Field Epidemiology Research Articles

Class A Penicillin-Binding Protein C Is Responsible for Stress Response by Regulation of Peptidoglycan Assembly in Clavibacter michiganensis.

ABSTRACTThe cell wall peptidoglycan of bacteria is essential for their survival and shape development. The penicillin-binding proteins (PBPs) are responsible for the terminal stage of peptidoglycan assembly. It has been shown that PBPC, a member of class A high-molecular-weight PBP, played an important role in morphology maintenance and stress response in Clavibacter michiganensis. Here, we reported the stress response strategies under viable but nonculturable (VBNC) state and revealed the regulation of peptidoglycan assembly by PBPC in C. michiganensis cells. Using atomic force microscopy imaging, we found that peptidoglycan of C. michiganensis cells displayed a relatively smooth and dense surface, whereas ΔpbpC was characterized by a “ridge-and-groove” surface, which was more distinctive after Cu2+ treatment. The peptidoglycan layer of wild type cells exhibited a significant increase in thickness and slight increase in cross-linkage following Cu2+ treatment. Compared with wild type, the thickness and cross-linkage of peptidoglycan decreased during log phase in ΔpbpC cells, but the peptidoglycan cross-linkage increased significantly under Cu2+ stress, while the thickness did not change. It is noteworthy that the above changes in the peptidoglycan layer resulted in a significant increase in the accumulation of amylase and exopolysaccharide in ΔpbpC. This study elucidates the role of PBPC in Gram-positive rod-shaped plant pathogenic bacterium in response to environmental stimuli by regulating the assembling of cell wall peptidoglycan, which is significant in understanding the survival of C. michiganensis under stress and the field epidemiology of tomato bacterial canker disease.IMPORTANCE Peptidoglycan of cell walls in bacteria is a cross-linked and meshlike scaffold that provides strength to withstand the external pressure. The increased cross-linkage in peptidoglycan and altered structure in VBNC cells endowed the cell wall more resistant to adversities. Here we systematically evaluated the stress response strategies in Gram-positive rod-shaped bacterium C. michiganensis log phase cells and revealed a significant increase of peptidoglycan thickness and slight increase of cross-linkage after Cu2+ treatment. Most strikingly, knocking-out of PBPC leads to a significant increase in cross-linking of peptidoglycan in response to Cu2+ treatment. Understanding the stress resistance mechanism and survival strategy of phytopathogenic bacteria is the basis of exploring bacterial physiology and disease epidemiology.

Epidemic Intelligence Service Alumni in Public Health Leadership Roles.

Since 1951, the Epidemic Intelligence Service (EIS) of the U.S. Centers for Disease Control and Prevention (CDC) has trained physicians, nurses, scientists, veterinarians, and other allied health professionals in applied epidemiology. To understand the program’s effect on graduates’ leadership outcomes, we examined the EIS alumni representation in five select leadership positions. These positions were staffed by 353 individuals, of which 185 (52%) were EIS alumni. Among 12 CDC directors, four (33%) were EIS alumni. EIS alumni accounted for 29 (58%) of the 50 CDC center directors, 61 (35%) of the 175 state epidemiologists, 27 (56%) of the 48 Field Epidemiology Training Program resident advisors, and 70 (90%) of the 78 Career Epidemiology Field Officers. Of the 185 EIS alumni in leadership positions, 136 (74%) were physicians, 22 (12%) were scientists, 21 (11%) were veterinarians, 6 (3%) were nurses, and 94 (51%) were assigned to a state or local health department. Among the 61 EIS alumni who served as state epidemiologists, 40 (66%) of them were assigned to a state or local health department during EIS. Our evaluation suggests that epidemiology training programs can serve as a vital resource for the public health workforce, particularly given the capacity strains brought to light by the COVID-19 pandemic.

