My Career Pathway as a

Public Health Veterinarian

at CDC

Stephanie R. Ostrowski, DVM, MPVM, ACVPM

CAPT (Retired, 2010) USPHS

Food Safety Resident I, CAHFS – UC Davis

• How old were you when you knew you wanted to be

a veterinarian?

• 5 acres; rural southern Maryland –

• Dogs, cats, horses, goats

• Rural, non-farm

• Worked for local small animal vet – high school

• Role model was our large animal practitioner –

• Calm and knowledgeable

“I started out as a child …” (Bill Cosby)

DVM 1980 University of Georgia

1977 --1st experience with cattle

USDA Brucellosis eradication

1978-80 Herd health, Intro to epi,

Large Animal Medicine /Surgery

1980-81 Atlanta Humane Society (1st job)

Black Beauty, James Herriot

and Vet School

Rural Practice, Here I come!

1981/82 Food Animal Internship

Caldwell, Idaho (WOI)

1982 (~6 mos) Ranch practice

Elko, Nevada

1983-84 Small Animal Practice

Atlanta, GA area

1984-87 Herd Health Residency

UC Davis

After Internship, Residency + MPVM … CDC?

(Hmmm … this is not rural practice, is it?)

Practice opportunities limited

Wanted to solidify epi skills

Applied to CDC’s Epidemic Intelligence

Service – got accepted (Yikes!)

• EIS matching program

• EIS spring conference + interviews

• Not quite what I was expecting, but ….

EIS Officer at NCEH (National Center for

Environmental Health), CDC

Division of Environmental Hazards and

Health Effects (EHHE) 1987-89

• DVM/ EIS Alum studying animals as sentinel

species at Superfund sites….

• OH NO! My mentor left for another CDC job!

• Lead poisoning became the focus

Community/ childhood lead screening

- Alaska, Hawaii, Tennessee

Occupational Health / Community exposures

- With NIOSH in Jamaica

Getting back to veterinary practice …

Worked 20 -30 hrs/ week at a small animal

emergency clinic while in EIS

• But I really missed herd health/ food animal

practice ….

1989 – left CDC for Dairy Practice – Texas

• Father was diagnosed with pancreatic cancer

in Florida; left TX practice after 6 months to

help / be there for him. No temp license in FL!

1990 – FDA CVM in Rockville, MD

• 6 months as target animal toxicity reviewer for

use of bovine somatotrophin in dairy cows

Returned to Atlanta; late 1990

Temp/ Part time Small Animal work

• Re-hired by Emergency Clinic ~ 18 mo

April 1991 CDC EIS Conf/ job fair -- Hired!

1992-1993: ATSDR -- Agency for Toxic

Substances and Disease Registry; Div. of

Health Assessment and Consultation

• Public Health Assessments

• Superfund Sites -- “One Health”

• Great boss, great colleagues, real issues of

importance to communities across U.S.

Division of Quarantine, NCID 1993- 98

Staff Veterinary Epidemiologist

• 42 CFR Part 71. Foreign Quarantine

• Immediate aftermath of Ebola Reston

• Non-human primate import program

Approx. 90% of importers could not meet import

quarantine biosafety standards.

Inspections: quarantine facilities and shipments

• Miscellaneous vector species

Imported Dogs and cats – rabies vaccination

Egyptian fruit bats – revised live bat permit

requirements (science, conservation only)

Exotic pets: rodents – monkeypox, hantaviruses

Wildlife

Domestic

Animal Human

Translocation

Human encroachment

Ex situ contact

Ecological manipulation

Human behaviors

Global travel

Urbanization

Biomedical

manipulation

Food processing/distribution

Technology and

Industry

Agricultural

Extensive Production

Encroachment

Introduction

“Spill over” &

“Spill back”

One Health

One Medicine

After Daszak P. et.al.

