Team hunts down causes of outbreaks
More than a dozen reports of painful abdominal cramping and diarrhea had poured into health departments across Ohio, Michigan and New York in the last weeks of April 2010.
Officials knew the cause: E. coli 0145. But the culprit had yet to be fingered.
A newly-formed investigative team of doctors, nurses, epidemiologists and environmental health specialists assembled on the second floor of the Columbus Public Health building on the Near East Side to plot a course of action.
After weeks of investigation, Columbus’ Outbreak Response Team singled out Romaine lettuce as the source of the outbreak.
“We call ourselves ‘the disease detectives,’” said Dr. Mysheika Roberts, Columbus Public Health’s medical director.
“We’re out there, trying to figure out what is getting people sick, trying to remove it so other people don’t get sick, and then trying to make sure we educate individuals so it doesn’t happen again.”
The team is charged with guarding Columbus’ population of more than 860,000 from infectious-disease outbreaks. On average, the group conducts nearly 100 outbreak investigations each year.
“In clinical medicine, you have a physician treating a single patient,” team member and Columbus epidemiologist Brynn Berger said. “In public health, our patient is the population.”
The team investigates the spread of a wide range of infectious diseases, from measles and the Ebola virus to mumps and salmonellosis. Some outbreaks are foodborne others are waterborne or come as a result of animal exposure.
Six team leaders can draw from as many as 25 people from across the city’s public health departments. Each case is approached from multiple disciplines and examined under multiple lenses as the team tries to piece together why and how an outbreak occurred.
“We want to pounce, because the goal is to prevent further illness,” said Dr. Elizabeth Koch, the director of Columbus Public Health department’s Office of Outbreak Response. “We aim for early detection by monitoring a lot of sources.”
The department’s entryway for most cases is the Office of Infectious Disease Investigation, headed by Naomi Tucker, a 12-year nurse with Columbus Public Health.
When a school nurse notices young patients showing similar symptoms, for instance, Tucker’s team gets a call. Investigators diagnose and establish connections between ongoing outbreaks, as well as review the medical care of people who came in contact with the disease, she said.
Then, they start to connect the dots: What did they eat? Where have they been? And with whom have they come in contact?
“Basically, my team looks at every single disease that comes in as the first case of the next outbreak,” Tucker said.
Down the hall, Berger and a team of fellow epidemiologists analyze and report data on infectious diseases to help the team identify the sources and paths of outbreaks. The data allows investigators to track locations and timelines of outbreaks, allowing the group to alter how they intervene, she said.
Data is always important, she said, but it proved pivotal in 2014 as the team responded to the largest mumps outbreak in Columbus in 35 years. A total of 484 mumps cases were reported in central Ohio that year. Of those, 163 were students at Ohio State University, according to a Columbus health report.
The team identified a large number of cases in fraternities and sororities, and began working to get healthcare information to the university’s Greek life community, Berger said.
Data examined by Tucker’s team serves as the backbone of investigations, said Jose Rodriguez, a Columbus Public Health spokesman.
Rodriguez is responsible for communicating with the public, from contacting news outlets and reaching out through social media to posting fliers in the community.
The “disease detectives” also want help from the same community they work to safeguard. Luke Jacobs, assistant administrator for the city’s division of environmental health, adopts the popular securityawareness slogan when he tells the community: “If you see something, say something.”
“From my perspective, the public is almost at the front line of this,” Jacobs said.
The outbreak team isn’t always on defense.
Tucker can help drive initiatives for vaccines and antibiotics, as well as teach preventive measures to the community, such as child-or-senior service providers, she said.
Jacobs assists in hunting down the cause of an outbreak by visiting locations implicated in an investigation to determine what in the environment might have caused the outbreak. But his team also helps stave off the spread of communicable diseases through different on-site monitoring, such as helping make sure food is served safely on game days at Ohio Stadium.
Most of the Outbreak Response Team’s work is unseen to the public, like the diseases it tracks.
“We do a lot of things behind the scenes that people don’t realize but, at the end of the day,” Roberts said, “it makes your community healthier and a safer place to live.”