Evaluation of the first two Frontline cohorts of the field epidemiology training program in Guinea, West Africa

BackgroundThe 2014–2016 Ebola virus disease outbreak in West Africa revealed weaknesses in the health systems of the three most heavily affected countries, including a shortage of public health professionals at the local level trained in surveillance and outbreak investigation. In response, the Frontline Field Epidemiology Training Program (FETP) was created by CDC in 2015 as a 3-month, accelerated training program in field epidemiology that specifically targets the district level. In Guinea, the first two FETP-Frontline cohorts were held from January to May, and from June to September 2017. Here, we report the results of a cross-sectional evaluation of these first two cohorts of FETP-Frontline in Guinea.MethodsThe evaluation was conducted in April 2018 and consisted of interviews with graduates, their supervisors, and directors of nearby health facilities, as well as direct observation of data reports and surveillance tools at health facilities. Interviews and site visits were conducted using standardized questionnaires and checklists. Qualitative data were coded under common themes and analyzed using descriptive statistics.ResultsThe evaluation revealed a significant perception of improvement in all assessed skills by the graduates, as well as high levels of self-reported involvement in key activities related to data collection, analysis, and reporting. Supervisors highlighted improvements to systematic and quality case and summary reporting as key benefits of the FETP-Frontline program. At the health facility level, staff reported the training had resulted in improvements to information sharing and case notifications. Reported barriers included lack of transportation, available support personnel, and other resources. Graduates and supervisors both emphasized the importance of continued and additional training to solidify and retain skills.ConclusionsThe evaluation demonstrated a strongly positive perceived benefit of the FETP-Frontline training on the professional activities of graduates as well as the overall surveillance system. However, efforts are needed to ensure greater gender equity and to recruit more junior trainee candidates for future cohorts. Moreover, although improvements to the surveillance system were observed concurrent with the completion of the two cohorts, the evaluation was not designed to directly measure impact on surveillance or response functions. Combined with the rapid implementation of FETP-Frontline around the world, this suggests an opportunity to develop standardized evaluation toolkits, which could incorporate metrics that would directly assess the impact of equitable field epidemiology workforce development on countries’ abilities to prevent, detect, and respond to public health threats.

A comparative cross-sectional evaluation of the Field Epidemiology Training Program-Frontline in Ethiopia

BackgroundThe Field Epidemiology Training Program (FETP)-Frontline is a three-month in-service training aimed at improving surveillance officers’ capacity to collect, analyze, and interpret surveillance data, and respond to health emergencies. We evaluated the effectiveness of the FETP-Frontline which was introduced in Ethiopia in 2016.MethodsWe conducted a comparative, randomized cross-sectional study to assess surveillance-related knowledge, skills, and performance among trained and untrained officers using a structured questionnaire and observation checklist. We compared the knowledge, skills, and performance scores of trained and untrained officers using the Fisher’s Exact test, chi-square test, and t-test at p-value < 0.05 for statistical significance.ResultsWe conducted the study among 74 trained and 76 untrained surveillance officers. About three-quarters of all participants were male, and the average age was 34 (± 8.6) years. Completeness and timeliness of surveillance reports were significantly higher among trained than untrained surveillance officers. The trained officers were more likely to have produced epidemiologic bulletins (55% vs 33%), conducted active surveillance six months before the survey (88% vs 72%), provided surveillance training (88% vs 65%), conducted strengths, weakness, opportunities, and threats (SWOT) analysis (55% vs 17%), and utilized Microsoft Excel to manage surveillance data (87% vs 47%). We also observed improved surveillance officers’ perceived skills and knowledge, and the availability and quality of surveillance formats and reports among the trained group.ConclusionsFETP-Frontline trained surveillance officers demonstrated better knowledge, skills, and performance in most surveillance activities compared to the untrained officers. FETP-Frontline can address competency gaps among district surveillance officers in Ethiopia and other countries. Scaling up the program to cover unreached districts can enable achieving the human resource development core capacity requirement of the International Health Regulations 2005.