Science 2000 287:443

Weekly

June 13, 2003 / 52(23);537-540

Multistate Outbreak of Monkeypox --- Illinois, Indiana, and

Wisconsin, 2003

CDC has received reports of patients with a febrile rash illness who had close contact with pet prairie dogs and other animals. The

Marshfield Clinic, Marshfield, Wisconsin, identified a virus morphologically consistent with a poxvirus by electron microscopy of skin lesion tissue from a patient, lymph node tissue from the patient's pet prairie dog, and isolates of virus from culture of these

tissues. Additional laboratory testing at CDC indicated that the causative agent is a monkeypox virus, a member of the orthopoxvirus group. This report summarizes initial descriptive epidemiologic, clinical, and laboratory data, interim infection-control guidance, and new animal import regulations.

Monkeypox

Outbreak,

2003

Emerging and Re-emerging Zoonoses,

1996–2005 --- or relatively rare events?

Nipah Virus

Hendra virus

Multidrug resistant Salmonella

Lyme Borreliosis

West Nile

Cryptosporidiosis

Reston virus

Venezuelan

Equine Encephalitis

E.coli O157

E.coli O157

Lassa fever

Yellow fever

Ebola Monkeypox

Influenza A(H5N1)

Rift valley

Fever

NV-CJD

Ross River

virus Equine

morbillivirus

Nv-CJD

E.coli non-O157

West Nile Virus

Reston Virus

Brucellosis

Hantavirus pulmonary

syndrome

Leptospirosis

Recent outbreaks Rabies / Angola and Indonesia

Marburg / Uganda Rocky Mountain Spotted Fever/ Mexico

Salmonella / USA Tularemia / USA, Kosovo Yellow fever / Ivory Coast

Brucellosis / Mongolia E. coli 0157 / Canada

Hantavirus / US BSE-vCJD/ UK

Nipah virus / Malaysia Avian Influenza / Hong Kong

West Nile / USA, Canada Ebola / Gabon, Congo

BSE /Canada Monkeypox / DRC/ US

SARS / Global Avian Influenza H5N1

Trying to advocate for a “One Health”

perspective before “One Health” was cool….

1996 Miami Port of Entry

Inventory Totals

• At least 3 federal agencies

have jurisdiction. (USDA,

CDC, USFWS)

• Importation of most

wildlife and products to

USA as items of commerce

(e.g., pet trade) is still

largely unrestricted.

• “Strip-mining” of foreign

ecosystems

Mammals = 6976

• Sugar Gliders =

4342

• Monkeys = 452

• Rodents = 1182

Reptiles = 1,078,656

• Caimans = 15,023

• Lizards = 935,307

• Snakes = 79,770

1996 Miami Q.S. Inventory Totals

Snakes:

• Adders = 214

• Anacondas = 514

• Boas = 25,516

• Cobras = 136

• Mambas = 44

• Pythons = 45,645

~30,000 baby reticulated pythons

• Vipers = 721

• Other = 7024

N.J. Cobra bite victim recovering as probe of snake

purchase continues (Thursday, February 3, 2011)

ATSDR Division of Toxicology 1998-2001

Emergency Response/ Consultation Team

• Emergency Planning and Response (CDC)

• Consultative veterinary support for ATSDR’s

10 Regional Offices

• Lead Office at CDC for industrial chemical

emergencies; interfaced with EPA and USCG

• HAZMAT spills – 24/7 phone consultation

• Food Chain/ livestock agriculture impact

Polio Eradication, Bangladesh -- 2000

Detailed to USDA / MAFF (UK) for FMD

Surveillance, May/June 2001

Surveillance of FMD-

unaffected farms in

Cumbria • Permit normal activities, lift

quarantine in infected areas.

• DVMs are “trusted agents”

in rural communities.

• Recognized far-reaching

economic and psycho-social

impacts on farmers and

rural communities.

Sept 11, 2001 – New York City

And then came 9-11, Anthrax attacks,

Response, and Recovery……

Assisted with staffing CDC Emergency

Operations Center

2001 – 2003: Emergency Bioterrorism

Response Coordinator for ATSDR

• Technical / science support for Twin

Towers environmental hazard assessment

• Anthrax Technical Sampling Teams

U.S. Postal Facilities, Congressional Offices

“How clean is clean enough?”

