Lessons Learned From the E-cigarette, or Vaping, Product Use–Associated Lung Injury (EVALI) Outbreak Response, Minnesota, 2019-2020

2021 ◽  
pp. 003335492110513
Author(s):  
Terra Wiens ◽  
Joanne Taylor ◽  
Cory Cole ◽  
Stefan Saravia ◽  
Jason Peterson ◽  
...  
Keyword(s):  
Public Health ◽  
Lung Injury ◽  
Health Agency ◽  
Lessons Learned ◽  
Noncommunicable Disease ◽  
Multidisciplinary Teams ◽  
Outbreak Response ◽  
Clinical Specimens ◽  
Incident Command ◽  
Product Use

Objective Electronic cigarette (e-cigarette), or vaping, product use–associated lung injury (EVALI) is a novel noncommunicable disease with an unknown cause. The objective of this analysis was to describe the Minnesota Department of Health’s (MDH’s) outbreak response to EVALI, including challenges, successes, and lessons learned. Methods MDH began investigating EVALI cases in August 2019 and quickly coordinated an agencywide response. This response included activating the incident command system; organizing multidisciplinary teams to perform the epidemiologic investigation; laboratory testing of e-cigarette, or vaping, products (EVPs) and clinical specimens; and collaborating with partners to gather information and develop recommendations. Results MDH faced numerous investigational challenges during the outbreak response of EVALI, including the need to gather information on unregulated and illicit substances and their use and collecting information from minors and critically ill people. MDH laboratorians faced methodologic challenges in characterizing EVPs. Despite these challenges, MDH epidemiologists successfully collaborated with the MDH public health laboratory, law enforcement, partners with clinical and toxicology expertise, and local and national public health partners. Practice Implications Lessons learned included ensuring the state public health agency has legal authority to conduct noncommunicable disease outbreak investigations and the necessity of cultivating and using internal and external partnerships, specifically with laboratories that can analyze clinical specimens and unknown substances. The lessons learned may be useful to public health agencies responding to similar public health emergencies. To improve preparedness for the next outbreak of EVALI or other noncommunicable diseases, we recommend building and maintaining partnerships with internal and external partners.

scholarly journals Containing COVID-19 Through Contact Tracing

2020 ◽  
Vol 136 (1) ◽  
pp. 32-38
Author(s):  
Nilesh Kalyanaraman ◽  
Michael R. Fraser
Keyword(s):  
Public Health ◽  
Health Agency ◽  
The United States ◽  
Lessons Learned ◽  
Local State ◽  
Contact Tracing ◽  
Public Health Agencies ◽  
Incident Command ◽  
Department Of Health

Containing coronavirus disease 2019 (COVID-19) through case investigation and contact tracing is a crucial strategy for governmental public health agencies to control the spread of COVID-19 infection in the United States. Because of the recency of the pandemic, few examples of COVID-19 contact-tracing models have been shared among local, state, and federal public health officials to date. This case study of the Anne Arundel County Department of Health (Maryland) illustrates one model of contact-tracing activity developed early in the outbreak. We describe the contact-tracing effort’s place within the broader county health agency Incident Command System, as well as the capabilities needed, team composition, special considerations, and major lessons learned by county health officials. Other local, state, tribal, territorial, and federal health officials and policy makers can use this case study to innovate, iterate, and further refine contact-tracing efforts to prevent the spread of COVID-19 infection and support community members in isolation or quarantine.

Not your typical “historian”

2018 ◽  
Vol 27 (5) ◽  
pp. 523-533
Author(s):  
Adrienne Lefevre ◽  
Madison Walter-Garcia ◽  
Kimberly Hanson ◽  
Julia Smith-Easley
Keyword(s):  
Public Health ◽  
Lessons Learned ◽  
Incident Management ◽  
Public Health Response ◽  
Content Type ◽  
Incident Command ◽  
Health Community ◽  
Health Response ◽  
Decision Making Processes

Purpose In the incident command system (ICS) structure, response documentation is formally found within the planning section. However, longer term emergency responses have demonstrated the need for a flexible and innovative role that encompasses a variety of activities, including response documentation, communications science, real-time evaluation of major themes, and information management. The paper aims to discuss this issue. Design/methodology/approach This need can be universally met through the functional role of “Historian,” a term specific to ICS, or in the case of public health response, incident management system (IMS). It should be noted that the Historian role discussed is not related to the academic study of history, but to archiving key successes and challenges during a response. Ideally the Historian should be activated at the start of an emergency response and remain active to capture the overall picture of the response, including internal information, such as lessons learned, response activities, and decision-making processes. Findings The Historian compiles details of response activities that inform leadership, donors and external communications products while alleviating pressures on the planning section. The primary, minimum output of an IMS Historian is a response timeline, which notes major internal and external events during a response with emphasis on major themes, lessons learned, and creating a user-friendly interface to display this information (see the list “Abbreviated Example of Hurricane Matthew Response Timeline” in the text). Originality/value In a world with competing priorities and ongoing emergencies, the Historian’s role of archiving details of response efforts can help the international public health community to share lessons learned and contribute to lower morbidity and mortality among those affected by emergencies.