A Massive Cholera Outbreak in Shaheed Benazir Abad, Sindh, Pakistan

Background: A team of Field Epidemiology and Laboratory Training fellows were deputed to investigate the cholera outbreak reported from Village Laiq Rahoo Taluka Daulat Pur of district Shaheed Benazir Abad on 14 June 2016 after reporting of 56 diarrheal cases from the district.&#x0D; Methods: The study was conducted from 15-19 June 2016. A case was defined any person who has presented with 3 or more episodes of watery stools or vomiting since last day, with or without; fever, nausea, abdominal cramps, blood or mucous in stool. Active case search was conducted in village. A case control study was carried out preceded by descriptive study. Data was collected on pretested questionniare. Environmental assessment was done. Stool samples were sent to National Institute of Health, Islamabad.&#x0D; Results: A total of 132 diarrheal cases were identified with Case Fatality Rate of 3%. Age range was 1 year to 60 years (Mean=18 years). Of all casaes males were 73 (56%). Population of village was 3308, so the overall attack rate was 4%. Commonly affected age group was 30-34 years with attack rate of 11% (22/206). Diarrhea n=132 (100%) and vomiting n=47 (45%) were leading symptoms among cases. Water source near the toilets &lt; less than 10 feet&gt; (OR: 11, 95% CI: 6-20, p: &lt;0.001), Eating from common OR=7.3, 95% CI: 4.2-12.6, p&lt;0.001) were the factors associated with outbreak. Vibrio Cholera was detected in 3 out of 5 stool samples and 4 out of 5 water samples revealed coliforms.&#x0D; Conclusion: Diarrhea outbreak was likely due to close proximity of water and sewage sources. It is recommended that hand pump should be installed away from toilets.

Population Size Estimation From Capture-Recapture Studies Using shinyrecap: Design and Implementation of a Web-Based Graphical User Interface.

BackgroundPopulation size estimates (PSE) provide critical information in determining resource allocation for HIV services geared toward those at high risk of HIV, including female sex workers, men who have sex with men, and people who inject drugs. Capture-recapture (CRC) is often used to estimate the size of these often-hidden populations. Compared with the commonly used 2-source CRC, CRC relying on 3 (or more) samples (3S-CRC) can provide more robust PSE but involve far more complex statistical analysis.ObjectiveThis study aims to design and describe the Shiny application (shinyrecap), a user-friendly interface that can be used by field epidemiologists to produce PSE.Methodsshinyrecap is built on the Shiny web application framework for R. This allows it to seamlessly integrate with the sophisticated CRC statistical packages (eg, Rcapture, dga, LCMCR). Additionally, the application may be accessed online or run locally on the user’s machine.ResultsThe application enables users to engage in sample size calculation based on a simulation framework. It assists in the proper formatting of collected data by providing a tool to convert commonly used formats to that used by the analysis software. A wide variety of methodologies are supported by the analysis tool, including log-linear, Bayesian model averaging, and Bayesian latent class models. For each methodology, diagnostics and model checking interfaces are provided.ConclusionsThrough a use case, we demonstrated the broad utility of this powerful tool with 3S-CRC data to produce PSE for female sex workers in a subnational unit of a country in sub-Saharan Africa.

Poisoning Associated with Consumption of a Homemade Medicinal Liquor - Chongqing, China, 2018.

On May 3, 2018, Chongqing Center for Disease Control and Prevention (CQCDC) received a report of 15 persons with numbness of the tongue or limbs and vomiting of unknown etiology; all ill persons had attended an adult birthday luncheon in Bishan District, Chongqing municipality, in southwest China. Initial reports indicated that one person had died. Within 2 hours, CQCDC and Western Chinese Field Epidemiology Training Program staff members launched an investigation that included identification of cases, laboratory testing of drinks, and patient interviews to identify the cause of what appeared to be a poisoning. Among the 15 cases, five persons died. The investigation of this apparent mass intoxication implicated a homemade alcoholic beverage produced from a highly toxic flowering plant in the genus Aconitum used in traditional Chinese medicine. Although the risk of aconite toxicity is known, approximately 5,000 cases of aconite poisoning incidents were reported in China, Germany, Japan, and other countries during 1993-2005; most cases of fatal poisoning occurred in China (1). This event highlights the importance of enforcing and complying with existing regulations regarding sale and purchase of Aconitum species (also known as wolfbane), and of dissemination of critical public health messages.

