Presentation on theme: "Public Health 101 – An Introduction for Public Health Stakeholders"— Presentation transcript:
1 Public Health 101 – An Introduction for Public Health Stakeholders 2009 NACCHO/APC Road ShowPublic Health 101 – An Introduction for Public Health StakeholdersPresented bySouthwest Center forAdvanced Public Health PracticeTarrant County Public Health, TX2009
2 Course ObjectivesIdentify the basic roles and responsibilities of a local public health agencyDiscuss the importance of collaboration between public health and its stakeholders in the event of an emergencyProvide examples of events that are within the scope of public health preparednessExplain and demonstrate how public health utilizes ICS during emergenciesDescribe several of the main steps in an outbreak investigationList scenarios where public health and first responders are most likely to interface
3 Course Outline Introduction to Public Health Public Health PreparednessIncident Command System (ICS)Public Health Response to EmergenciesStrategic National Stockpile (SNS)Introduction to EpidemiologyIsolation and QuarantineCase Study: Avian Influenza Outbreak
4 What is Health?Health is a state of complete physical, mental and social well- being and not merely the absence of disease or infirmity.
5 Public Health vs. Medicine PatientEntire PopulationsIndividualsInterventionAssess, Policy Development & AssuranceMedicalTreatmentProcessSystem ManagementPatient ManagementOutcomeHealthy CommunityHealing
6 Public Health Objectives Prevent epidemics and the spread of diseaseProtect against environmental hazardsPrevent injuriesPromote and encourage healthy behaviorsRespond to disasters and assist communities in recoveryAssure the quality and accessibility of health services… derived from American Public Health Association, Ten Essential Services
7 Typical Menu of Public Health Services Personal Health Services (clinical services)ImmunizationsSTD/HIV testing and counselingChronic disease counselingTuberculosis servicesFamily planning and maternal & child health servicesTravel health servicesBUT…providing direct clinical services is only one part of the mission of a local health department
8 Population Based Public Health Services Environmental HealthInfectious Disease Control and InvestigationLaboratory ServicesHealth Education ServicesRestaurant permits and inspections,Public swimming pool inspections and water quality testing,Food-borne illness complaints, West Nile virus prevention and control measures, Septic tank permitsCommunicable disease and food-borne outbreaks, Bioterrorism surveillance and rapid responseBSL level 3 laboratory testing – biological agents and pandemic influenza,Food and water testing
9 The Public Health System Federal AgenciesState AgenciesFunctions outlined in Tarrant County and City of Fort Worth Emergency Operations Plan (EOP)Emergency Support Function (ESF) VIIILocal Agencies
10 Public Health’s Many Partners PoliceHome HealthEMSChurchesCommunity CentersMCOsCorrectionsHealth DepartmentParksSchoolsElected OfficialsHospitalsMass TransitDoctorsNursing HomesPhilanthropistEnvironmental HealthCivic GroupsCHCsFireTribal HealthLaboratory FacilitiesDrug TreatmentEconomic DevelopmentMental HealthEmployers
11 Which level of government is responsible for protecting public health? 10th Amendment to the U.S. Constitution:All powers not delegated to the Federal government shall be reserved for the state governmentsStates are responsible for protecting public health
12 What is Public Health Preparedness? “Plans,procedures,policies,training,and equipmentnecessary tomaximize theability to prevent,respond andrecover frommajor events.”(HSPD-21)
13 Public Health Preparedness Builds Infrastructure for: Everyday health threatsInfectious & foodborne diseasesPublic Health EmergenciesBioterrorism, pandemics
14 Preparedness Professionals – Many Voices, One Mission PhysiciansStatisticiansEpidemiologistsEmergency Preparedness Coordinator and Nurse CoordinatorMedia Relation SpecialistsSupport Staffxxxxxxxxxxxxxxxxxxx
15 Preparedness and Bioterrorism What is bioterrorism???-- The use of...BacteriaVirusesParasitesTheir by-products…in a terrorist act.
