1. Surviving a Hepatitis A Outbreak: Don’t Lose the Lessons Learned Center for Pubic Health Preparedness © 2006. All Rights Reserved

2. Purpose Show how you can study events within a working health department and preserve the lessons learned so that you can use good ideas in the future and avoiding repeating mistakes

3. Hepatitis A: Anatomy of an Outbreak Charles J. Vukotich, Jr. MS Senior Project Manager Adjunct Assistant Professor Samuel Stebbins, MD, MPH Director, Center for Public Health Preparedness University of Pittsburgh Graduate School of Public Health

4. With contributions from and thanks to: Virgina Dato Joel Hersh Marcus Eubanks Michael Fiore Elizabeth A. Gettig Kathi Traynor David Holzemer & the Center for Instructional Development & Distance Education Marianne Kasica & University Archives Michelle Meyer Kurt Holliday James McRae

5. Products 1 hour Narrarated PowerPoint with Video University of Pittsburgh Internet Based Studies in Education and Research –https://cme.hs.pitt.edu/servlet/IteachController Servlet?actiontotake=displaymainpage&site= upcphphttps://cme.hs.pitt.edu/servlet/IteachController Servlet?actiontotake=displaymainpage&site= upcphp PA Learning Management System (PA Prepared) –http://webserver.health.state.pa.us/health/lmshttp://webserver.health.state.pa.us/health/lms

6. Products Case Study Exercise –PowerPoint slide show for teaching Archive of Releases, Literature, and Audio and Video Interviews

7. Process Gather Official Documentation –News Releases CDC FDA PA Dept. of Health –Newspaper Articles –Published Articles MMWR NEJM

8. Process Follow-up telephone conversations to gather missing data, and clarify. Oral History –Video Interviews –Audio Interview

9. Approaching an Outbreak Recognition Case Tracking – Case Control Inspection Prevention Identification of Source - Epidemiology Laboratory Testing Media/Communications

10. Practical Tips Prepare in Advance Create Consensus for Action Identify Skills –Statistical –Archival –Interview/Survey –Analytical –Writing –Video/Photographic –Graphic

11. Practical Tips In creating the team, always remember to choose someone to document the action Identify Resources –Internal Retirees –External

12. Practical Tips Centers for Public Health Preparedness –http://www.bt.cdc.gov/training/cphp/http://www.bt.cdc.gov/training/cphp/ –University of Pittsburgh is one

13. Centers for Public Health Preparedness

14. Practical Tips Centers for Public Health Practice Work with Other Academic Entities –School of Public Health –School of Medicine –History Department

15. Practical Tips Save everything –Emails (easy) –Notes –Labs slips and other forms –Official notices, including press releases Set up a box to throw everything in so that it can be sorted out later. Designate a team member to sort and organize continuously

16. Using Oral History Interview Plan Releases

17. Using Oral History What specifically triggered your involvement? What happened from there? Tell me the whole story.Subtext: Try to get them to go day by day. When outbreak was first noted. When did you think/know that it was an outbreak? When did you think it was a common source? When did you think it was Restaurant Z? When did you mobilize people to investigate? When did you mobilize people to inspect? When did you call for Federal help? When did you begin to take preventive action? What prompted you to take preventive action? Was there an “Aha!” moment(s) for you in all this? Can you tell me the story of the process of tracing this outbreak back to Mexico? Who else had an important role? What was it? Do you think that I should talk to this person? What led to the decision to do prophylaxis? What this good medicine or just good PR? Is it common to have deaths associated with a Hep A outbreak? In its 12/9/2003 release, FDA noted fecal-oral transmission of Hepatitis A, and it made me think that they might be concerned about secondary infections without specifically mentioning it. Did you see any evidence of secondary infections or have any concern in this regard? On a scale of 1 to 10, how would you rate this response? What things went well? (1 to 3) What could be improved? (1 to 3) What resources did you think were critical for this response? How did you get these resources? Were they sufficient?

18. Using Oral History Transcripts –Verbatim –Editing to eliminate ‘ums’ and ‘ahs’ –Editing to clarify remarks –Editing to eliminate extraneous remarks Varied Schools of Thought

19. Using Oral History Analysis –Comparing What People Said –Comparison to External Sources Usually Do Analysis From Transcript Preserve Original Materials

20. Thank You Questions should be directed to: Chuck Vukotich 412-383-2400 vukotichc@edc.pitt.edu or UPCPHP@pitt.edu