Combined application of field epidemiology and laboratory etiology analysis in the investigation of a foodborne disease outbreak in Xinjiang uygur Autonomous Region, 2016

Objectives: To analyze the causes of a foodborne outbreak in rural areas of Xinjiang between April 2 and April 5 in 2016. Methods: Cases and the relevant background information were obtained by consulting outpatient records of local health centers and regional people's hospitals and interviewing doctors and residents. All samples were collected by the laboratory test through epidemiological and food hygiene investigations. The χ2 test (Fisher's exact probability method) was used to compare differences in incidence rates. Molecular typing, virulence genes and single nucleotide polymorphisms (SNPS) were analyzed by using Pulsed Field Gel Electrophoresis (PFGE) and Whole Genome Sequencing (WGS). Results: A total of 142 cases were found in this study, with incidence rate at 5.7‰ (142/24 979). Among all cases, the main symptoms were nausea (94%), vomiting (92%) and abdominal pain (67%), and the incubation period was about 2 h (1-7.5 h). There were 16 Staphylococcus aureus isolates identified and all of them could produce A+C+E mixed enterotoxin. PFGE showed 100% homology. WGS further revealed that there were 9 and 1 strains contained by Sequence Type 1 (ST1) and ST5405, respectively. All ST1 strains were in the same clade on the genome tree. Among these, 7 strains shared close proximity (74 SNPs) and 2 strains shared close relationships as well (127 SNPs). The S. aureus isolates that caused the outbreak were introduced by a mutant isolate from the milk supply station. Conclusions: This foodborne outbreak was mainly caused by Staphylococcus aureus contamination.

Innovative solution to admission process of Intermediate Field Epidemiology Training Program during COVID-19 Pandemic, Liberian Experience, 2021

Introduction: The unpredictability of COVID-19 outbreak as it waxes, and wanes has led governments to different preventive measures. There were lockdowns, restriction of movements, and closure of institutions which disrupted regular education and trainings. In the developed world, this necessitated movement of education online rather than in-person. Online education had not been well established in Liberia before this outbreak. Therefore, the restrictions resulted in the suspension of the training of public health workforce, a critical component of effective outbreak response. The Liberia Field Epidemiology Training Program (FETP) could not continue to wait till the conditions are right to admit a new cohort. Therefore, we innovated to admit new cohort in a cost-effective manner while maintaining the standard.

Strengthening the global one health workforce: Veterinarians in CDC-supported field epidemiology training programs

BackgroundEffective prevention, detection, and response to disease threats at the human-animal-environment interface rely on a multisectoral, One Health workforce. Since 2009, the U.S. Centers for Disease Control and Prevention (CDC) has supported Field Epidemiology Training Programs (FETPs) to train veterinarians and veterinary paraprofessionals (VPPs) alongside their human health counterparts in the principles of epidemiology, disease surveillance, and outbreak investigations. We aim to describe and evaluate characteristics of CDC-supported FETPs enrolling veterinarians/VPPs to understand these programs contribution to the strengthening of the global One Health workforce. MethodsWe surveyed staff from CDC-supported FETPs that enroll veterinarians and VPPs regarding cohort demographics, graduate retention, and veterinary and One Health relevant curriculum inclusion. Descriptive data was analyzed using R Version 3.5.1. ResultsForty-seven FETPs reported veterinarian/VPP trainees, 68% responded to our questionnaire, and 64% reported veterinary/VPP graduates in 2017. The veterinary/VPP graduates in 2017 made up 12% of cohorts. Programs reported 74% of graduated veterinarians/VPPs retained employment within national ministries of agriculture. Common veterinary and One Health curriculum topics were specimen collection and submission (93%), zoonotic disease (90%) and biosafety practices (83%); least covered included animal/livestock production and health promotion (23%) and transboundary animal diseases (27%). Less than half (41%) of programs reported the curriculum being sufficient for veterinarians/VPPs to perform animal health specific job functions, despite most programs being linked to the ministry of agriculture (75%) and providing veterinary-specific mentorship (63%). ConclusionsOur results indicate that FETPs provide valuable training opportunities for animal health sector professionals, strengthening the epidemiology capacity within the ministries retaining them. While veterinary/VPP trainees could benefit from the inclusion of animal-specific curricula needed to fulfill their job functions, at present, FETPs continue to serve as multisectoral, competency-based, in-service training important in strengthening the global One Health workforce by jointly training the animal and human health sectors.

