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Session Title: Outbreaks: How Do You Evaluate Responses to the Unexpected?
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Panel Session 389 to be held in Washington Room on Thursday, November 8, 1:55 PM to 3:25 PM
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Sponsored by the Health Evaluation TIG
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| Chair(s): |
| Thomas Chapel,
Centers for Disease Control and Prevention,
tchapel@cdc.gov
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| Abstract:
Outbreaks are, by definition, sudden, unexpected increases in prevalence of disease. When responding to outbreaks, public health programs cannot follow standard program protocols. An intensive intervention must be rapidly employed. Interventions must be flexible and tailored to meet the specific context of the outbreak, thus making each response unique. Often, outbreak response is labor and resource intensive. Public health programs have a responsibility to evaluate outbreak response and ensure that they are conducted efficiently and effectively, but the unique nature of the responses make this difficult. This panel examines different approaches to meeting the challenges of evaluating these unusual interventions.
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Using Evaluation Data for Estimating Workforce Capacity Requirements for Emergency Response
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| Joan Cioffi,
Centers for Disease Control and Prevention,
jcioffi@cdc.gov
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| Christine Rosheim,
Centers for Disease Control and Prevention,
crosheim@cdc.gov
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Can an evaluation of historical emergency response efforts be used to predict the size and skills needed for a scalable public health response? This discussion describes the use of historical data and exercise feedback to design personnel teams to function as the building blocks of a public health response. A model was developed and tested on the basis of agency response to Hurricane Katrina in 2005, severe acute respiratory syndrome (SARS) in 2003, and pandemic influenza planning in 2006. The model for estimating workforce requirements was tested on three hypothetical scenarios - anthrax, smallpox, and viral hemorrhagic fever. The tool is being pilot-tested during upcoming emergency preparedness exercises but has already been useful in identifying potential gaps in the numbers and skill sets needed for operations and logistics, laboratory testing, and public information functions and roles. Although the model was specific to the Centers for Disease Control and Prevention, it can be tailored to other agencies or needs. The project demonstrates the usefulness of evaluation data for model development.
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Evaluating the Division of Tuberculosis Elimination Outbreak Response, is Value Added?
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| Maureen Wilce,
Centers for Disease Control and Prevention,
mwilce@cdc.gov
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| Brandii Mayes,
Saint Louis City Department of Health Communicable Disease,
mayesb@stlouiscity.com
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| Maryam Haddad,
Centers for Disease Control and Prevention,
mhaddad@cdc.gov
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| John Oeltmann,
Centers for Disease Control and Prevention,
joeltmann@cdc.gov
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| Kashef Ijaz,
Centers for Disease Control and Prevention,
kijaz@cdc.gov
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Although TB is curable and preventable, 14,097 persons were reported with TB in the United States during 2005. Each year, dozens of TB outbreaks occur in diverse communities with differing public health contexts. At the request of state health departments, complex outbreaks often require the intervention of the Outbreak Investigations Team (OIT), DTBE. During an outbreak response, the OIT performs numerous epidemiology driven investigative activities and provides recommendations for program improvement to prevent future outbreaks. Although substantial resources are invested in conducting these activities, evaluating its programmatic impact is difficult due to the diversity of situations and tailored responses. In 2006, DTBE conducted a retrospective evaluation, using a utilization approach, to examine the impact and value of outbreak response efforts. This presentation will discuss the benefits and limitations associated with selected methods for data collection and analysis. It will also address challenges associated with aggregately evaluating unique and tailored activities.
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Assessment of a Customizable Tuberculosis Outbreak Response Plan
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| Laura Freimanis Hance,
Westat,
laurafreimanis@westat.com
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| Karen R Steingart,
Francis J Curry National Tuberculosis Center,
karenst@u.washington.edu
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| Christine Hahn,
Idaho Department of Health and Welfare,
hahnc@dhw.idaho.gov
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| Lisa Pascopella,
Francis J Curry National Tuberculosis Center,
lpascopella@nationaltbcenter.edu
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| Charles Nolan,
Public Health - Seattle and King County,
charles.nolan@metrokc.gov
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A customizable TB outbreak response plan (ORP) was developed for a low-incidence region. We assessed usefulness of ORP by comparing local outbreak response activities to ORP guidance.
All key stakeholders involved in the outbreak response were interviewed using a semi-structured questionnaire. Common themes were used to assess validity of and identify gaps in ORP. A subset of participants provided structured feedback on ORP.
We interviewed 11 public health and six community stakeholders. ORP mirrored response activities. Stakeholders considered ORP sections on outbreak definition and communication most helpful (ORP introduced criteria for defining and guidelines for communicating a TB outbreak). We added an appendix with ten steps to take for a suspected TB outbreak and an evaluation checklist.
Interactive assessment of ORP revealed the importance of a standard TB outbreak definition, response steps, and evaluation framework. This assessment by end users informed changes that improved the usefulness of the programmatic tool.
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Challenges of Evaluating Rapid Responses to Syphilis Outbreaks
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| Betty Apt,
Centers for Disease Control and Prevention,
bapt@cdc.gov
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Syphilis is a sexually transmitted disease that can be cured with antibiotics, and transmission can be halted during a brief incubation period. Responding rapidly to outbreaks of syphilis can significantly reduce spread of the disease; however, due to the nature of outbreaks, it can be difficult to determine the effectiveness of interventions that are used. It is critical that health departments identify, contact, and treat sex partners, particularly pregnant women, quickly to prevent them from acquisition/transmission of syphilis. When an outbreak occurs, CDC's Division of STD Prevention may send out a Rapid Response Team to assist the project area with control activities. However, evaluating the effectiveness of the Response Team has been difficult due to the uniqueness of every outbreak and the focus on providing services rather than collecting data. This presentation will describe how a retroactive assessment led to proactive changes that will allow better evaluation of each response.
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