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Editor’s Note
The purpose of this website is twofold – to provide news about public health preparedness that is timely, and to host a forum where the public health community can discuss issues. While the forum is not open to the general public at this time, your comments and suggestions are welcome and can be submitted to the editor at phpr.forum@dhhs.nc.gov. The primary contributors to the forum are the Office of Public Health Preparedness and Response, the state’s seven Public Health Regional Surveillance Teams, counties, partners and stakeholders.

FORUM

Staff Changes

July 13, 2011

PHP&R has been reclassified as a branch and is undergoing significant staff changes. A full listing of these changes will be made soon.

March 2, 2010

Public Health Regional Surveillance Team 3 has introduced Ashanti Z. Corey, MPH as the team's newest staff member filling their epidemiologist vacancy.

Ms. Corey was most recently a graduate research assistant with the Texas A&M School of Rural Public Health. She also worked with the USA Center for Rural Public Health Preparedness and with Dr. Scott Lillibridge at the National Center for Emergency Preparedness and Response. (Dr. Lillibridge was the founding director of the Bioterrorism Preparedness and Response Program at the Centers for Disease Control and Prevention and special assistant to the HHS Secretary for National Security and Emergency Management.)

Ms. Corey earned her bachelors degree in Psychology at Louisiana State University and her Master of Public Health at Texas A&M School of Rural Public Health.

February 25, 2010

Partners,

It has been my pleasure to serve as the Team Leader for PHRST-5. Though I will still work very closely with PHRST-5, by providing program support and oversight, the day to day operations will now officially be led by Wendy Boggs. Since joining the Regional Surveillance Team in 2004, she has worked with five other PHRST nurses in NC to assist with preparedness planning , coordinating efforts and resources with local health departments and community partners, incident/event responses, disease outbreaks and planning/participating in preparedness and response exercises. Under Wendy's leadership, the team will continue its efforts to provide Health Departments and their partners in the region and across the state, with the necessary support required to make it the most capable to prepare for and respond to issues of public health significance. I have enjoyed serving as the team leader of PHRST-5 and look forward to my continued work with all of you. Please join me in re-introducing and welcoming Wendy Boggs as the new team leader of PHRST-5.

Steven Ramsey, RS
Preparedness Manager
Guilford County Dept. of Public Health

July 7, 2009

Public Health Regional Surveillance Team 1 has introduced Jim Madson as the team’s newest staff member filling their nurse epidemiologist vacancy.

During his 24-year career in the Army, Jim spent seven years as an army biological research specialist before returning to nursing school at George Mason University. In 1995, Jim was appointed as an Army public health nurse and in 2001 attended the University of South Carolina School of Public Health where he obtained an MPH with emphasis on Epidemiology and Biostatistics.

His military service took him to a wide variety of locations, including California, Kentucky, Haiti, Honduras, South Carolina, Texas and Italy. He has a diverse work history with experiences in clinical infectious diseases such as TB, HIV, and STDs; planning and coordinating community events such as annual influenza mass vaccination clinics; membership and/or chairmanship on multidisciplinary committees and teams; instructing at the Army Public Health Campus in San Antonio; and conducting public health investigations and education of multiple health problems in the populations he served.

His last assignment was to serve as the hospital emergency response manager and garrison public health emergency officer. Jim's educational background, professional expertise, and work experience have prepared him well for nurse epidemiologist position with PHRST 1.

Jim is married with three children, ages 18, 15, and 8

PHRST 1 and the public health preparedness community look forward to working with Jim and welcome him and his family to North Carolina.

April 1, 2009

Mary Young joined PHP&R on February 2 as the Public Health Program Manager. Mary has previous state experience having previously worked with NC Emergency Management as the Emergency Services Coordinator. In that position she coordinated state disaster response for Emergency Support Function (ESF) 4 – Fire, ESF 8 – Public Health & Medical, ESF 9 – Search and Rescue and ESF 13 – Public Safety and Security for state declared disasters.

July 13, 2011

Flu-Ville – A Nice Place to E-Visit

Congratulations to Lee Thach of Perquimans County for winning first place in the Centers for Disease Control and Prevention's web-based contest to develop an educational flu prevention application. Thach is a graphic and flash designer who developed web sites for Albemarle Regional Health Services and Beaufort County's Health Department and is working on a site for the Martin-Tyrrell-Washington District Health Department.

Launched by the CDC in April, the "Flu App Challenge!" offered $35,000 in prizes for the most innovative applications based on CDC flu data. The challenge called for app designers to create "a technical solution that promotes healthy behavior for flu prevention." Thach was awarded $15,000 for his first place finish as determined by a panel of five judges. (See fluapp.challenge.gov for contest details.)

Thach's app challenges players to prevent the spread of influenza through an avatar who oversees the building and maintenance in a bustling city. It is up to the player to vaccinate city residents, promote healthy habits and learn how to prevent the spread of influenza while coordinating the actions of an ever-growing population. Players can save different cities in each state and try different methods to control and prevent the spread of influenza.

