.Conclusions Evaluation findings support previous research indicating need for competency-based field-based training programs that include a strong mentoring component. These characteristics in a field-based training program can increase applied epidemiology capacity in various ways.Background The Council of State and Territorial Epidemiologists (CSTE) implemented the Applied Epidemiology Fellowship (AEF) in 2003 to train public health professionals in applied epidemiology and strengthen applied epidemiology capacity within public health institutions to address the identified challenges. The CSTE recently evaluated the outcomes of the fellowship across the last 9 years. .Purpose To review the findings from the outcome evaluation of the first nine classes of AEF alumni with particular attention to how the fellowship affected alumni careers, mentors' careers, host site agency capacity, and competencies of the applied epidemiology workforce.Methods The mixed-methods evaluation used surveys and administrative data. Administrative data were gathered over the past 9 years and the surveys were collected in late 2013 and early 2014. Descriptive statistics and qualitative thematic analysis were conducted in early 2014 to examine the data from more than 130 alumni and 150 mentors. © 2014 American Journal of Preventive Medicine.


Rosenberg L.,Council of State and Territorial Epidemiologists | Kubota K.,Association of Public Health Laboratories
Foodborne Pathogens and Disease | Year: 2013

Over 1,100 foodborne disease outbreaks cause over 23,000 illnesses in the United States annually, but the rates of outbreaks reported and successful investigation vary dramatically among states. We used data from the Centers for Disease Control and Prevention's outbreak reporting database, Association of Public Health Laboratories' PulseNet laboratory subtyping network survey and Salmonella laboratory survey, national public health surveillance data, and national surveys to examine potential causes of this variability. The mean rate of reporting of Salmonella outbreaks was higher in states requiring submission of all isolates to the state public health laboratory, compared to those that do not (5.9 vs. 4.1 per 10 million population, p=0.0062). Rates of overall outbreak reporting or successful identification of an etiology or food vehicle did not correlate at the state level with population, rates of sporadic disease reporting, health department organizational structure, or self-reported laboratory or epidemiologic capacity. Foodborne disease outbreak surveillance systems are complex, and improving them will require a multi-faceted approach to identifying and overcoming barriers. © Mary Ann Liebert, Inc.


Verlee K.E.,Council of State and Territorial Epidemiologists | Verlee K.E.,Current affiliation Spectrum Health | Wells E.V.,University of Michigan
Public Health Reports | Year: 2012

Clostridium difficile (C. difficile) causes an intestinal bacterial infection of increasing importance in Michigan residents and health-care facilities. The specific burden and health-care costs of C. difficile infection (CDI) were previously unknown. We evaluated the frequency, mortality, and health-care charges of CDI from Michigan hospital discharge data. Methods. The Michigan Department of Community Health purchased discharge data from all Michigan acute care hospitals from the Michigan Health and Hospital Association. We extracted all hospital discharges from 2002 through 2008 containing the International Classification of Diseases, Ninth Revision code for intestinal infection due to C. difficile. Discharges were stratified by principle diagnosis and comorbidity level. Total hospitalization charges were standardized to the 2008 U.S. dollar. Results. From 2002 through 2008, 68,686 hospital discharges with CDI occurred. The annual rate increased from 463.1 to 1096.5 CDI discharges per 100,000 discharges. CDI discharge rates were substantially higher among the elderly, females, and black people. Of all CDI discharges, 5,924 (8.6%) patients died. The mean total health-care charge for the time period was $67,149, and the annual mean increased 35% from 2002 to 2008. Hospital charges varied significantly by race/ethnicity and age. People with Medicaid insurance accrued the highest charges. Conclusion. Across Michigan, the CDI burden is growing substantially and affecting vulnerable populations. Surveillance utilizing hospital discharge data can illuminate trends and inform intervention targets. To reduce disease and health-care charges, increased prevention and infection-control efforts should be directed toward high-risk populations, such as the elderly. ©2012 Association of Schools of Public Health.


