Michael C. Samuel, DrPH STD Control Branch California Department of Public Health 1 hour and 30 minutes Items for participants to consider before course begins: What type of outbreak response team and/or plan does your health
What type of aberration and/or outbreak detection system does your health
What recent STD outbreaks have occurred in your jurisdiction? How were these handled? What were the key control measures and/or other findings?
Please review the following three Outbreak Module handouts for 15-20 minutes each prior to the course: Handout 1, Equipment and Supply List
Review the equipment and/or supplies that you will need to have on hand or
vendors you will need to identify to provide equipment or supplies, if you should have an outbreak. Is there anything missing from the list that you are likely to need?
Handout 2, Outbreak Response Team Key Roles and Responsibilities List
Review each of the outbreak team roles and the responsibilities associated
with each role. Identify those roles that need to be filled within your program.
Handout 3, Detailed Evaluation List
Review this comprehensive list from CDC that indicates the criteria on which
an outbreak evaluation should be based. Do these evaluation items make sense to you? Is there anything missing from the list?
Handout 1: Equipment and Supply Assessment Diagnostic Equipment
o Darkfield microscope o Stat-RPR testing kits o Blood drawing supplies o Band-aids, alcohol, cotton, etc o Shock kit o Urine specimen cups o STD and/or HIV specimen collection and transport media/kits/equipment o Lab slips o Dry ice o Rubber gloves o Specimen storage and transport capabilities – coolers/refrigeration/freezers
o Azithromycin o Benzathine Penicillin G o Doxycycline o Ceftriaxone o Cefixime o Sharps container o Cups, water
o Laptop computers – all necessary applications should be installed and tested
o Maps/GPS o Calling cards o Mobile vans o Tables/Chairs o Cellular phones, walkie-talkies, wireless communication devices o Printer/copier/fax combo with ink/toner o Local and state ID cards o Pens, pencils, “sharpies” o Paper pads, file folders o Paper clips, binder clips, stapler, staples, rubber bands, etc o Clip boards o Cash, traveler’s checks o Appointment cards o Camera o Names and contact info of clinic and health department personnel o STD prevention materials (brochures, posters, condoms, etc.) o Food o Porta-Potties Handout 2: Outbreak Response Team Key Roles and Responsibilities Health Department Lead:
o Oversees response o First point of contact o Arranges initial meeting o Assesses resource and person capacity o Ensures that all team members understand roles and responsibilities o Ensures timely communication between ORT and other involved persons o Develops investigative tools o Declares outbreak response over o Reviews and provides guidance for presentations and data summaries
Field Services Specialist (DIS/CDI/Public Health Nurses):
o Interviews cases o Assures treatment of cases/partners o Provides community assessment
Field Services Supervisor:
o Assigns cases to field staff o Reviews case interviews o Determines need for more resources, including field staff o Supports control activities o Develops training materials for field staff
o Assists in development of investigative tools o Develops and modifies outbreak databases and data collection tools o Oversee data entry o Organizes and analyzes data o Assists field staff as needed o Produces presentations and other data output summaries as needed o Produces final written report o Conducts final evaluation
o Coordinates treatment o Consults on medical issues o Develops treatment algorithm
o Point person for media-related activities o Communicates outbreak to CDC o Notifies other relevant public health agencies o Supports media-related control activities Logistics Lead
Program Development Liaison
o Identifies appropriate control measures o Implements targeted outreach to high-risk clients and/or locales o Coordinates control activities
Handout 3:Evaluation Surveillance
o Was the outbreak identified in a timely manner? o How many additional cases were identified through outreach or other active
o Why were these cases not identified through passive systems? o What could have been done to identify these patients earlier? o What was the lag time between laboratory test or disease diagnosis and field
o Were field staff levels adequate for the response? o Were staff adequately trained to respond using non-traditional approaches o Were field staff able to respond to the outbreak in a timely manner? o Were geographic or population gaps in coverage identified? o What were the partner services indicators for the outbreak? What could bias the
o Were cases interviewed, managed, and closed in a timely fashion? Were cases
o Were field staff able to contact and interview cases? o Were necessary supplies available (blood draw kits, treatment, mobile vans,
etc.)? What could have been done to make these supplies more readily available?
o Were there staff or supplies that would have been necessary or helpful that were
not readily available? How could these be secured in the future?
o Were cases treated? Was treatment prompt? o Overall, how effective were the current clinical services? o Were sufficient clinics open with convenient hours to serve the community? o How well trained were the clinicians providing these services? o Were additional services utilized? In what capacity? How effective were they? o What clinical services would have been necessary or helpful but unavailable?
How could these services be secured in the future?
Laboratory and Diagnostic Services
o Were the laboratory services adequate? o Were specimens properly obtained and handled? o Were diagnostics utilized effective? Would others have been more effective?
Morbidity and Population
o Has the morbidity of the infection been reduced in the area of the response? o What populations were primarily affected? o What are some reasons for the outbreak developing in this geographic area?
Among these populations? At this magnitude?
o If an outbreak were to develop in this area again, what would you suggest? In
o What community partnerships were called upon during this response? o Have community contacts been kept in the loop now that the outbreak has
o What role did each of these partnerships have in the response? o What community partnerships were unavailable that would have been necessary
o What barriers to community mobilization existed? What strategies were
o How can these partnerships be sustained for outbreak preparedness?
o Which outlets succeeded in getting the word out about the message? Which
o Which reporters covered the story accurately? o What confusion existed regarding smooth flow of communications?
o How expensive was the outbreak response? o Were the funds needed diverted from other important functions? If so, what? o Are the costs justified in light of the outcome?
surveillance) would have made to preparedness activities forT Guttuso, J Roscoe, and J Griggs conceived and designed the study andthe 2002 malaria emergency in western Kenya. analysed and interpreted the data; T Guttuso acquired the data; T GuttusoThe highlands of western Kenya have seasonaland J Roscoe drafted the manuscript; and J Roscoe and J Griggs undertookcritical revision of the manusc
DERECHOS SEXUALES Y DERECHOS REPRODUCTIVOS20 1. EL PANORAMA POLÍTICO Durante los debates para la campaña presidencial desarrollada durante el primer semestre del año 2011 estuvieron presentes algunos de los derechos sexuales y reproductivos, entre ellos el derecho al aborto te-rapéutico, que entonces alcanzó el consenso de todos los candidatos. Se debatió también sobre posibilidad d