16 Preparedness and Bioterrorism The threat and reality of bioterrorism have focused attention on public health preparedness for emergenciesxxxxxxxxxxxxxxxx
17 Preparedness and Bioterrorism Possible agents of bioterrorismAnthraxSmallpoxPlagueBotulism
18 Preparedness and Bioterrorism What might an attack of bioterrorism look like?Not necessarily explosions or plumes of smokeMay not be readily apparent and detectableSick people arrive at hospitals or doctors’ officesDelayed recognition and diagnosisPopulation panic
19 Collaboration is critical to success! Roles in PreparednessPlanningCoordination/CollaborationTraining and ExerciseResponseEvaluation and Corrective ActionxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxCollaboration is critical to success!
20 Roles in Preparedness Situation Examples: Outbreaks from contaminated food or water, infectious diseases, etc.Natural disasters: hurricanes, floods, fires
21 Roles in Preparedness Examples of public health job roles: Health threats investigatorPublic service/mediaPost-event trackingEnvironmental investigators
22 Incident Command System Allows a more effective, efficient response to emergenciesExamples:HazMat incidentsTerrorist incidentsNatural disastersIncidents involving multiple casualties
23 Incident Command & Public Health In the event of a public health emergency the public health director will interact with the local EOC or incident command post.The public health Department of Operations Center (DOC) may be activated to facilitate tactical communications.
24 Public Health Responding to Emergencies Public health is integrated in local emergency response planning effortsLocal public health responsibility ensures:Health problems are monitored(injury & disease surveillance)Services to correct the problem are availablexxxxxxxxxxxxxxxxxx
25 Public Health Responding to Emergencies In what type events would you expect Public Health to assume lead role for providing health and medical services ?Events involving biological agents, catastrophic disease outbreaks, pandemics, or any other covert health threat in which PH is the first notified agency
26 Public Health Responding to Emergencies Responsibilities include securing, assisting, & supporting other agencies with the following:Health and medical servicesResourcesPersonnelxxxxxxxxxxxxxxxxxxxxx
27 Public Health Preparedness Summary Build public health infrastructure to respond to threats from:BioterrorismNatural disasters & disease outbreaksRequires collaboration between agencies:PlanningTraining & exercisesResponseCommunicationManagement of resources
29 Strategic National Stockpile (SNS) A national stockpile available in the event of a major terrorist attack against the civilian US populationNational repository consisting of:Pharmaceuticals (i.e., antibiotics and vaccines)Antidotes and antitoxinsMedical and surgical supplies
30 Strategic National Stockpile SNS is a federal asset deployed locally after a major disasterThe governor of the affected state requests deployment of SNS from:
31 Strategic National Stockpile Delivered within 12 hours of federal decision to deploy SNS assets12-hour “Push Package”Push packages are warehoused in strategically- positioned locations around the US
32 Local Response to Strategic National Stockpile SNS deployment is a large-scale event requiring adequate:SecurityPre–determined Points of DistributionCrowd controlTraffic control
33 Local Response to Strategic National Stockpile Essential that First Responders and others in contact with exposed civilians are the first to be medicated
34 Local Response to Strategic National Stockpile Must prepare to dispense medicine to a large number of people in a relatively short time span
35 Local Response to Strategic National Stockpile Expect to work with Public Health:Work collaborativelyImplement emergency response according to prior planningHave conducted prior training and exercisesInteragency Cross-Training
37 What is Epidemiology?Study of the spread and causes of diseases or events in specified populations, and the control of health problems.
38 Epidemiology concerned with OUTBREAKS An adverse health event involving an unusual increase in cases among a certain population of individuals, within a certain period of time, in a certain location
39 Areas of Epidemiology Infectious diseases Environmental Behavioral ForensicDisaster
40 Key Elements in Epidemiology PersonPlaceTimePerson - Age, Sex, Race or ethnicity Place - Geographic location (epidemic? Pandemic?), Proximity to potential exposure, Clustering Time - Date / time of exposure or onset of illness, Seasonality of infectious diseases, Identifying endemic versus epidemic disease rates
41 Epidemiology Study Examples (risk or exposure outcome) Smoking (exposure) increases the risk of developing Lung Cancer (outcome)
42 Epidemiology Study Examples (risk or exposure outcome) Eating undercooked hamburger (exposure) increases the risk of infection with the bacteria E. coli (outcome).
43 Epidemiology Study Examples (risk or exposure outcome) Getting a flu shot (exposure) decreases the risk of becoming ill with the flu (outcome).