• Level B HAZMAT Response Team/ FBI

AMI Building, Boca Raton, FL

Anthrax Investigation in Postal Facility, Fall 2001

ATSDR , NCEH, and NIOSH environmental health

scientists and environmental engineers

Coordinator for CDC/ATSDR’s

Chemical Terrorism Response Program

CDC’s Emergency Response Plan

Chemical Weapons of Opportunity Training

Program with ACMT

• >5,000 federal officers, public health, and

physicians trained

Department of State/ USAID consultation

• Russian-American Biotechnology &

Toxicology projects

• Developed environmental health Cooperative

Agreements with India and Poland

Deployed with USPHS to

Hurricanes Katrina and Rita, Fall 2005

Following Hurricanes Katrina and Rita,

we saw a lot of …..

Blaming the victims ….

• Much bad press, unfair assumptions, and

misconceptions regarding:

Owners, Animals, State Animal Health Authorities

Discrediting of previously successful

evacuation strategies and experiences

• Louisiana State Pet Evacuation Plans

• Good record of successful evacuation

sheltering for owned pets in previous years

Response to Hurricanes Katrina and Rita, 2005

Pet Owner Behavior in Disasters

Studies indicate that pet-owning households are significantly less likely to evacuate during mandatory orders than households without pets (AJE 2001 153:659-665);

The more pets, the less likely household will evacuate. Owners will frequently go to great effort and risk personal loss or injury to protect or rescue the animals they love.

Why? A sense of personal responsibility for the lives entrusted to our care is a hallmark of ethical human beings.

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The Federal PETS Act of 2006 and PKEMRA -- What a Difference a couple of Laws Make!

Federal Coordination of Response Resources for Household Pets

and Service Animals to States and Local Governments

CAPT Stephanie R. Ostrowski, DVM

USPHS Veterinary Category

NCEH/ATSDR CDC, Atlanta, GA

FEMA Special Liaison for Animal Activities, 2005/2006

PETS Mission Area Lead for Evacuation Planning 2006

Companion Animals Management Unit, FEMA LA Warm

JFO, 2007

2008 AVMA Annual Conference

July 21, 2008

Hurricanes Katrina and Rita, 2005

Livestock at Risk; Animal Carcasses

Avian Flu and “Swine Flu” 2006-2009

Preparedness and Response

Pandemic Flu Preparedness (decades)

Avian Flu in Nigeria; 2006 (CDC, WHO…)

• CDC Technical Consultative Mission

• Abuja, Nigeria. Epi, lab, programmatic aid ($$)

• Virulent strain; Avian cases; loss of

commercial parent and grandparent stock

“Swine Flu” H1N1 2008/09 – relatively mild

• Mass vaccination – US 2009 Flu season

• Human cases only; swine not affected

• Slaughter of all hogs in Egypt (bad policy)

State and Local Response:

H1N1 Lessons Learned

CAPT Stephanie R. Ostrowski, DVM, MPVM, DACVPM

Acting Program Director

Career Epidemiology Field Officer (CEFO) Program

Coordinating Office for Terrorism Preparedness and Emergency Response

July 7, 2009

Veterinarians at CDC AVMA Directory, 2006

State Health DepartmentAssigneesReproductive Health

Injury prevention/NIOSH

Office of the Director

AIDS/STD

Infectious Diseases

Immunizations

Environmental Health

Laboratory AnimalMedicineEIS office

Total: ~94

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Diane Gross, DVM, PhD

1. Avian Flu – CDC/ WHO

human/ animal interface

issues (lead for Africa and

Asia)

2. Cost-effectiveness of

Brucella vaccination of cattle

in Egypt

EISO Kristy Murray, DVM (1998 – 2000) Looking for Ebola reservoir species -- Collecting bats in the

Philippines. (Also was on my Bangladesh STOP Polio team)