To play Flu-Ville! visit www.fuelthebrain.com/Game/fluVille/.

February 26, 2010

H1N1 Reminder: Deadline for spending Phase I, II, and III Funds is May 31, 2010

PHP&R is advising our public health partners that the deadline for spending Public Health Emergency Response (PHER) Phase III-Response H1N1 Aid-to-Counties (ATC) funds awarded to Local Health Departments (AA 851) and PHRST Teams (AA 853), is May 31, 2010. This is also the spending end-date for Phase I/II funds for Planning (Counties –AA 848; PHRST – AA 850) and Enhanced Surveillance (Counties- AA 849).

At this point we are being warned that it is unlikely we will be able to carry these funds forward to the next fiscal year, so it is essential that you spend these funds before the deadline. There is some discussion at the federal level to allow carry forward of Phase I and II funds but this is not yet guaranteed.

To facilitate this effort, earlier this month we prepared and distributed a list of possible "approvable" uses for all phases of H1N1 funds at the local level. We also noted (see NOTES below) the key reasons why certain requests have been disallowed and listed the means/mechanisms are available to LHDs for those proposals.

If you have specific questions about these issues please contact Fred Jamison, PHP&R Operations Manager, at fred.jamison@dhhs.nc.gov or 919-715-1411.

PHP&R has approved 252 Prior Approval (PA) requests regarding use of AA 848-Planning, AA 849-Enhanced Surveillance, and AA 851-Response funds, based on 258 PA requests to date. The overall PA approval rate is 98 percent. Prior Approval must be obtained for equipment/supplies purchases over $2,500.

LHD Large H1N1 Purchases

The following is a list of approved H1N1 PA request items submitted by LHDs.

Temporary staffing agreements.
Off-site facility rental or use reimbursement agreements for H1N1 mass vaccinations.
Non-motorized enclosed trailer for off-site H1N1 outbreaks/vaccination clinics.
Mobile immunization work stations; chairs and tables (most portable) for H1N1 vaccination clinics.
Portable and fixed unit refrigerators, medical supplies (PPE, hand sanitizer) and equipment for H1N1 vaccination clinics.
Storage units for H1N1 supplies and equipment; fixed and portable Points of Dispensing (POD) boxes/packs; H1N1 file record cabinets.
Portable and fixed electronic signage for H1N1 public notification/communication (e.g., clinics, education, meetings).
Digital Photo ID System for mass vaccination clinics; ID card swipe for H1N1 vaccine access/storage/security.
Voice Over IP equipment to make H1N1 immunization appointments, order vaccine, consult with providers, and establish dedicated H1N1 hotline number; auto-dialer system for direct H1N1 communications to assure timeliness and completion of H1N1 immunizations.
Inserting system for preparing/rapidly disseminating H1N1 immunization notices/mailers; blast fax H1N1 communications equipment
Bar code inventory system for H1N1 vaccine and SNS supplies management.
Generators dedicated to H1N1 facilities/mobile trailers for vaccine refrigeration/vaccination clinics.
Equipment for PPE quantitative fit testing for H1N1 outbreaks, or fit testing compliance services.
Billboard and media (radio & TV - private & government) H1N1 immunization advertising.
Laptop and notebook computers for H1N1 planning, epi surveillance, and H1N1 response (e.g., NCIR reporting)
Large printing orders for H1N1 consent packets; clinic flyers, brochures, posters, etc.; and direct mail expenses
LHD-logo jackets, lab coats/jackets, shirts, T-shirts for H1N1 clinics

Use of H1N1 ATC funds can be further maximized, especially during the current period of reduced H1N1 case activity in preparation for the next H1N1 wave, by making greater use of the following mobilization strategies:

Temporary Staffing Agreements to build the LHD H1N1 work force. To relieve local health departments/districts of any additional H1N1 workload, temporary staffing, volunteers and partners could be H1N1-trained by qualified public health consultants working under contract at the direction of the local health director.
Electronic notification system acquisition to build rapid patient/partner/public notification capabilities throughout the counties. Examples are dedicated H1N1 hot lines, auto-dialer appointment/reminder/recall systems, and flash fax communications.
Mobilized Equipment Procurement to build LHD transport and off-site mass vaccination capabilities. Examples are non-motorized enclosed, H1N1 equipped trailers; mobile immunization work stations; portable refrigerators and generators; and POD boxes/packs.

Denials of Prior Approval requests were due to:

Federally unallowable costs (such as building construction projects, vehicle purchase, or motorized trailer proposals),
General purpose use, not specific to direct H1N1 service activities per CDC H1N1 PHER guidance, benefitting/subsidizing general health department operations, and/or
general preparedness equipment (e.g., radio systems) which is suitable for funding with Public Health Emergency Preparedness (PHEP) funding (AA 514) in accord with the AA 514 deliverables.