Methodology for assessment of public health preparedness and response synergies between institutional authorities and the community

2020 ◽  
Author(s):  
Daniel H. de Vries ◽  
John Kinsman ◽  
Judit Takacs ◽  
Svetla Tsolova ◽  
Massimo Ciotti
Keyword(s):  
Public Health ◽  
Data Collection ◽  
Methodological Approach ◽  
Effective Means ◽  
Field Work ◽  
Lessons Learned ◽  
Outbreak Response ◽  
Study Approach ◽  
Rich Data

Abstract Background: This paper describes a participatory methodology that supports investigation of the collaboration between communities affected by infectious disease outbreak events and relevant official institutions. The core principle underlying the methodology is the recognition that synergistic relationships, characterised by mutual trust and respect, between affected communities and official institutions provide the most effective means of addressing outbreak situations. Methods: The methodological approach and lessons learned were derived from four qualitative case studies including (i) two tick-borne disease events: Crimean-Congo haemorrhagic fever in Spain, and tick-borne encephalitis in the Netherlands (2016); and (ii) two outbreaks of acute gastroenteritis (norovirus in Iceland, 2017, and verocytotoxin-producingEscherichia coli [VTEC] in Ireland, 2018). These studies were conducted in collaboration with the respective national public health authorities in the affected countries by the European Centre for Disease Prevention and Control (ECDC). Results: An after-event qualitative case study approach was taken using mixed methods. Lessons highlight the critical importance of collaborating with national focal points during preparation and planning, and interviewer reflexivity during fieldwork. Field work for each case study was conducted over one working week, which although limiting the number of individuals and institutions involved, still allowed for rich data collection due to the close collaboration with local authorities. The analysis focused on the specific actions undertaken by the participating countries’ public health and other authorities in relation to community engagement, as well as the view from the perspective of the community. Conclusions: The overall objective of the assessment to identify synergies between institutional decision-making bodies and community actors and networks before, during and after an outbreak response to a given public health emergency. The methodology is generic and could be applied to a range of public health emergencies, zoonotic or otherwise. The methodology emphasises reflexivity among fieldworkers, a relatively short time needed for data collection, potential generalisability of findings, insider-outsider perspectives, politically sensitive findings, and how to deal with ethical and language issues.

scholarly journals E-cigarette, or vaping, product use-associated lung injury: a review

Pneumonia ◽  
2020 ◽  
Vol 12 (1) ◽  
Author(s):  
Samuel H. Belok ◽  
Raj Parikh ◽  
John Bernardo ◽  
Hasmeena Kathuria
Keyword(s):  
Public Health ◽  
Lung Injury ◽  
Supportive Care ◽  
Pulmonary Disease ◽  
Healthcare Providers ◽  
Disease Entity ◽  
Case Definitions ◽  
Health Implications ◽  
Product Use ◽  
Other Substances

Abstract Background E-cigarette, or Vaping, Product Use-Associated Lung Injury (EVALI) is a disease entity related to the use of battery-operated or superheating devices that create an aerosolized form of nicotine and tetrahydrocannabinol (THC) and/or other substances for inhalation. Methods We performed a literature review to document epidemiology, pathogenesis and risk factors, diagnosis, clinical presentation, evaluation and management of EVALI. Results In the summer of 2019, an outbreak of EVALI cases brought this disease entity into the national spotlight. Since being recognized as a serious pulmonary disease with public health implications, more than 2600 cases have been reported to CDC with 68 deaths as of February 2020. The pathophysiology of EVALI remains unknown. Substances such as Vitamin E acetate have been implicated as a possible causes of lung injury. The CDC has established case definitions of “confirmed EVALI” cases to help guide identification of the disease and assist in surveillance. While clinical judgement by healthcare providers is imperative in the identification of EVALI cases, the heterogeneous presentations of EVALI make this difficult as well. Ultimately most investigative studies should be aimed at ruling out other disease processes that can present similarly. Treatment is centered around removing the offending substance and providing supportive care. Conclusions EVALI is a serious pulmonary disease with public health implications. Diagnosis requires a high degree of suspicion to diagnose and exclusion of other possible causes of lung disease. It may be beneficial to involve a pulmonary specialist early in the management of this disease which is generally supportive care.

