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A. ORGANIZATION CHART Operations Section Case Investigation Team Epidemiology and Surveillance Branch Investigation Group Data Branch Information & Guidance Branch EPIDEMIOLOGY & SURVEILLANCE BRANCH Contact Investigation Team Laboratory Liaison Team Disease Containment Implementation Branch TAB A1 Field Investigation Team(s) FOR MORE INFORMATION Surveillance Team Surveillance Group Medical Treatment Branch Syndromic Surveillance Team Syndromic Surveillance Field Unit (s) Sample Prep Unit Lab Testing Team Laboratory Group PCR Unit Conventional Testing Unit Lab Receiving / Documentation Team Lab Surge Team B. DESCRIPTION a. Purpose & Objectives The purpose of the Epidemiology and Surveillance Branch is to gather information about the infectious disease emergency. This module follows the Infectious Disease Emergency Response (IDER) framework as described in Tab A – Part D. It is important to remember that each position in the organizational chart above represents a function, not staff member. Functions within the Epidemiology & Surveillance Branch will be activated as needed during a response. Branch objectives include: 1. Determine appropriate epidemiology and surveillance strategies for the infectious disease emergency 2. Conduct surveillance 3. Conduct or facilitate laboratory testing 4. Conduct epidemiological investigations 5. Identify sources of disease and causes of disease spread 6. Monitor trends in the incidence and prevalence Tab A: Epidemiologic Investigations & Surveillance Overview Tab A1: Epidemiology & Surveillance Branch Tab A1.1: Investigation Group Tab A1.2: Surveillance Group Tab A2: Data Branch Tab A2.1: Data Analysis Group Appendices References: Infectious Disease Emergency Response Toolkit, Copyright © 2011 San Francisco Bay Area Advanced Practice Center Alameda County Department of Public Health Bioterrorism Defense Plan, 2007. of disease to identify new or unrecognized exposures or risk factors 7. Describe the epidemiological and clinical features of an event 8. Report cases to the proper agencies The majority of these objectives will be achieved by the Acute Communicable Disease Unit at ACPHD. Additional support will be provided as needed by Public Health Nurses, staff from Community Assessment and Policy Evaluation Unit (CAPE), Information Systems (IS), and other trained staff from DCDCP. b. Methods Primary strategies for epidemiology and surveillance include: Surveillance. Surveillance is the continuous analysis, interpretation, and dissemination of systematically collected data, generally using methods distinguished by their practicality, uniformity and rapidity rather than by accuracy or completeness. By observing trends in time, place, and persons, changes can be observed or anticipated and appropriate action, including investigative or control measures, can be taken. At ACPHD, the CDSS database provides a comprehensive overview of all reported communicable diseases, infectious disease outbreaks, and sentinel events occurring in Alameda County, and will be used as the main surveillance system. Alternative databases, such as EpiCenter, CalREDIE, the California Health Alert Network and other state-wide databases will also be used for surveillance purposes, depending on the type of infectious disease emergency. Consult Tab A1.2 – Surveillance Group for a comprehensive overview of surveillance systems, data sources and key surveillance partners used in Alameda County. Investigation. Epidemiological investigation uses epidemiology tools, including case investigation, contact investigation, and laboratory testing to establish person, place, and time associated with an event. Additional, more labor-intensive, epidemiological investigations include cohort and case-control studies. Investigation efforts during an infectious disease emergency response will be coordinated by Acute Communicable Disease (ACD), using Public Health Nurses and staff from the CAPE unit as size and scale of the emergency increases. Laboratory Testing. Testing of human, animal, and environmental specimens/samples can identify or confirm the identification of organisms responsible for an infectious disease emergency. Laboratory testing can also assist in determining the responsible organism’s transmissibility, pathogenicity, and/or antibiotic susceptibility. The Alameda County Public Health Laboratory leads all efforts relating to lab specimen testing. In the absence of a developed ICS module for the Laboratory Group, this plan will refer to the