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Thomas CM, Shaffner J, Johnson R, Wiedeman C, Fill MMA, Jones TF, Schaffner W, Dunn JR. Lessons Learned From Implementation of Mpox Surveillance During an Outbreak Response in Tennessee, 2022. Public Health Rep 2024:333549231223710. [PMID: 38264963 DOI: 10.1177/00333549231223710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES Mpox surveillance was integral during the 2022 outbreak response. We evaluated implementation of mpox surveillance in Tennessee during an outbreak response and made recommendations for surveillance during emerging infectious disease outbreaks. METHODS To understand surveillance implementation, system processes, and areas for improvement, we conducted 8 semistructured focus groups and 7 interviews with 36 health care, laboratory, and health department representatives during September 9-20, 2022. We categorized and analyzed session transcription and notes. We analyzed completeness and timeliness of surveillance data, including 349 orthopoxvirus-positive laboratory reports from commercial, public health, and health system laboratories during July 1-August 31, 2022. RESULTS Participants described an evolving system and noted that existing informatics platforms inefficiently supported iterations of reporting requirements. Clear communication, standardization of terminology, and shared, adaptable, and user-friendly informatics platforms were prioritized for future emerging infectious disease surveillance systems. Laboratory-reported epidemiologic information was often incomplete; only 55% (191 of 349) of reports included patient address and telephone number. The median time from symptom onset to specimen collection was 5 days (IQR, 3-6 d), from specimen collection to laboratory reporting was 3 days (IQR, 1-4 d), from laboratory reporting to patient interview was 1 day (IQR, 1-3 d), and from symptom onset to patient interview was 9 days (IQR, 7-12 d). CONCLUSIONS Future emerging infectious disease responses would benefit from standardized surveillance approaches that facilitate rapid implementation. Closer collaboration among informatics, laboratory, and clinical partners across jurisdictions and agencies in determining system priorities and designing workflow processes could improve flexibility of the surveillance platform and completeness and timeliness of laboratory reporting. Improved timeliness will facilitate public health response and intervention, thereby mitigating morbidity.
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Affiliation(s)
- Christine M Thomas
- Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
| | - Julie Shaffner
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
- Career Epidemiology Field Officer Program, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Renee Johnson
- Division of Laboratory Services, Tennessee Department of Health, Nashville, TN, USA
| | - Caleb Wiedeman
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
| | - Mary-Margaret A Fill
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
| | | | | | - John R Dunn
- Communicable and Environmental Diseases and Emergency Preparedness Division, Tennessee Department of Health, Nashville, TN, USA
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Thomas ES, Madewell ZJ, Still WL, Rowse J, Shapiro B, Gately E, Shaffner J, Mangla AT, Ricaldi JN. Notes from the Field: Transmission of Mpox to Nonsexual Close Contacts - Two U.S. Jurisdictions, May 1-July 31, 2022. MMWR Morb Mortal Wkly Rep 2023; 72:1351-1352. [PMID: 38096121 PMCID: PMC10727140 DOI: 10.15585/mmwr.mm7250a3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
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Sami S, Horter L, Valencia D, Thomas I, Pomeroy M, Walker B, Smith-Jeffcoat SE, Tate JE, Kirking HL, Kyaw NTT, Burns R, Blaney K, Dorabawila V, Hoen R, Zirnhelt Z, Schardin C, Uehara A, Retchless AC, Brown VR, Gebru Y, Powell C, Bart SM, Vostok J, Lund H, Kaess J, Gumke M, Propper R, Thomas D, Ojo M, Green A, Wieck M, Wilson E, Hollingshead RJ, Nunez SV, Saady DM, Porse CC, Gardner K, Drociuk D, Scott J, Perez T, Collins J, Shaffner J, Pray I, Rust LT, Brady S, Kerins JL, Teran RA, Hughes V, Sepcic V, Low EW, Kemble SK, Berkley A, Cleavinger K, Safi H, Webb LM, Hutton S, Dewart C, Dickerson K, Hawkins E, Zafar J, Krueger A, Bushman D, Ethridge B, Hansen K, Tant J, Reed C, Boutwell C, Hanson J, Gillespie M, Donahue M, Lane P, Serrano R, Hernandez L, Dethloff MA, Lynfield R, Como-Sabetti K, Lutterloh E, Ackelsberg J, Ricaldi JN. Investigation of SARS-CoV-2 Transmission Associated With a Large Indoor Convention - New York City, November-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71:243-248. [PMID: 35176005 PMCID: PMC8853477 DOI: 10.15585/mmwr.mm7107a4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Cáceres VM, Goodell J, Shaffner J, Turner A, Jacobs-Wingo J, Koirala S, Molina M, Leidig R, Celaya M, McGinnis Pilote K, Garrett-Cherry T, Carney J, Johnson K, Daley WR. Centers for Disease Control and Prevention's Temporary Epidemiology Field Assignee program: Supporting state and local preparedness in the wake of Ebola. SAGE Open Med 2019; 7:2050312119850726. [PMID: 31205697 PMCID: PMC6537056 DOI: 10.1177/2050312119850726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 04/22/2019] [Indexed: 11/17/2022] Open
