Local Health Department (LHD) Zoonotic Disease Surveillance and Response

State: OH Type: Model Practice Year: 2010

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This practice expands the capacity of the health department to identify emerging zoonotic diseases and respond to human and animal needs as community emergencies occur. By redefining existing mandated animal and vector programs the LHD can utilize modest pet vaccination clinic revenue to fund needed equipment and laboratory testing. This allows the collection of baseline epidemiologic data on emerging zoonotic pathogens and vectors, which could spread to the human population. Public outreach allows us to identify, engage, and evaluate a continuous supply of volunteers trained to collect field samples, and respond to community emergencies. In an extremely tight municipal fiscal environment, creative program management can utilize existing programs and funding to expand surveillance, field data and our animal emergency services response.

Goal: To increase awareness and elicit support from the public to identify, assess and reduce the risk of existing and emerging zoonotic pathogens/vectors during community emergencies.

Objective 1: To expand the public health capacity for surveillance of animal disease outbreaks and response to the identified needs of people and animals in an emergency.

Objective 2: To promote collaboration between individual citizens, not-for-profit/community organizations and governmental agencies through effective community partnerships.

Objective 3: Provide continuous training for community volunteers in disease surveillance and emergency response activities. 
1. Added training to the rabies vaccination clinics, 
2. Utilized the ART volunteers to help staff the clinics, 
3. Used the clinics to solicit/enlist more ART volunteers, 
4. Created a special purpose fund from the vaccination clinic proceeds to support the ART as well as its activities, |
5. Began training on animal disease (vector borne, direct and EID) surveillance as well as the usual response activities, and 
6. Offered all of these activities and results back to the general public, community partners and other CPH internal programs.