A US metropolitan county health department’s response to a measles outbreak in a childcare facility – challenges faced and lessons learned

2020 ◽  
pp. 175791392095520
Author(s):  
Diane Meyer ◽  
Marc Trotochaud ◽  
Lisa Ferguson ◽  
Jennifer Vines ◽  
Russell Barlow ◽  
...  
Keyword(s):  
Public Health ◽  
Health Department ◽  
Lessons Learned ◽  
Outbreak Response ◽  
Public Health Community ◽  
Local Public Health ◽  
Measles Outbreak ◽  
Health Community ◽  
Childcare Facility ◽  
Measles Outbreaks

Aims: In June 2018, the Multnomah County Health Department located in Portland, Oregon, US, responded to a measles exposure in a local childcare facility. This analysis describes lessons learned and challenges encountered during this measles response that may inform public health policy and help other local public health authorities prepare for measles outbreaks. These lessons will become increasingly important as measles cases continue to increase in both the US and abroad. Methods: A semi-structured videoconference interview was conducted with nine health department staff who were directly involved in the health department’s response to the measles outbreak. Interview notes were iteratively discussed between all authors to identify those outbreak response challenges and lessons learned that were generalizable to the broader public health community. Results: Some of the key challenges and lessons learned included the need for increased provider recognition and reporting of measles cases, difficulty in determining which staff and children to exclude from attending daycare during the 21-day postexposure monitoring period, determining who would be prioritized to receive immunoglobulin, and the need for childcare staff vaccine status requirements. Conclusion: Lessons from this response highlight important considerations for public health practitioners and policy makers. Given the relative severity of measles and the potential for spread in facilities that serve infants and young children, the public health community must continue to address key gaps through planning and policy.

Journaling among home care workers during the COVID-19 pandemic: A promising method for qualitative data collection

2021 ◽  
pp. 147332502110648
Author(s):  
Julia I Bandini ◽  
Julia Rollison ◽  
Jason Etchegaray
Keyword(s):  
Public Health ◽  
Data Collection ◽  
Home Care ◽  
Lived Experiences ◽  
Health Agency ◽  
The United States ◽  
Lessons Learned ◽  
Future Research ◽  
Care Workers ◽  
Home Care Workers

Qualitative methods that capture individual lived experiences throughout rapidly changing circumstances are particularly important during public health emergencies. The COVID-19 pandemic has put home care workers at risk as they provide vital services in homes to individuals with chronic conditions or disabilities. Using a 6-week journaling process in which we enrolled participants at different points, we sought to examine experiences of home care workers ( n = 47) in the United States in New York and Michigan during April–July 2020 of the COVID-19 pandemic. Our methods for data collection and analysis were guided by a general qualitative approach as we aimed to examine the weekly perspectives and lived experiences of home care workers. We asked individuals to respond to our journaling prompts weekly to capture their reflections in “real time.” To better understand home care workers’ perspectives on journaling and the broader external context in which they provided care, we triangulated our data with interviews with home care workers ( n = 19) and home health agency representatives ( n = 9). We explored the feasibility of a rolling journaling process during an unprecedented public health emergency, characterized by rapid changes and uncertainty in day-to-day life, and reflect on lessons learned to guide future research on journaling for data collection, particularly for marginalized workers during public health crises, when events are evolving rapidly.

Lessons Learned From Implementing an Incident Command System During a Local Multiagency Response to a Legionnaires’ Disease Cluster in Sydney, NSW

2017 ◽  
Vol 12 (4) ◽  
pp. 539-542 ◽  
Author(s):  
Emma Quinn ◽  
Travers Johnstone ◽  
Zeina Najjar ◽  
Toni Cains ◽  
Geoff Tan ◽  
...  
Keyword(s):  
Public Health ◽  
Health Risk ◽  
Environmental Health ◽  
Lessons Learned ◽  
Effective Response ◽  
Public Health Risk ◽  
Incident Command System ◽  
Incident Command ◽  
Disease Cluster ◽  
Legionnaires Disease

AbstractThe incident command system (ICS) provides a common structure to control and coordinate an emergency response, regardless of scale or predicted impact. The lessons learned from the application of an ICS for large infectious disease outbreaks are documented. However, there is scant evidence on the application of an ICS to manage a local multiagency response to a disease cluster with environmental health risks. The Sydney Local Health District Public Health Unit (PHU) in New South Wales, Australia, was notified of 5 cases of Legionnaires’ disease during 2 weeks in May 2016. This unusual incident triggered a multiagency investigation involving an ICS with staff from the PHU, 3 local councils, and the state health department to help prevent any further public health risk. The early and judicious use of ICS enabled a timely and effective response by supporting clear communication lines between the incident controller and field staff. The field team was key in preventing any ongoing public health risk through inspection, sampling, testing, and management of water systems identified to be at-risk for transmission of legionella. Good working relationships between partner agencies and trust in the technical proficiency of environmental health staff aided in the effective management of the response. (Disaster Med Public Health Preparedness. 2018;12:539–542)

scholarly journals The use of anonymized and aggregated telecom mobility data by a public health agency during the COVID-19 pandemic: Learnings from both the operator and agency perspective

