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.

State-level emergency preparedness and response capabilities.

BACKGROUND: Prior assessments of public health readiness had identified gaps in radiation preparedness. In recent years, preparedness planning has involved an "all-hazards" approach. Current assessment of the national status related to radiation public health emergency preparedness capabilities at the state and local health department levels was needed. METHODS: A survey of state health departments related to radiation readiness was undertaken in 2010 by the Council of State and Territorial Epidemiologists (CSTE). States with nuclear power plants were instructed to consider their responses exclusive of capabilities and resources related to the plants given that the emergency response plans for nuclear power plants are specific and unique. RESULTS: Thirty-eight (76%) state health departments responded to the survey, including 26 of the 31 states with nuclear power plants. Specific strengths noted at the state level included that the majority of states had a written radiation response plan and most plans include a detailed section for communications issues during a radiation emergency. In addition, more than half of the states indicated that their relationship with federal partners is sufficient to provide resources for radiation emergencies, indicating the importance states placed on federal resources and expertise. Specific weaknesses are discussed and include that most states had completed little to no planning for public health surveillance to assess potential human health impacts of a radiation event; less than half had written plans to address exposure assessment, environmental sampling, human specimen collection and analysis, and human health assessment. Few reported having sufficient resources to do public health surveillance, radiation exposure assessment, laboratory functions and other capabilities. DISCUSSION: Levels of planning, resources and partnerships varied among states, those with nuclear power plants were better prepared. Gaps were evident in all states; however and additional training and resources are needed to ensure adequate levels of preparedness. CONCLUSION: Overall results of this assessment indicate that in most measures of public health capacity and capability, states are poorly prepared to adequately respond to a major radiation emergency event. Specific recommendations are noted in the discussion.

St. Louis encephalitis in early infancy.

We describe a case of St. Louis encephalitis in a 19-day-old infant who presented with fever and seizure activity. To our knowledge, this is the youngest case of St. Louis encephalitis ever reported.