When denied, PHP&R has suggested alternative ways to LHDs of using PHER, PHEP funds and/or other LHD or county funds in combination so a portion of the total proposed cost could be leveraged with other funds to make the proposal acceptable on a cost sharing, guidance appropriate basis. Those LHDs that reframed their funding strategies to do this have all been approved.

We hope this helps to remind you of the oncoming deadlines and allows you time to work with your agencies to make the best use of these critical funds.

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May 22, 2009

Utilization of Scarce Resources During a Pandemic

Whether referred to as “utilization of scarce resources,” “altered standards of care,” or “rationing,” decisions regarding patient care during a pandemic will be difficult for health care providers, patients and the public.

In 2006, the NC Institute of Medicine conducted a year-long look at the ethical considerations regarding these difficult decisions and published their initial findings, “Stockpiling Solutions: North Carolina's Ethical Guidelines for an Influenza Pandemic”. These findings were brought to a series of public forums to discuss how the principles would play out in clinical and public settings.

This year, the NC Division of Public Health and the North Carolina Medical Society (NCMS) are developing guidelines for health care practitioners. These guidelines will attempt to provide OBJECTIVE guidelines for use in SUBJECTIVE circumstances when faced with competing demands. Those demands include:

limited treatment modalities,
limited resources for treating (including medications, number and types of hospital beds, ventilators and personnel),
expectations of the patient and the public, and
perceived legal liability risks.

Preserving the guidelines’ objectivity will be accomplished through persistent review of the scientific literature and review of other states’ activities. To that end, we recently participated in the National Academy of Sciences’ Institute of Medicine’s regional summit on altered standards of care and we are working within the Region IV Emergency Support Function 8 (Health and Medical) Unified Planning Coalition with other southeastern states to share promising practices.

The North Carolina guidelines are being developed through a series of meetings of an expanded NCMS Ethical and Judicial Affairs Committee. The committee’s goal is to have the first draft completed by this fall for thorough vetting by a large, multidisciplinary task force. General public review and comment via the NCMS website is expected in late 2009 or early 2010.

For further information, please stay tuned or contact Jan Rhyne, MD (JRhyne@nhcgov.com) or Julie Casani (Julie.casani@dhhs.nc.gov)

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April 1, 2009

The Career Epidemiology Field Officer program: Bridging local, state and federal epidemiology

(This article was first published in the Winter 2008 edition of Epi Notes.)

Following the terrorist and anthrax attacks in 2001, US Health and Human Services Secretary Tommy Thompson directed the CDC to assign an EIS (Epidemic Intelligence Service) officer or graduate to every state. In response, the CDC created the Career Epidemiology Field Officer (CEFO) Program in early 2002; that has since comprised a national cadre of EIS-trained CEFOs who work with states and large local health departments to develop epidemiologic and emergency response capacities.

The objectives of the CEFO Program include:

providing epidemiologic expertise to state terrorism and emergency response planning and policy;
providing leadership, training, and technical support for maintaining and building local epidemiologic capacity;
building partnerships with state and local agencies with responsibility for preparedness and response activities; and
recruiting and supervising new epidemiologists, including EIS Officers.

Since 2002, three CEFOs have served in the NC Division of Public Health. Dr. Megan Davies completed her EIS assignment in Louisiana in 2000 and served in the Injury Center at CDC before becoming North Carolina’s first CEFO. During her tenure, Megan focused on enhancing infectious disease surveillance capacity within the state. She was instrumental in establishing the Public Health Epidemiologist Program that includes 12 hospital-based epidemiologists who serve as surveillance sentinels while building relationships between the clinical and public health communities. In addition, Megan assisted in the development of NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) – a national model for near real-time, statewide enhanced surveillance. Megan left the CEFO program in 2007.

Brant Goode became the state’s second CEFO after completing his EIS training in North Carolina in 2006. Brant quickly assumed leadership roles in pandemic influenza preparedness and response planning and training. He assisted in the development of a nationwide public health training program for responding to highly pathogenic avian influenza outbreaks and pandemic influenza. Following Brant’s departure in 2008, North Carolina received its third and current CEFO, Dr. Aaron Fleischauer, in August.

Aaron has served as a CDC epidemiologist since 2002 when he entered the Bioterrorism Preparedness and Response Program’s EIS program. Like Megan, Aaron will focus on continuing to strengthen the state’s surveillance capability. Additionally, he will focus on establishing a comprehensive disaster epidemiology program to enhance and integrate local and state epidemiologic resources. The program will address preparedness and response needs such as:

community needs assessments,
surveillance,
response team planning and training, and
developing a situation awareness tool to enhance the sharing of epidemiologic information to and from local health departments during a disaster.

Megan, Brant and Aaron’s experience serving our state echoes the sentiment shared by CEFOs nationwide – “When local public health is strong the nation’s public health system is strong.” For six years, the CEFO program has worked to build the all-hazards epidemiologic capability within North Carolina while continuing to strengthen the relationship between local and state health public health and the federal government.

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