Sugerman D.E.,Epidemic Intelligence Service | Barskey A.E.,Centers for Disease Control and Prevention | Delea M.G.,Council of State and Territorial Epidemiologists | Ortega-Sanchez I.R.,Centers for Disease Control and Prevention | And 5 more authors.
Pediatrics | Year: 2010

OBJECTIVE: In January 2008, an intentionally unvaccinated 7-year-old boy who was unknowingly infected with measles returned from Switzerland, resulting in the largest outbreak in San Diego, California, since 1991. We investigated the outbreak with the objective of understanding the effect of intentional undervaccination on measles transmission and its potential threat to measles elimination. METHODS: We mapped vaccination-refusal rates according to school and school district, analyzed measles-transmission patterns, used discussion groups and network surveys to examine beliefs of parents who decline vaccination, and evaluated containment costs. RESULTS: The importation resulted in 839 exposed persons, 11 additional cases (all in unvaccinated children), andthe hospitalization of an infant too young to be vaccinated. Two-dose vaccination coverage of 95%, absence of vaccine failure, and a vigorous outbreak response halted spread beyond the third generation, at a net public-sector cost of $10 376 per case. Although 75% of the cases were of persons who were intentionally unvaccinated, 48 children too young to be vaccinated were quarantined, at an average family cost of $775 per child. Substantial rates of intentional undervaccination occurred in public charter and private schools, as well as public schools in upper-soeioeconomic areas. Vaccine refusal clustered geographically and the overall rate seemed to be rising. In discussion groups and survey responses, the majority of parents who declined vaccination for their children were concerned with vaccine adverse events. CONCLUSIONS: Despite high community vaccination coverage, measles outbreaks can occur among clusters of intentionally undervaccinated children, at major cost to public health agencies, medical systems, and families. Rising rates of intentional undervaccination can undermine measles elimination.


Stricof R.,Council of State and Territorial Epidemiologists | Stricof R.,New York State Department of Health
Clinical Governance | Year: 2012

Purpose: This paper aims to describe experience to date with mandatory public reporting of healthcare-associated infection rates from a perspective inside one of the first and most advanced of the state programs, to help frame the research agenda of an interdisciplinary university faculty collaborative. Design/ methodology/ approach: The paper is a narrative review of personal experience. Findings: Key factors enabling program achievements include starting with a sufficient pilot phase, including strong provisions for audit and validation, a balance of viewpoints among advisors to the program, adoption of internationally respected data systems, and ability to sponsor improvement projects in reporting hospitals. Identified pitfalls and needs for more progress also must be addressed. Practical implications: Public health departments are in uncharted territory with this new area of activity, faced with fundamental knowledge gaps that potentially hamper chances of success. Perspectives explored in this part of the Universities Council Symposium help frame a research agenda and guide evolution of less advanced programs. Originality/value: This review helps frame the research agenda of an interdisciplinary university faculty collaborative and guides evolution of less advanced programs. © 2012 Emerald Group Publishing Limited.


Haley V.B.,New York State Department of Health | DiRienzo A.G.,Albany State University | Lutterloh E.C.,New York State Department of Health | Lutterloh E.C.,Albany State University | Stricof R.L.,Council of State and Territorial Epidemiologists
Infection Control and Hospital Epidemiology | Year: 2014

objective. To assess the effect of multiple sources of bias on state- and hospital-specific National Healthcare Safety Network (NHSN) laboratory-identified Clostridium difficile infection (CDI) rates. design. Sensitivity analysis. setting. A total of 124 New York hospitals in 2010. methods. New York NHSN CDI events from audited hospitals were matched to New York hospital discharge billing records to obtain additional information on patient age, length of stay, and previous hospital discharges. "Corrected" hospital-onset (HO) CDI rates were calculated after (1) correcting inaccurate case reporting found during audits, (2) incorporating knowledge of laboratory results from outside hospitals, (3) excluding days when patients were not at risk from the denominator of the rates, and (4) adjusting for patient age. Data sets were simulated with each of these sources of bias reintroduced individually and combined. The simulated rates were compared with the corrected rates. Performance (ie, better, worse, or average compared with the state average) was categorized, and misclassification compared with the corrected data set was measured. results. Counting days patients were not at risk in the denominator reduced the stateHOrate by 45% and resulted in 8%misclassification. Age adjustment and reporting errors also shifted rates (7% and 6% misclassification, respectively). conclusions. Changing the NHSN protocol to require reporting of age-stratified patient-days and adjusting for patient-days at risk would improve comparability of rates across hospitals. Further research is needed to validate the risk-adjustment model before these data should be used as hospital performance measures. © 2013 by The Society for Healthcare Epidemiology of America. All rights reserved.