An outbreak of malaria caused by increase in malaria breeding sites in swamps.

On 10th June 2019, routine analysis of malaria surveillance data at the National Malaria Control Division, Ministry of Health in Uganda revealed that there was an unusual increase in the number of malaria cases reported in the Oyam District. On 11th June 2019, the District Health Officer in Oyam District convened a meeting with the District Health Team (DHT) in which the District Biostatistician confirmed that the number of malaria cases had indeed exceeded the upper limit, starting in epidemic week 24 (approximately the week of June 10). The District Health Officer issued a formal request to the Ministry of Health for assistance in dealing with the malaria outbreak in Oyam. Two field epidemiology residents were assigned to work with the District Health Team to investigate the outbreak. The residents followed the steps in conducting vector borne disease outbreak investigations including preparation for field work, establishment of the existence of an outbreak by analyzing surveillance data, descriptive data analysis, hypothesis generation, conducting environmental and entomological assessments, conducting analytic studies with a focus on the utility of retrospective cohort studies as well as reporting findings. This case study teaches trainees in Field Epidemiology and Laboratory Training Programs, public health students, public health workers who are interested or who may participate in vector borne disease outbreak investigation and response.

Ethical challenges and moral distress among field epidemiologists

BackgroundAs ‘disease detectives’ and directors of public health programs, field epidemiologists play essential roles in protecting public health. Although ethical issues receive considerable attention in medical and research settings, less is known about ethical challenges faced by field epidemiologists in public health programs. Similarly, little is known about moral distress among field epidemiologists, i.e., situations in which they are constrained from acting on what they know to be morally right. Moral distress is strongly associated with empathy fatigue, burnout, reduced job retention, and disengagement. To better understand ethics training needs for field epidemiologists, in February 2019, members of TEPHIConnect, an online and mobile networking platform for Field Epidemiology Training Program (FETP) alumni, were invited to participate in an anonymous survey about ethical challenges and moral distress.ResultsAmong 126 respondents from 54 countries, leading causes of ethical dilemmas included inadequate informed consent (61%), inequitable allocation of resources (49%), and conflicts of interest (43%). These occur primarily in settings of disease outbreaks (60%); research (55%); and public health programs at the state, province, or national level (45%) or community level (43%). Work-related moral distress was reported by 91% of respondents, including 26% who experience it “frequently” or “almost always.” Field epidemiologists working in low- and low-middle income countries were more likely to report moral distress “frequently” or “almost always” than those in higher-income countries (33.0% vs 9.1%, P = 0.006). The most common perceived contributors to moral distress included excessive stress and work demands (30%) and inadequate support from leaders (25%).ConclusionsField epidemiologists face significant work-related ethical challenges, which are endemic to public health and political systems. A substantial proportion of field epidemiologists also experience some degree of moral distress, often in association with these challenges. These findings indicate an unmet need among field epidemiologists for support in navigating ethical challenges, as well as for resources to address the human and professional consequences of moral distress.

