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U.S. Department of Health and Human Services

  

TB Notes 1, 2005

No. 1, 2005

Updates from the SEOIB

Heard of any outbreaks?
DTBE’s Outbreak Evaluation Unit (OEU) in Action

At one time or another, public health personnel at the local, state, and national levels investigate TB outbreaks. These outbreaks are natural opportunities for studying a classic “epidemiologic triad”: the interaction of the environment, the host, and the pathogen Mycobacterium tuberculosis. This article briefly describes how DTBE gathers information about outbreaks and how DTBE can be of assistance in responding to them.

The Outbreak Evaluation Unit (OEU): The OEU is comprised of members from the Outbreak Investigations Team from the Surveillance, Epidemiology, and Outbreak Investigations Branch (SEOIB), the Field Services and Evaluation Branch (FSEB), the Communications, Education, and Behavioral Studies Branch (CEBSB), the Mycobacteriology Laboratory Branch (MLB), and the DTBE Office of the Director (OD). This group combines the functions and expertise of the various branches, which enables DTBE to evaluate reports of recent transmission of M. tuberculosis  thoroughly. These reports are assembled and shared by the program consultants from FSEB. The OEU meets each Tuesday to receive new reports, to monitor progress on pending reports, and to recommend how DTBE can participate with state and local program officials in the investigation and control of possible outbreaks. As guided by the OEU, DTBE offers various types of responses that are described below.

Types of Responses: One or a combination of these responses can be offered to the local and state TB control officials:

  1. Telephone consultation. During a telephone consultation, a team consisting of members from SEOIB, FSEB, CEBSB, and MLB (if needed) consult with the state or local personnel about the investigation and control of an outbreak. The consultation is interactive and often requires a series of conference calls as results from the investigation become available. The FSEB program consultant for the jurisdiction coordinates the scheduling on behalf of DTBE.
  2. Technical on-site assistance. Aside from the standard epi-aid response, DTBE can designate a team that is specially composed to meet a request from jurisdictional authorities. This approach suits situations that do not require the intensive response that is characteristic of epi-aids.
  3. On-site outbreak investigation (epi-aid). An epi-aid is the traditional CDC response to a request for on-site assistance. For an epi-aid related to TB, an Epidemic Intelligence Service (EIS) officer is invited by state and local officials to join an outbreak investigation team. The epi-aid provides a prompt, standard CDC response to state and local needs for epidemiologic assistance, and it affords a unique training opportunity for the assigned officer to develop epidemiologic skills.

An epi-aid for TB begins when the state epidemiologist invites CDC participation by sending a request to OD, DTBE. Epi-aids are collaborative by design---the CDC personnel work closely with the state and the local health officials during the outbreak investigation.

A typical epi-aid for a TB outbreak investigation offers the following:

  • On-site assistance from DTBE for 2-3 weeks, during which a DTBE epi-aid team comprised of the EIS officer, a DTBE staff epidemiologist, frequently a TB public health advisor, and on some occasions an epidemiology elective student from a health-professions college to work collaboratively with the state or the local outbreak-response team.
  • An entrance meeting with the jurisdictional public health officials. The purpose is to review the objectives of the investigation, to determine the person in charge in the jurisdiction for potential coverage from news media, to create a preliminary plan for the investigation, and to schedule periodic update meetings. 
  • An exit interview with the jurisdictional public health officials. The EIS officer, along with the epi-aid team and the collaborating state or local outbreak-response team, present the preliminary findings and provide preliminary recommendations for control of the outbreak and any further investigations that might be needed.
  • Temporary duty assignments for program assistance. If the investigation team determines that a DTBE public health advisor would facilitate the programmatic response to an outbreak, the FSEB program consultant for the jurisdiction arranges this.
  • Outbreak response emergency supplemental funds. Limited emergency supplemental funds are allocated by Congress through DTBE for tuberculosis outbreak abatement. If an outbreak response requires new resources (e.g., extra personnel to be hired by contract), the FSEB program consultant for the jurisdiction reviews the proposal for how additional funds could be used.
  • A final report (the trip report). This describes the methods and results of the investigation and the final recommendations from CDC. The report is sent to the jurisdictional public health officials approximately 2 months after an investigation. Sometimes they take longer because of ongoing data collection and new findings.

The detection of tuberculosis outbreaks plays a crucial role in the elimination of this disease. Suspected episodes of transmission of M. tuberculosis should be discussed with your program consultant.

—Reported by Kashef Ijaz, MD
and John A. Jereb, MD
Div of TB Elimination

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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