Boulton M.L.,University of Michigan | Hadler J.,Council of State and Territorial Epidemiologists | Beck A.J.,University of Michigan | Ferland L.,Council of State and Territorial Epidemiologists | Lichtveld M.,Tulane University
Public Health Reports | Year: 2011

Objectives. To assess the number of epidemiologists and epidemiology capacity nationally, the Council of State and Territorial Epidemiologists surveyed state health departments in 2004, 2006, and 2009. This article summarizes findings of the 2009 assessment and analyzes five-year (2004-2009) trends in the epidemiology workforce. Methods. Online surveys collected information from all 50 states and the District of Columbia about the number of epidemiologists employed, their training and education, program and technologic capacity, organizational structure, and funding sources. State epidemiologists were the key informants; 1,544 epidemiologists provided individual-level information. Results. The number of epidemiologists in state health departments decreased approximately 12% from 2004 to 2009. Two-thirds or more states reported less than substantial (<50% of optimum) surveillance and epidemiology capacity in five of nine program areas. Capacity has diminished since 2006 for three of four epidemiology-related Essential Services of Public Health (ESPHs). Fewer than half of all states reported using surveillance technologies such as Web-based provider reporting systems. State health departments need 68% more epidemiologists to reach optimal capacity in all program areas; smaller states (<5 million population) have higher epidemiologist-to-population ratios than more populous states. Conclusions. Epidemiology capacity in state health departments is suboptimal and has decreased, as assessed by states' ability to carry out the ESPHs, by their ability to use newer surveillance technologies, and by the number of epidemiologists employed. Federal emergency preparedness funding, which supported more than 20% of state-based epidemiologists in 2006, has decreased. The 2009 Epidemiology Capacity Assessment demonstrates the negative impact of this decrease on states' epidemiology capacity. ©2011 Association of Schools of Public Health.


Beck A.J.,University of Michigan | Boulton M.L.,University of Michigan | Lemmings J.,Council of State and Territorial Epidemiologists | Clayton J.L.,University of Michigan
American Journal of Preventive Medicine | Year: 2012

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.


Pittman J.,Council of State and Territorial Epidemiologists
Journal of Public Health Management and Practice | Year: 2016

CONTEXT:: Communication in the form of written and oral reports and presentations is a core competency for epidemiologists at governmental public health agencies. Many applied epidemiologists do not publish peer-reviewed articles, limiting the scientific literature of best practices in evidence-based public health. OBJECTIVES:: To describe the writing and publishing experiences of applied epidemiologists and identify barriers and facilitators to publishing. DESIGN:: Telephone focus groups and an 18-question multiple-choice and short-answer Web-based assessment were fielded in 2014. SETTING AND PARTICIPANTS:: Six focus groups composed of 26 applied epidemiologists and an online assessment answered by 396 applied epidemiologists. Sample selection was stratified by years of experience. MAIN OUTCOME MEASURES:: Past publishing experience, current job duties as related to publishing, barriers and facilitators to writing and publishing, and desired training in writing and publishing were assessed through focus groups and the online assessment. RESULTS:: Focus groups identified 4 themes: job expectations, barriers to publishing, organizational culture, and the understanding of public health practice among reviewers as issues related to writing and publishing. Most respondents (80%) expressed a desire to publish; however, only 59% had published in a peer-reviewed journal. An academic appointment (among doctoral educated respondents) was identified as a facilitator to publishing as was access to peer-reviewed literature. Time (68%) was identified as the greatest barrier to writing and publishing. Other major barriers included lack of encouragement or support (33%) within the public health agency and agency clearance processes (32%). Assistance with journal selection (62%), technical writing skills (60%), and manuscript formatting (57%) were listed as the most needed trainings. CONCLUSION:: Public health agencies can be facilitators for epidemiologists to contribute to the scientific literature through increasing access to the peer-reviewed literature, creating a supportive environment for writing and publishing, and investing in desired and needed training. The results have implications for modifying workplace policies surrounding writing and publishing. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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