An Outbreak of COVID-19 Among Health Care Workers at a Diabetes Center, Al Ahsa, Saudi Arabia, April 2020

Background On April 2, 2020, the Field Epidemiology Training Program was asked by a diabetes mellitus center, Facility A, in Al-Ahsa to investigate a confirmed case of COVID-19 in a health care worker. Patients with diabetes are at increased risk for serious complications from COVID-19. Objective This study seeks to identify any additional cases, the source of infection and mode of transmission, and implement mitigation measures to prevent further transmission. At the time of the investigation, few COVID-19 cases had been identified in the region. Methods We reviewed medical charts and other available data on cases in the infection control department, the public health department, and the COVID-19 center. We interviewed cases about their health status and possible sources of infection. We analyzed data using descriptive statistics. Results All staff (N=50) at Facility A were tested for COVID-19; 2 (4%) tested positive. The first case was a nurse that reported attending a nursing conference in Riyadh several days prior to symptom onset. She was the first recognized case of COVID-19 in Facility A, so we classified her as the index case. We identified 1 more case that reported using shared cupboard clothes, the same coffee machine, and chatting with the index case in a break room without using personal protective equipment. Both cases reported wearing personal protective equipment during patient care. Both cases survived. Conclusions We found evidence of person-to-person transmission between cases while socializing at work, and no evidence of transmission from health care workers to patients. We identified potentially risky practices in Facility A, although none were related to patient care. We helped Facility A develop additional policies to reduce the risk of COVID-19 transmission among staff, even when not providing direct patient care. Facility A was closed during the investigation and reopened after applying all prevention measures.

Field studies of anthracnose symptoms and pathogen infection in different phases of the persimmon growing season

AbstractAnthracnose is the main disease of persimmon and is caused by Colletotrichum spp. The study of field epidemiology is essential for the development of efficient management of this disease. In this study, we investigated infection by Colletotrichum spp. throughout the persimmon growing season to understand the host–pathogen interactions better. We observed the production of primary inoculum of persimmon anthracnose and described how epidemics progress from secondary infections during the fruit crop season. The field study was carried out in an organic orchard with three susceptible persimmon cultivars, Fuyu, Kakimel and Jiro, for three consecutive seasons. Our results indicate that the pathogen survives in 1‐year‐old shoots, which are the sources of primary inoculum. Later that growing season, the inoculum reaches flowers and new shoots, developing symptoms and producing the secondary inoculum. Fruit drop was also observed, with or without symptoms of anthracnose, throughout the plant cycle. In some of the symptomless fruit, collected from the plant and from the ground where they had fallen, latent infections of Colletotrichum spp. were detected. Shoots, flowers, immature and ripened fruit remained infected throughout the growing season, producing conidia that could lead to new secondary infections within and among plants. The incidence of anthracnose in fruit at harvest and postharvest proved to be less relevant for disease management. Practices for chemical and cultural control of the disease throughout the persimmon growing season are discussed.

Data management needs assessment for the scale-up of district health information system and introduction of routine (essential) immunization module in Bauchi State, Nigeria, 2015.

Introductionthe National Primary Health Care Development Agency, African Field Epidemiology Network, United States Centers for Disease Control and Prevention and the Bill and Melinda Gates Foundation are implementing a Routine Immunization (RI) Module as part of their Routine Health Data Management System based on the 2013 - 2015 Accountability Framework for RI in Nigeria. To inform planning and evidence-based decision making, a data management needs assessment was conducted in Bauchi state which was one of the states selected for the deployment of the DHIS2 RI module.Methodsdesk reviews were conducted, and a semi-structured questionnaire was administered in four Local Government Areas (LGAs) in Bauchi state that were selected based on the initial evaluation of the performance of all 20 Bauchi LGAs. Ganjuwa and Shira were selected as high-performing LGAs and Alkaleri and Bogoro as low-performing LGAs. Four Health Facilities (HF) were selected in each LGA based on rural or urban classification, type of HFs (private or public), security and accessibility.Resultslocal Immunization Officers (LIOs) prepare monthly reports in high-performing LGAs, and Community Health Care workers are mostly (69%) responsible for report compilation at the HFs. Shira and Alkaleri met 77% and 44% of training indicator targets, respectively, in the previous 12 months. Data recording and reporting was the type of training received the most by health facility personnel. Functioning refrigerators were in all visited LGAs, working thermometer and updated temperature monitoring charts were available in all the cold chain stores. However, no health facility reported having available computers for data-related activities.Conclusionthis assessment provided an improved understanding of the Bauchi state Routine Health Data Management System and informed the content of the state-wide scale-up.