Public Health Laboratory instead. Consult the Epidemiology and Surveillance Branch modules for details regarding the above strategies. See the Appendix H1: Respiratory Aerosolized Transmissible (RAT) Disease Annex for information on specific epidemiology and surveillance strategies as they relate to respiratory aerosolized transmissible diseases. Refer to Chapter 3 of the Pandemic Influenza Response Plan for information specific to a pandemic influenza event. C. IMPLEMENTATION a. Activation Activate the Epidemiology and Surveillance Branch for every infectious disease response at ACPHD. The Epidemiology and Surveillance Branch Director is responsible for completion of epidemiology and surveillance objectives. b. Functions of the Epidemiology & Surveillance Branch Pre Event Actions: Identify, communicate, and oversee strategies to accomplish objectives and design operational plans in accordance with the Incident Action Plan. Approve scope of surveillance strategies and investigation activities. Coordinate training of epidemiology and surveillance staff. Event Actions: Coordinate Surveillance Group, Investigation Group, and Public Health Laboratory activities. Ensure approval from the Incident Commander (IC) prior to sharing any identified or de-identified laboratory data or information on suspected/confirmed cases or contacts. Review the case definition and submit to the Operations Chief. Determine whether to conduct a study, and if so, what type; inform Operations Chief. Collaborate with the Data Branch to interpret and summarize surveillance information for response and external stakeholders. Review any requested data from the Data Branch (composed of CAPE and IS staff) and provide interpretation and summary data for the response and external partners (in collaboration with Data Branch.) Ensure close coordination with the Data Branch regarding data collection, summaries, analysis, and questionnaire development. Ensure close coordination with ACPHD staff responsible for disease containment activities, especially regarding any isolation and quarantine or restriction, exclusion and clearance. Ensure close coordination with Public Information Officer (PIO) and medical partners, especially regarding case definitions, reporting and testing criteria, etc. Ensure close coordination with healthcare providers, Emergency Medical Services, and healthcare facilities regarding reporting of cases and/or any coordination of health care systems data transfer. Assure coordination with other partners/agencies/modules providing epidemiological assistance. Prioritize and assign responsibilities according to objectives and plans. Communicate with the Operations Chief regularly. Post Event Actions: Order demobilization of branch response elements and ensure proper documentation. D. STAFF POSITIONS The following positions are required for minimum staffing levels: Epidemiology and Surveillance Branch Director Epidemiology and Surveillance Branch Deputy Administrative Assistant Staff Maintain staffing capacity to support surge epidemiological investigations in response to the specific incident. All italicized positions are only necessary if the scope of the outbreak calls for the additional support staff. Refer to the Job Action Sheets in appendices Ca1-Ca3 for more information. E. REPORTING The Epidemiology & Surveillance Branch Director reports directly to the Operations Section Chief. Following approval, incident-specific information will be provided to other Operations Section Branch Directors. F. DELIVERABLES The Epidemiology and Surveillance Branch is responsible for producing the following: Module Objectives and Update, ICS Form 202b (for each Operational Period) Documents assigned to Epidemiology and Surveillance Groups, Teams, and Units G. RESOURCES The following resources will be required to perform response operations: a. Protocols, forms, guidelines, and MOUs Items ICS Forms Activation and Notification Location Appendix A Appendix B Organization Chart for Epidemiology and Surveillance Branch and Data Branch Epidemiology & Surveillance Branch JAS Appendix B2 Surveillance and Reporting Forms Appendix D Health Education Materials Appendix F EpiPrep Training Materials Appendix G RAT Annex Appendix H1 Appendices Ca1-3 b. Office and Communication Supplies Item Telephone Fax machine access Computer with local network, internet access Printer access 800 MHz Radio/cell phone/pager Copy machine access No. Required 1 1 1+ Location or Request From Logistics Logistics Logistics 1 1 Logistics Logistics 1 Logistics