Michael C. Samuel, DrPH STD Control Branch California Department of Public Health 1 hour and 30 minutes STD Program Management Pre-Course Exercises Items for participants to consider before course begins: What type of outbreak response team and/or plan does your health department have? What type of aberration and/or outbreak detection system does your health department have in place? What recent STD outbreaks have occurred in your jurisdiction? How were these handled? What were the key control measures and/or other findings? Please review the following three Outbreak Module handouts for 15-20 minutes each prior to the course: Handout 1, Equipment and Supply List Review the equipment and/or supplies that you will need to have on hand or vendors you will need to identify to provide equipment or supplies, if you should have an outbreak. Is there anything missing from the list that you are likely to need? Handout 2, Outbreak Response Team Key Roles and Responsibilities List Review each of the outbreak team roles and the responsibilities associated with each role. Identify those roles that need to be filled within your program. Handout 3, Detailed Evaluation List Review this comprehensive list from CDC that indicates the criteria on which an outbreak evaluation should be based. Do these evaluation items make sense to you? Is there anything missing from the list?
Handout 1: Equipment and Supply Assessment Diagnostic Equipment o Darkfield microscope o Stat-RPR testing kits o Blood drawing supplies o Band-aids, alcohol, cotton, etc o Shock kit o Urine specimen cups o STD and/or HIV specimen collection and transport media/kits/equipment o Lab slips o Dry ice o Rubber gloves o Specimen storage and transport capabilities coolers/refrigeration/freezers Treatment Supplies o Azithromycin o Benzathine Penicillin G o Doxycycline o Ceftriaxone o Cefixime o Sharps container o Cups, water Hardware/Software o Laptop computers all necessary applications should be installed and tested prior to outbreak response Other Supplies o Maps/GPS o Calling cards o Mobile vans o Tables/Chairs o Cellular phones, walkie-talkies, wireless communication devices o Printer/copier/fax combo with ink/toner o Local and state ID cards o Pens, pencils, sharpies o Paper pads, file folders o Paper clips, binder clips, stapler, staples, rubber bands, etc o Clip boards o Cash, traveler s checks o Appointment cards o Camera o Names and contact info of clinic and health department personnel o STD prevention materials (brochures, posters, condoms, etc.) o Food o Porta-Potties
Handout 2: Outbreak Response Team Key Roles and Responsibilities Health Department Lead: o Oversees response o First point of contact o Arranges initial meeting o Assesses resource and person capacity o Ensures that all team members understand roles and responsibilities o Ensures timely communication between ORT and other involved persons o Develops investigative tools o Declares outbreak response over o Reviews and provides guidance for presentations and data summaries Field Services Specialist (DIS/CDI/Public Health Nurses): o Interviews cases o Assures treatment of cases/partners o Provides community assessment Field Services Supervisor: o Assigns cases to field staff o Reviews case interviews o Determines need for more resources, including field staff o Supports control activities o Develops training materials for field staff Epidemiologist: o Assists in development of investigative tools o Develops and modifies outbreak databases and data collection tools o Oversee data entry o Organizes and analyzes data o Assists field staff as needed o Produces presentations and other data output summaries as needed o Produces final written report o Conducts final evaluation Medical Consultant: o Coordinates treatment o Consults on medical issues o Develops treatment algorithm Communications Liaison o Point person for media-related activities o Communicates outbreak to CDC o Notifies other relevant public health agencies o Supports media-related control activities Logistics Lead o Procure supplies/resources o Coordinate supplies/resources Program Development Liaison o Identifies appropriate control measures o Implements targeted outreach to high-risk clients and/or locales o Coordinates control activities
Handout 3: Evaluation Surveillance o Was the outbreak identified in a timely manner? o How many additional cases were identified through outreach or other active surveillance activities? o Why were these cases not identified through passive systems? o What could have been done to identify these patients earlier? o What was the lag time between laboratory test or disease diagnosis and field staff notification? Resources o Were field staff levels adequate for the response? o Were staff adequately trained to respond using non-traditional approaches o Were field staff able to respond to the outbreak in a timely manner? o Were geographic or population gaps in coverage identified? o What were the partner services indicators for the outbreak? What could bias the utility of these indicators? o Were cases interviewed, managed, and closed in a timely fashion? Were cases treated promptly? o Were field staff able to contact and interview cases? o Were necessary supplies available (blood draw kits, treatment, mobile vans, etc.)? What could have been done to make these supplies more readily available? o Were there staff or supplies that would have been necessary or helpful that were not readily available? How could these be secured in the future? Clinical Services o Were cases treated? Was treatment prompt? o Overall, how effective were the current clinical services? o Were sufficient clinics open with convenient hours to serve the community? o How well trained were the clinicians providing these services? o Were additional services utilized? In what capacity? How effective were they? o What clinical services would have been necessary or helpful but unavailable? How could these services be secured in the future? Laboratory and Diagnostic Services o Were the laboratory services adequate? o Were specimens properly obtained and handled? o Were diagnostics utilized effective? Would others have been more effective? Morbidity and Population o Has the morbidity of the infection been reduced in the area of the response? o What populations were primarily affected? o What are some reasons for the outbreak developing in this geographic area? Among these populations? At this magnitude? o If an outbreak were to develop in this area again, what would you suggest? In this population?
Community Partnerships o What community partnerships were called upon during this response? o Have community contacts been kept in the loop now that the outbreak has subsided? o What role did each of these partnerships have in the response? o What community partnerships were unavailable that would have been necessary or helpful in this response? o What barriers to community mobilization existed? What strategies were attempted to overcome them? o How can these partnerships be sustained for outbreak preparedness? Communications o Which outlets succeeded in getting the word out about the message? Which didn t? o Which reporters covered the story accurately? o What confusion existed regarding smooth flow of communications? Costs o How expensive was the outbreak response? o Were the funds needed diverted from other important functions? If so, what? o Are the costs justified in light of the outcome?