CDR Jennifer McQuiston, DVM

Oral Rabies Vaccine Effectiveness

12

Public Health Veterinarians in the

Federal Government

90 85115

1200

670

40

6

439

90 1210

111620

2

82

HHS-CDC

HHS-NIH

HHS-FDA

USDA-FSIS

USDA-APHIS

USDA-ARS

Coop State Research, Ed, Ext

DOD-Army

DOD-Air Force

Environmental Protection Agency

DOI-USGS

DOI-Fish and Wildlife

DOI-National Park Service

DO Commerce

DOS/USAID

DOI/Forest Service

USDA-ORACBA

DHS

Total: ~2,800

USDA-

FSIS

USDA-

APHIS

DOD-

Army

HHS-FDA

11

USPHS Job Benefits

Military Pay Scale and Increases

30-days vacation annually + holidays

Special Pays

• Basic Allowance for Housing (non-taxed)

• Board-Certified Pay (taxed)

TriCare (military) Health Coverage

• On/off base (Emory University in ATL)

• No premium or co-pay for officer; v.

affordable for family

Retirement-eligible at 20 years

Veterans Benefits: GI Bill (education)

How do I find a federal job?

http://www.usajobs.opm.gov/

Many jobs are not designated “for veterinarians”

Make contacts at meetings

Entry or advancement often requires advanced education and/or board certification in a specialty • MPH, MS, MPVM, PhD

• Preventive medicine, lab animal medicine

FSIS short 100 veterinarians now and ~ 100-200 in the next 5 years – no additional training needed for many of their positions

40

Summary

Exciting career opportunities in public

health exist for veterinarians

Training programs are important entry

points

~ 0.5% of U.S. public health workforce;

2.8% of federal workforce

A large % of federal public health

veterinarians expected to retire in

coming years

• The need for public health veterinarians is

growing

41

Veterinarians at CDC

As of December 2008

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Job Activity

19

Student experiences

State and local health

departments

Opportunities with USDA, FDA

University of Maryland program

Public Health Service co-step program

CDC - Summer student employment

CDC – Epidemiology elective

37

Epidemiology elective

http://www.cdc.gov/eis/applyeis/elective.htm

September through June

6-8 weeks

Defined project, often a chance to assist with

outbreak investigations

Deadline: May 30th of your Junior year

38

What is the EIS Program?

Epidemic Intelligence Service (aka “Disease

Detectives”)

Established in 1951

Mission: To prevent & control communicable

diseases

A 2 year training program in applied

epidemiology

Domestic and International Service

• Respond to Requests for Epidemiologic Assistance

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State and Local Health Departments

E. coli E. coli

Malaria Malaria

Cryptosporidiosis Cryptosporidiosis

Legionnaires'

Disease/Norwalk virus Copper in drinking water Copper in drinking water

Norwalk Virus

Hanta Virus Hanta Virus

TB in immigrants TB in immigrants

Lead screening Lead screening

Cyclosporiasis Cyclosporiasis

Bombing

Hurricane Hugo

Where do EIS Officers Train?

West Nile

Virus/Anthrax Forest

Fires

Hurricanes

21

How do I find out more about EIS?

http://www.cdc.gov/eis/about/about.htm

55-75 officers, 6-9% are

veterinarians

Application process begins in May

for the following year’s class

Additional training or experience in

public health encouraged prior to

application

36

Post-DVM opportunities

Fellowships

• Emerging Infectious Diseases fellowship

Through APHL

• American Teachers of Preventive Medicine

Fellowship

Master’s of Public Health

• Work study through CDC for Emory students

39

There is growing public concern regarding food safety, zoonotic diseases, environmental health issues, bio- and agro-terrorism

Veterinarians are broadly trained and uniquely prepared to address these challenges

Critical shortage of public health and food safety veterinarians projected in next 5-10 years

Take home messages 42

Acknowledgments

Nina Marano, CDC, HHS

Jennifer McQuiston, CDC, HHS

Diane Gross, CDC

Jennifer Wright, CDC

Kathryn Feldman, University of Maryland

Steve McLaughlin, CDC

Stephanie Ostrowski, CDC

Marta Guerra, CDC

John Dunn, Tennessee Department of Health

Matt Schech, NIH

45