Randolph Daley, DVM, MPHCaptain, USPHS

Chief, Field Services BranchDivision of State and Local Readiness

PIHOA Board MeetingAugust 12, 2014

Career Epidemiology Field Officer

Supporting Epidemiology Preparedness in the Pacific Islands

Office of Public Health Preparedness and Response

Division of State and Local Readiness

Public Health Concernsin the Pacific

DiseasesInfectious — Measles, Chikungunya,

Malaria, Dengue, Leptospirosis, Hansen’s Disease, Tuberculosis, Influenza

Chronic — Cardiovascular disease, Diabetes

Environmental HealthNatural disasters — typhoons, tsunamisFood and water systems

Surveillance System DevelopmentPopulation Movements

Career Epidemiology Field Officer (CEFO) Program

Created in 2002 in response to attacks of 9/11

Mission — strengthen nationwide epidemiologic capability for public health preparedness and response

Assigns CDC epidemiologist to health departments

Funded through CDC’s Public Health Emergency Preparedness (PHEP) cooperative agreement

How Can a CEFO Benefit the Health Department?

Applied epidemiology Surveillance Outbreak investigation Analysis Communication

Additional expertise Clinical Scientific

How Can a CEFO Benefit the Health Department?

Connection to CDC Field Services Branch support CDC subject matter experts Liaison for information exchange

CEFO Activities

Strengthen state and local surveillance systems

Conduct outbreak investigations and response

Lead community assessment activities Provide expertise on the design,

implementation, and analysis of epidemiologic studies

Develop response plans for public health emergencies

Build partnerships for emergency preparedness

Serve on emergency response teams Lead portions of state’s planning and

response activities Lead or participate in emergency response

exercises

Surveillance

DevelopmentPostdisaster systems — outpatient,

shelter settingsRoutine — reportable conditions

MaintenanceEvaluationCoordination with CDC — BioSense

Cases of Cholera — Sofala Province, Mozambique

1 2 3 4 5 6 7 8 9 100

50100150200250300350400450

1999

2000

Week of the Year

Wee

kly

Cli

nic

al C

hol

era

Cas

es

1950

52

54

56

58

1960

62

64

66

68

1970

72

74

76

78

1980

82

84

86

88

1990

92

94

96

98

2000

0100200300400500600700800900

Year

Ca

se

s (

tho

us

an

ds

)Measles — United States, 1950–2006

2 Doses

EndemicElimination Declared

Vaccine Licensed 1963

Outbreak Investigations

Local/RegionalNationalPandemic preparednessRecent examples

Healthcare-associated infections — Hepatitis C, Clostridium difficile

Cyclosporiasis Middle East Respiratory Syndrome (MERS)

1

2

3

6

7

4

5

12 13 14 28Exposure Date

Index Case

2nd Generation Case

3rd Generation Case

PA

PA

MI

MI

TX TX

TX

Measles Outbreak — United States,August 2007

CASPER

Community Assessment for Public HealthEmergency Response

Methodology for postdisaster rapid needs assessment

Community assessmentPreparednessDisease burdenRisk factors

CASPER

CASPER

CASPER

Workforce Development

Training activitiesLecturesWorkshopsStudent Programs

MentorshipJunior health department staffEpidemic Intelligence Service (EIS)

OfficersCouncil of State and Territorial

Epidemiologist (CSTE)Applied Epidemiology Fellows

Public Health Associate Program (PHAP) Fellows

Preparedness Field Assignees (PFAs)

CEFOs in Action

Field Services Branch

Mission — strengthen nationwide public health preparedness and response capability through service at state, tribal, local, and territorial health departments

Programs Career Epidemiology Field Officer Preparedness Field Assignee

Staff CDC Headquarters — 11 CEFOs — 33 PFAs — 17

Career Epidemiology Field OfficersAssignment Locations, September 2014

Jackson Schmitz

Fleischauer MacFarquha

r

Goode

Patel Campagnolo Miller

Dentinger Harper Quinn

Thoroughma

n Groenewold

Pickard

O’Leary

Buss

Holzbauer

SunenshineAdams

Carter Tarkhashvili

M

orr

iso

n

Nett

Margaret Riggs

Kurkjian

McFadden

Pre

ace

ly

Navon

Wilken

Thomas

Roth Murphree

Edison

David Callahan

Mary DottAs of September, 2014, 33 CEFOs are assigned to 27 jurisdictions

Venuto

CEFO for the Pacific IslandsConceptPacific Island Health Officers

Association (PIHOA) Regional approach Concentration of CDC staff

Direct CDC funding Pilot of alternative funding model National health security

Collaborative direction

CEFO for the Pacific Islands

ChallengesMultiple Jurisdictions Assessment of risk and needs Collaborative prioritization from PIHOA

Board Regional projects Planned activities in all jurisdictions Enhancement of jurisdictional staff

Travel Dedicated funding Collaboration with other CDC programs In-kind support

CEFO for the Pacific Islands

ChallengesRight Candidate Diverse epidemiology skills Experience with Pacific jurisdictions Experience with CDC Collaborative and diplomatic Independent Clinical skills

CEFO for the Pacific Islands

OpportunitiesExperienced epidemiologist dedicatedto the Pacific Islands

Crosscutting approach across multiple disease areas

Strengthen regional collaborationAttract additional resources

Collaboration with regional partners Enhanced communication with CDC CDC fellowship programs

CEFO for the Pacific Islands

TimelinePlanning meetingsFeasibility assessment — June 6–13,

2014Development of support mechanisms

Contract, cooperative agreement Supervisory collaboration

Application processProgress report — August 12, 2014

CEFO for the Pacific Islands

TimelineCEFO candidate selection — Oct 2014Contract in place with PIHOA — Nov

2014CEFO assignment — Dec 2014Jurisdictional risk and needs

assessmentCooperative agreement with PIHOA —

Apr 2014

Conclusions

CEFOs provide variety of skills and expertise

CEFO placement and support must be a collaborative effort

CEFO Program will benefit Pacific Island jurisdictions

Randolph Daleywdaley@cdc.gov

CEFO Program(770) 488-8881cefo@cdc.gov

www.cdc.gov/phpr/science/cefo.htm

Questions?

Office of Public Health Preparedness and Response

Division of State and Local Readiness

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Preparedness Field Assignee (PFA) Program

Two-year practicum placing graduates of Public Health Associate Program (PHAP) with PHEP awardees

Funded directly by CDC

Mission — Develop skill in emergency preparedness and response through field experience

PFAs make a significant contribution to the awardee

PFA Activities Emergency response plans Technical assistance Exercise development and evaulation Outbreak investigations Partnership development for community

resilience GIS mapping of at-risk populations Situational awareness reports Capability-based gaps analysis

Preparedness Field AssigneesAssignment Locations, August 2014

As of August 1, 2014, 17 PFAs are assigned to 16 state , territorial, or local health departments.

McCullough

Joseph

Lira

Awardees with PFAs

Kirley

Vento

Bowman

Jean,Kurian (NYC)

Li (Los Angeles)

Cutts (Chicago)

BlackShultz

Peart

Driesse

Haugen

Burgess