Public Health Workers’ Knowledge, Attitude, and Practice Regarding COVID-19: The Impact of the Field Epidemiology Training Program in the Eastern Mediterranean Region

Background Globally, there is a growing need for public health professionals skilled in preventing and responding to the surge of emerging and re-emerging infectious diseases. This is particularly important to the Eastern Mediterranean countries that are facing emergencies in addition to the increased public health risks of unprecedented scale during the COVID-19 pandemic. Public health professionals are instrumental in responding to the COVID-19 pandemic in terms of detecting and monitoring new cases, conducting investigations, tracing contacts, ensuring patients are being tested, applying isolation and quarantine protocols, providing up-to-date information, educating the community, and producing statistics and models to track disease progression. Objective This study aims to compare knowledge, attitude, and practice (KAP) regarding COVID-19 between public health workers (PHWs) that attended the Field Epidemiology Training Program (FETP trained) and those who did not attend FETP (non-FETP trained). Methods A multicountry cross-sectional survey was conducted among PHWs who participated in the COVID-19 pandemic in 10 countries in the Eastern Mediterranean Region. An online questionnaire that included demographic information and KAP regarding the COVID-19 pandemic was distributed among PHWs. The scoring system was used to quantify the answers; bivariate and multivariate analyses were performed to compare FETP-trained with non-FETP–trained PHWs. Results Overall, 1337 PHWs participated, with 835 (62.4%) &lt;40 years of age and 851 (63.6%) male participants. Of them, 423 (31.6%) were FETP trained, including 189 (44.7%) at an advanced level, 155 (36.6%) at an intermediate level, and 79 (18.7%) had basic level training. Compared to non-FETP–trained participants, FETP-trained participants were older and had higher KAP scores. FETP participation was low in infection control and public health laboratories. KAP mean scores for intermediate-level attendees were comparable to the advanced level. Conclusions FETP-trained participants had better KAP than non-FETP–trained PHWs. Expanding the intermediate level, maintaining the rapid response training, and introducing the laboratory component are recommended to maximize the benefit from the FETP. Infection control, antimicrobial resistance, and coordination are areas where training should be included.

Epidemiology, burden and seasonal variation of fasciolosis determined through faecal examination and excretory/secretory antigens based ELISA

The study was conducted to evaluate predominance and the related risk factors of sheep fasciolosis in Faisalabad district, Punjab, Pakistan. In addition, comparison of the coprological examinationand excretory/secretory antigens (ES Ag)-based ELISA was also performed to determine the variation in the prevalence of fasciolosis. Ofthe1200 faecal and blood samples,128 (10.67%) and 241 (20.08%) samples were found positive for Fasciola infection and anti-Fasciola antibodies respectively.The prevalence of fasciolosis was significantly (P &lt; 0.05) higher in female and adultanimals. Most of the animals showed moderate (55.47%) infection which was significantly higher than mild (28.91%) and severe (15.63%) infections. The highest prevalence of fasciolosis was determined in December (26.00% through faecal examination; 42.00% through ELISA) with a mean EPG of 842.3 while lowest in May (02.00% through faecal examination; 07.00% through ELISA) with a mean EPG of 650. The frequency distribution of fasciolosis was significantly (P &lt; 0.05) highest in the winter (faecal examination 20.67%; ELISA 34.67%) followed in order by the monsoon (faecal examination 09.00%; ELISA 18.67%), spring (faecal examination 08.33%; ELISA 17.33%) and summer (faecal examination 04.67%; ELISA 09.67%). The highest mean EPG of fasciolosis was determined in the spring (894) followed in order by the winter (851.67), summer (654.67) and monsoon (616.33). Although the faecal examination is the gold standard and the “best method” in the diagnosis of sheep fasciolosis; however, the serological tests should not be excluded especially the home-made ES Ag-based ELISA which might be preferred and more affordable risk assessment tool in the field epidemiology.