44 Simplified Steps in an Outbreak Investigation Confirm outbreak and verify diagnosisPerform field work and complete studyImplement control and prevention measuresCommunicate findingsTo handout
45 Disease Reporting: Notifiable Diseases Healthcare providers are required by law to report patients with certain diseases and conditions:Report immediately (in most states)Potential BT agents (anthrax, smallpox, plague)Botulism (foodborne)Viral hemorrhagic fever, including EbolaOther selected contagious serious diseases that may affect children and immune compromised or un-protected victimshandout
47 History of QuarantineIn the fourteenth century, to protect cities from plague epidemics, ships arriving in Venice from infected ports had to sit at anchor for forty days before landing.“Quarantine” is derived from the Latin word quaresma, meaning forty.
49 Isolation:The separation of someone who’s infected or contaminated from others so that the infection or contamination is not spread
50 QuarantineLimitation of freedom of movement of a well person who’s been exposed to an infectious agent1) For duration of incubation periodGoal is to prevent people who have not been exposedEmphasize difference between isolation and quarantine
51 What Does it Mean to be Isolated or Quarantined? No contact with any new peopleCan not leave home or place of containmentFor evaluation and verification purposes patient needs to check in with Public Health every day
52 What is Voluntary Compliance? Voluntary compliance with isolation, quarantine or other control measures means a patient cooperates and complies with Public Health’s instructions to comply with the recommended control measures in order to prevent the spread of disease.
53 What is Involuntary Detention? This is what Public Health will pursue if an individual does not voluntarily comply with an ordered control measure.
54 To What or Who Can “Control Measures” be Imposed? Person (s)Groups (5 or more individuals)Area (city block, ZIP code, county)Buildings (hospital, hotel, business)*Common Carrier (plane, bus, train)*
55 Who Can Enforce these Rules? Local law enforcement must enforce an order issued by local health authority.
57 Case study: Influenza Outbreak Background on avian influenza:Strains of influenza that infect birdsCirculate among wild water birdsBird-to-bird transmission via:Fecal materialSalivaNasal & respiratory secretions
58 A Pandemic is a World-Wide Epidemic A new bacteria or virus that caninfect humansNearly all people have no immunity to the new organismHigh mortality rateEasily spread from person toperson.The hallmarks of a PANDEMIC are that humans are susceptible to the “new” disease; and since the disease is NEW TO HUMANS. almost NO ONE will have ANY immunity to it, which we expect to would cause a lot of deaths. Of course, it must pass from human to human easily in order to spread quickly; however, many bacteria and virus can live on hard surfaces for a few days, so practicing cleanliness and hygiene are important to control.Population must be “immunologicially naïve” --- have no immunity to it because it is a “new” disease.
59 Background – Avian Influenza Varying severity and infectiousness among birdsThe highly pathological avian influenza (HPAI) is the virus that is a pandemic among migrating water fowl.Potential to combine with human flu virus to produce a “new” influenza transmissible to humans that could be lethal.I think this slide could be deleted but I clarified the H5N1 situation here.
60 Viral reassortmentMixing of viral genes from two different animal species simultaneouslyExample:Human infected with human and avian influenza virus at the same time
61 Influenza Virus Transmission Influenza viruses have the potential to mutate rapidly and gain the ability to spread from:Birds to farm animals (i.e., pigs)Animals to humansBirds to humans (directly)
62 Avian Influenza Virus Transmission Concerns Strain efficiently transmitted between birds and humansStrain efficiently transmitted from human to human
63 I put this in because it breaks up the seriousness, and it usually gets a chuckle or two.
64 Influenza Outbreak Scenario A highly infectious form of avian influenza begins to circulate among poultry at a farm in Hong Kong.
65 Influenza Outbreak The owner of the farm also has several pig pens The pig pens are located right next to the bird cagesThe feed troughs for both the pigs and poultry are often interchanged
66 Influenza OutbreakThe avian flu virus mutates and infects several of the pigs.The virus mutates again and is transmitted from one of the pigs to the farm owner.Bird →Pig →Human
67 Influenza Outbreak The farm owner wakes up one morning suffering from: FeverSore throatCoughingMuscle aches
68 Influenza OutbreakIn the afternoon, he travels into the crowded capital city to sell his poultry at the local market.He is in extremely close contact with customers for several hours.