Abstract
Objectives: The Centers for Disease Control and Prevention launched the Temporary Epidemiology Field Assignee (TEFA) Program to help state and local jurisdictions respond to the risk of Ebola virus importation during the 2014–2016 Ebola Outbreak in West Africa. We describe steps taken to launch the 2-year program, its outcomes and lessons learned. Methods: State and local health departments submitted proposals for a TEFA to strengthen local capacity in four key public health preparedness areas: 1) epidemiology and surveillance, 2) health systems preparedness, 3) health communications, and 4) incident management. TEFAs and jurisdictions were selected through a competitive process. Descriptions of TEFA activities in their quarterly reports were reviewed to select illustrative examples for each preparedness area. Results: Eleven TEFAs began in the fall of 2015, assigned to 7 states, 2 cities, 1 county and the District of Columbia. TEFAs strengthened epidemiologic capacity, investigating routine and major outbreaks in addition to implementing event-based and syndromic surveillance systems. They supported improvements in health communications, strengthened healthcare coalitions, and enhanced collaboration between local epidemiology and emergency preparedness units. Several TEFAs deployed to United States territories for the 2016 Zika Outbreak response. Conclusion: TEFAs made important contributions to their jurisdictions’ preparedness. We believe the TEFA model can be a significant component of a national strategy for surging state and local capacity in future high-consequence events.
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Affiliation(s)
- Victor M Cáceres
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jessica Goodell
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie Shaffner
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alezandria Turner
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jasmine Jacobs-Wingo
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samir Koirala
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Monica Molina
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robynn Leidig
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Martín Celaya
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kara McGinnis Pilote
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tiana Garrett-Cherry
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jhetari Carney
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kym Johnson
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - W Randolph Daley
- Division of State and Local Readiness, Center for Preparedness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Wiedeman C, Shaffner J, Squires K, Leegon J, Murphree R, Petersen PE. Notes from the Field: Monitoring Out-of-State Patients During a Hurricane Response Using Syndromic Surveillance — Tennessee, 2017. MMWR Morb Mortal Wkly Rep 2017; 66:1364-1365. [PMID: 29240731 PMCID: PMC5730217 DOI: 10.15585/mmwr.mm6649a6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Shaffner J, Jones TF, Moncayo AC. Challenges to Arboviral Surveillance in Tennessee: Health-Care Providers' Attitudes and Behaviors. Am J Trop Med Hyg 2016; 94:1330-5. [PMID: 27022148 DOI: 10.4269/ajtmh.15-0493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 02/02/2016] [Indexed: 11/07/2022] Open
Abstract
Surveillance of arboviruses depends on health-care providers' ability to diagnose and report human cases of disease. The purposes of this study were to assess Tennessee providers' 1) self-efficacy toward diagnosis and management, 2) clinical practices, and 3) variation in these measures by provider characteristics. A survey was e-mailed to 13,851 providers, of which 916 (7%) responded. Respondents diagnosed more arboviruses in the previous year than were recorded in surveillance records, an indication of underreporting. Respondents had low to moderate self-efficacy toward diagnosis and management of arboviruses. Although more than 70% (N = 589) used paired serology, only 46% (N = 396) asked patients to return for a convalescent specimen draw within the correct time frame. One of the most commonly reported barriers to testing was uncertainty about which tests to order. Providers working in family medicine and urgent care, nurse practitioners, and those at outpatient facilities had lower rates of high self-efficacy than their counterparts working in other settings and from other specialties. Clinical practices were influenced by specialty, designation, setting, and geography but not by years of experience. Education to improve arboviral surveillance in Tennessee is warranted. Topics could include proper diagnosis and management, appropriate testing and overcoming barriers to testing, and public health reporting.
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Affiliation(s)
- Julie Shaffner
- Vector-Borne Diseases Section, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
| | - Timothy F Jones
- Vector-Borne Diseases Section, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
| | - Abelardo C Moncayo
- Vector-Borne Diseases Section, Division of Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee
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