What Has the Pandemic Revealed about the Shortcomings of Modern Epidemiology? What Can We Fix or Do Better?

In this commentary, we discuss themes that emerged from our symposium about what modern epidemiology as a science may learn from the COVID-19 pandemic. We reflect on the successes and limitations of this discipline from multiple perspectives, including from junior and senior epidemiologists and scientists on the front lines of generating evidence for the COVID-19 pandemic response in Wuhan, China, to Ontario, Canada. These themes include the role of the traditional scientific process in a public health emergency; epidemiologic methods and data that are critical for an effective pandemic response; the interventions that epidemiologists recommended and interventions that we may explore in the future; inequitable impacts of the COVID-19 pandemic contrasted with homogeneity in the epidemiologist workforce; effective and honest communication of uncertainty; trust and collaboration; and the extent to which these themes are currently reflected in our training programs and discipline. We look forward to insights from field epidemiologists directly involved in the ongoing response to the COVID-19 pandemic and further reflection from epidemiologists throughout our discipline.

Field epidemiology training programs contribute to COVID-19 preparedness and response globally

BackgroundField epidemiology training programs (FETPs) have trained field epidemiologists who strengthen global capacities for surveillance and response to public health threats. We describe how FETP residents and graduates have contributed to COVID-19 preparedness and response globally.MethodsWe conducted a cross-sectional survey of FETPs between March 13 and April 15, 2020 to understand how FETP residents or graduates were contributing to COVID-19 response activities. The survey tool was structured around the eight Pillars of the World Health Organization’s (WHO) Strategic Preparedness and Response Plan for COVID-19. We used descriptive statistics to summarize quantitative results and content analysis for qualitative data.ResultsAmong 88 invited programs, 65 (74%) responded and indicated that FETP residents and graduates have engaged in the COVID-19 response across all six WHO regions. Response efforts focused on country-level coordination (98%), surveillance, rapid response teams, case investigations (97%), activities at points of entry (92%), and risk communication and community engagement (82%). Descriptions of FETP contributions to COVID-19 preparedness and response are categorized into seven main themes: conducting epidemiological activities, managing logistics and coordination, leading risk communication efforts, providing guidance, supporting surveillance activities, training and developing the workforce, and holding leadership positions.ConclusionsOur findings demonstrate the value of FETPs in responding to public health threats like COVID-19. This program provides critical assistance to countries' COVID-19 response efforts but also enhances epidemiologic workforce capacity, public health emergency infrastructure and helps ensure global health security as prescribed in the WHO’s International Health Regulations.

Continuing Contributions of Field Epidemiology Training Programs to Global COVID-19 Response.

We documented the contributions of Field Epidemiology Training Program (FETP) trainees and graduates to global COVID-19 preparedness and response efforts. During February-July 2021, we conducted surveys designed in accordance with the World Health Organization's COVID-19 Strategic Preparedness and Response Plan. We quantified trainee and graduate engagement in responses and identified themes through qualitative analysis of activity descriptions. Thirty-two programs with 2,300 trainees and 7,372 graduates reported near-universal engagement across response activities, particularly those aligned with the FETP curriculum. Graduates were more frequently engaged than were trainees in pandemic response activities. Common themes in the activity descriptions were epidemiology and surveillance, leading risk communication, monitoring and assessment, managing logistics and operations, training and capacity building, and developing guidelines and protocols. We describe continued FETP contributions to the response. Findings indicate the wide-ranging utility of FETPs to strengthen countries' emergency response capacity, furthering global health security.