1. Anatomy and Physiology of an Outbreak Team

2. Goals The goals of this presentation are to discuss: Management strategies during an outbreak investigation Team member roles Necessary equipment Lines of communication

3. In the Beginning… Successful investigations require a multidisciplinary approach, effective communication and collaboration Steps: Assemble team members Present available information Outline plan for investigation and team communication Assign roles and responsibilities

4. Questions to Consider What resources, including personnel, are available? What resources could be provided by outside collaborators? Who will direct the day-to-day investigation?

5. More Questions to Consider Who will interact with the media? How will data be shared and analyzed? Who will write the final report and present the information? How will the team communicate with each other?

6. Team Member Roles Team Leader Experience in outbreak investigation and epidemiology Selection can be result of outbreak setting or etiologic agent Role can be filled by: County health director, Public health nurse, Epidemiologist, or Environmental health specialist Role may change depending on stage of investigation

7. Team Member Roles Epidemiologist Develop study design and survey questionnaires Create database and conduct data analysis

8. Team Member Roles Microbiologist Verify the diagnosis Subtype pathogens to help refine case definition

9. Team Member Roles Environmental health specialists (EHS) Collect food and environmental samples Provide guidance on food safety regulations and engineering

10. Team Member Roles Interviewers Collect data in person or by telephone Role can be filled by health department personnel, state or federal personnel, or health science students

11. Team Member Roles Clinicians Administer vaccines or prophylaxis Collect clinical specimens Role can be filled by health department or local medical community May include veterinarians, depending on type of outbreak

12. Team Member Roles Regulators Facilitate identification of the source of outbreak and develop prevention strategies Role can be filled by state or federal agency employees

13. Team Member Roles Media Spokesperson Deliver clear and consistent messages to community Role can be filled by one outbreak team member or representatives from each agency

14. Team Equipment Computer with access to internet Email communication Literature searches (PUBMED) Data entry and analysis (Epi-Info 2002 http://www.cdc.gov/epiinfo/epiinfo.htm) Written reports

15. Team Equipment Specimen collection tools Rectal swabs or specimen cups Phlebotomy equipment Cooler to transport specimens

16. Communication Information flows in both directions Leader should update the team during meetings, conference calls, or email Members provide regular updates to team leader Acts as tool for measuring progress Enables leader to provide feedback and direction to team members

17. Communication Keep lines of communication open through regular meetings or phone Include local, state, and federal public health agencies Document progress Allows all members to remain up-to-date Assists in drafting final report

18. Conclusion Working as a team requires: A wide range of expertise Clear communication A rapid but careful and systematic approach in dealing with outbreaks

19. References Butler JC, Cohen ML, Friedman CR, Scripp RM, Watz CG. Collaboration between public health and law enforcement: new paradigms and partnerships for bioterrorism planning and response. Emerg Infect Dis 2002;8(10):1152-6. Frace RM, Jahre JA. Policy for managing a community infectious disease outbreak. Infect Control Hosp Epidemiol 1991;12(6):346-7. Sobel J, Griffin PM, Slutsker l, Swerdlow DL, Tauxe RV. Investigation of multistate foodborne disease outbreaks. Public Health Rep 2002;117(1):8-19.