Data & Policy ◽  
2021 ◽  
Vol 3 ◽  
Author(s):  
Kristofer Ågren ◽  
Pär Bjelkmar ◽  
Elin Allison
Keyword(s):  
Public Health ◽  
Personal Data ◽  
Health Agency ◽  
Lessons Learned ◽  
Public Health Agency ◽  
Public Institution ◽  
Aggregated Data ◽  
Personal Data Protection ◽  
Mobility Data ◽  
Telecom Operator

Abstract The COVID-19 pandemic and associated measures implemented have rapidly changed how people move about and behave in society. Utilizing data on people’s mobility could provide unique and valuable insights to governments and institutions to better manage the crisis. These entities, however, have not traditionally had access to, nor the experience of applying, continuous anonymized and aggregated data on people mobility. This article aims to show how the Public Health Agency in Sweden successfully collaborated with a Nordic Telecoms operator to make use of such data during the COVID-19 pandemic. Specifically, it investigates how the collaboration started, approaches used to go from data to insight, outcomes and impact, and lessons learned on both sides. Telia, the largest telecom operator in the Nordics, had an existing product commercially available that provided anonymized and aggregated insights about people’s movement. Several challenges existed within Telia as it was the first time worldwide a collaboration with a Public Health Agency would take place and social benefits had to be weighed against commercial and reputational risks. The hypothesis at the beginning of the pandemic was that the solution could be adapted to fit the needs of policymakers and the internal challenges could be overcome, while providing a meaningful contribution to the fight against the virus. The results show that it is possible to both form a mutually beneficial collaboration between a telecom operator and a public institution, and to make use of mobility data in evidence-based policymaking without compromising applicable personal data protection laws.

scholarly journals A Meaningful Journey to Onboard Syndromic Data through a Local HIE

2015 ◽  
Vol 7 (1) ◽  
Author(s):  
Jeffrey Johnson ◽  
Jessica Yen ◽  
Brit Colanter ◽  
Eric McDonald
Keyword(s):  
Public Health ◽  
Information Exchange ◽  
Health Information Exchange ◽  
Health Agency ◽  
Meaningful Use ◽  
The United States ◽  
Lessons Learned ◽  
Local Health ◽  
Local Public Health ◽  
Public Health Agencies

This presentation aims to highlight key activities, technical approaches, data discoveries, lessons learned and outcomes achieved while onboarding local hospitals for syndromic Meaningful Use Stage 2 through a local health information exchange. The federal meaningful use initiative is currently a major driver to enable greater establishment of syndromic surveillance capacity across the United States. The role and efforts by local and state public health agencies in the syndromic onboarding process varies greatly. We describe efforts from a local public health agency to onboard, validate and integrate meaningful use syndromic information.

Public health incident management: Logistical and operational aspects of the 2009 initial outbreak of H1N1 influenza in Mexico

2016 ◽  
Vol 13 (1) ◽  
pp. 71 ◽  
Author(s):  
Miguel A. Cruz, PhD ◽  
Nicole M. Hawk, MPA ◽  
Christopher Poulet, MS ◽  
Jose Rovira, MS ◽  
Edward N. Rouse, MPA
Keyword(s):  
Public Health ◽  
H1n1 Influenza ◽  
Incident Management ◽  
Outbreak Response ◽  
Incident Command ◽  
Health Leadership ◽  
Response Team ◽  
Public Health Leadership ◽  
Operational Aspects

Hosting an international outbreak response team can pose a challenge to jurisdictions not familiar with incident management frameworks. Basic principles of team forming, organizing, and executing mission critical activities require simple and flexible communication that can be easily understood by the host country's public health leadership and international support agencies. Familiarity with incident command system principles before a public health emergency could save time and effort during the initial phases of the response and aid in operationalizing and sustaining complex field activities throughout the response. The 2009 initial outbreak of H1N1 in Mexico highlighted the importance of adequately organizing and managing limited resources and expertise using incident management principles. This case study describes logistical and operational aspects of the response and highlights challenges faced during this response that may be relevant to the organization of public health responses and incidents requiring international assistance and cooperation.

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