69 Influenza OutbreakA couple days later, several of the customers from the market begin to show symptoms of flu-like illness:CoughingFeverSore throatMuscle aches
70 Influenza OutbreakSeveral of them work in the kitchen of a nearby hotel restaurantThe restaurant is popular among Americans on business trips in Hong Kong.
71 Influenza OutbreakA Tarrant County resident traveling in Hong Kong on a business trip stays at the hotel.He eats at the hotel restaurant on an evening in which one of the infected workers is preparing food.
72 Influenza Outbreak The businessman is infected with flu. Within a few days of eating at the restaurant, he exhibits flu-like symptoms.The following day, he flies home to DFW.
74 Influenza OutbreakWithin days after the resident returns home, local hospitals see an increase in patients presenting with:coughingfevermuscle aches
75 Influenza OutbreakLocal physicians report similar trends in symptoms seen in recent days in their private practices.
76 Influenza OutbreakOver the next couple days, several EMS workers who’ve been transporting ill patients, call in sick to work complaining of flu-like symptoms.The work-force loses capacity because so many employees have fallen ill.
77 Question 1What factors might be contributing to EMS staff contracting influenza?(Hint: prior influenza vaccination likely would NOT be effective in preventing infection from an avian flu virus)
78 AnswerStaff were not taking appropriate protective measures around infected persons:Not regularly washing hands after contact with sick individualsFailing to wear personal protective equipment (masks and gloves)Failing to disinfect contaminated surfaces and medical equipment after transporting patients
79 Question 2Could this influenza outbreak have been prevented completely?
80 Answer Highly unlikely : Population has little to no immunity against a new avian flu virus strainPrior influenza vaccination not protective against avian flu virus strainMinimum of 6 months needed to develop a new flu vaccineHowever . . .
81 Question 3Could the magnitude of this outbreak have been reduced?
82 AnswerYes – it is likely the magnitude of the outbreak could have been reduced by:Earlier attention to health alertsRegular hand washing after contact with patientsWearing personal protective equipment (masks, gloves, gowns)Regularly disinfecting surfaces and medical equipment
84 Answer Yes - general quarantine precautions would apply: An infected patient (with SARS, Avian, TB or even H1N1) on an international flight CAN be detained at the airport terminalCDC, airport and local public health authorities can request flight manifests and have passengers undergo medical screening for their safetyA non-compliant patient can be arrested and sent to forced isolation or quarantine
85 Question 5Why would a non-compliant person be arrested and sent to forced isolation or quarantine?
86 AnswerSo the non-compliant patient does not endanger the public or themselves.
87 Influenza Outbreak Summary BE RESPONSIBLE!!It is especially important . . .Wash hands or use sanitizers regularlyPractice good respiratory hygiene and cough etiquetteDon’t come to work when you are sickGet a flu shot each year
88 Influenza Outbreak Disclaimer Currently no sustainable human-to-human transmission of bird flu has been reportedHowever, cases of human-to-human transmission continue to occur and the virus continues to mutateTherefore, we must be prepared for this possibility
90 * - Originating authors CreditsThis course was made possible through the efforts of public health and EMS staff from Dekalb County, GA and Tarrant County, TX:Darren Collins*, MPH, DekalbJason Craw* DekalbBill Stephens, MS, TarrantKay Sanyal-Mukherji, MPH, TarrantMicky Moerbe, MPH, TarrantDiana Cervantes, MS, TarrantJennifer Dowdy, MPH, TarrantMark Fulmer, MS, TarrantTerry Lafon, RN, TarrantTeresa Bates, LVN, TarrantDonald Fisher, MS, TarrantReviewed by Dr. Elvin Adams, MD, FACEP, Health Authority, Tarrant* - Originating authorsThis training was produced by the Southwest Center for Advanced Public Health Practice (Center) at Tarrant County Public Health, and was supported by Cooperative Agreement Number U50/CCU from the Centers for Disease Control and Prevention (CDC) to the National Association of County and City Health Officials (NACCHO). Its contents are solely the responsibility of Center and do not necessarily represent the official views of CDC or NACCHO