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Columbus Public Health
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Local Health Department (LHD) Zoonotic Disease Surveillance and Response
This practice expands the capacity of the health department to identify emerging zoonotic diseases and respond to human and animal needs as community emergencies occur. By redefining existing mandated animal and vector programs the LHD can utilize modest pet vaccination clinic revenue to fund needed equipment and laboratory testing. This allows the collection of baseline epidemiologic data on emerging zoonotic pathogens and vectors, which could spread to the human population. Public outreach allows us to identify, engage, and evaluate a continuous supply of volunteers trained to collect field samples, and respond to community emergencies. In an extremely tight municipal fiscal environment, creative program management can utilize existing programs and funding to expand surveillance, field data and our animal emergency services response. Goal: To increase awareness and elicit support from the public to identify, assess and reduce the risk of existing and emerging zoonotic pathogens/vectors during community emergencies. Objective 1: To expand the public health capacity for surveillance of animal disease outbreaks and response to the identified needs of people and animals in an emergency. Objective 2: To promote collaboration between individual citizens, not-for-profit/community organizations and governmental agencies through effective community partnerships. Objective 3: Provide continuous training for community volunteers in disease surveillance and emergency response activities. 1. Added training to the rabies vaccination clinics, 2. Utilized the ART volunteers to help staff the clinics, 3. Used the clinics to solicit/enlist more ART volunteers, 4. Created a special purpose fund from the vaccination clinic proceeds to support the ART as well as its activities, |5. Began training on animal disease (vector borne, direct and EID) surveillance as well as the usual response activities, and 6. Offered all of these activities and results back to the general public, community partners and other CPH internal programs.
Hurricane Katrina and the New Orleans flooding underscored the reality that responding to human emergencies must include the needs of both the people and animals involved in the community emergency. Zoonotic disease surveillance must be coupled with building the infrastructure for a comprehensive community-wide emergency response.The Public Health Veterinarian (PHV) is a member of committees, and community partnerships at the federal, state, regional, county, and local level involved in planning and preparing for officially declared government animal emergencies. These groups use building blocks set out by all levels of emergency management agencies beginning with the broad foundation set out in the National Preparedness Goals. At all levels of government, it is acknowledged that deficiencies exist in government’s ability to respond to all hazards, and all sizes of emergencies. For animals, all hazards include animal disease (animals are the emergency) as well as animal disaster (animals are in an emergency). In addition to this, the PHV responds to local endemic and emerging vector borne diseases as well as animal complaints and issues ranging from an individual to the community level. While obtaining surveillance data of vector borne diseases and simultaneously working with the Communicable Disease, Infectious Disease, Epidemiology, and Food Protection programs there is a need to differentiate a singular animal related zoonotic disease or complaint/issue as either a blip on the Public Health surveillance screen or the next Emerging Infectious Disease. In addition, it is of concern that animals could be used, affected, or manipulated in such a way as to become a means for spread of bio-terrorism. In light of the extensive list of possible animal threats to public health, safety and welfare, it is further understood the surveillance system necessary to respond to such potential lies in having the resources available to investigate each and every incident in relation to its direct and indirect effect on the public. Additionally, such surveillance must be done in a balanced state of unity whereby government does not infringe on the personal rights of the individual, yet protects the majority through a fair and balanced sense of public duty. This ultimately means that the public must become its own surveillance as well as response tool. Experience has shown that volunteer organizations that are not kept engaged will not remain cohesive. Volunteer organizations that do not continually enlist new volunteers as well as give something back to their volunteers will diminish due to attrition and/or will experience volunteer burn out. Volunteer organizations that are entirely dependent upon outside funding are susceptible to loss of funding with sudden discontinuation of resources/services. It was also recognized that if animal disease surveillance is limited to “free” state and or federally funded testing, the “blip” on the Public Health surveillance screen can not necessarily be differentiated from baseline disease, if the disease is endemic, or from the index case of an EID. As a result, timely baseline zoonotic disease testing and the subsequent reporting needed to blunt the generalized spread of a disease is, therefore, likely to be absent. Our ART volunteers are being educated, trained and incorporated in various field techniques and reporting mechanisms necessary to recognize and respond to animal disease and disaster situations regardless of the size or location of the event. They are encouraged to present their animal concerns, involvement and knowledge to the group so as to improve our surveillance capabilities without added costs to the Health Department. Collaboration with and/or membership in the following revealed the absence of sustained and combined animal disease surveillance training with emergency response activities (rabies vaccination clinics) using a united community volunteer-regulatory agency Animal Response
Agency Community RolesIt brought together these regional and community partners, and sponsors the rabies vaccination clinics and associated training sessions necessary to provide continued funding and sustainable surveillance and response capabilities. Columbus Public Health through ART provides the collaborative hub to involve the following community partners. Capital Area Humane Society; Columbus Academy of Veterinary Medicine; Columbus Zoo and Aquarium; Franklin County Board of Health; Franklin County Emergency Management and Homeland Security; Franklin County Engineer’s Office; Ohio Department of Health; Ohio State University College of Veterinary Medicine; Worthington Med-Vet; American Red Cross; Franklin County Department of Animal Care and Control; Ohio Association of Veterinary Technicians; Ohio Department of Natural Resources – Division of Wildlife; Survey Volunteers; Veterinary Clinics or Hospitals; Environmental Protection Agency; Columbus Police Department; Columbus Public Health Department; Other Police Departments (within county); Bexley Animal Control Officer; Franklin County Sherriff’s Office; Ohio Department of Agriculture; and Primary Animal Plan Coordinator Ohio Department of Public Safety – Emergency Management Ohio Department of Public Safety – Homeland Security To help provide the organizational framework, contribute on-call services and resources in an officially declared community emergency. Costs and ExpendituresImplementation: Based on a community assessment, Columbus Public Health identified the following potential hazardous circumstances which would likely create emergency needs for our community: Chemical agent Drought Earthquake Fire Flood/Dam Failure Food Contamination/Poison Dangerously Contagious/Infectious Disease Hazardous Materials Seasonal Heat Explosive Devices Pandemic Flu Outbreak Power Shortage/Failure Radiological Hazards Tornado Transport Accident Water Contamination Winter Storm Local Animal complaints/issues To insure the most flexibility to respond to any community emergency and to command the necessary expertise and resources, a broad coalition of government agencies, community organizations, individual professionals and volunteers was required. The Animal Response Team (ART) was formed in 2006 as apart of an intern project designed by the Public Health Veterinarian. Through the intern project, Columbus Public Health reached out to over 400 animal providers and resources in our community through a mass mailing detailing the ART program design and mission. A respondent survey asked the providers what services and resources they could contribute during an emergency. Through this documentation of resources, they were invited to join our coalition. Based upon the enthusiastic responses to the surveys, a database was created documenting all of the available private resources and services. ART was officially formed and by February 2009 had developed into a comprehensive community-wide emergency surveillance and response team. ART is intended to act as the hub coordinating the emergency response activities of local, state and federal agencies within the community. More recently, ART has begun to reach out to the general community, through the Columbus Public Health website. The website explains the ART program and provides a mechanism to continually update the ART database and engage the animal emergency response coalition. Columbus Public Health rabies vaccination clinics provides a venue to identify, engage, and assess volunteers to be trained in zoonotic disease surveillance and ART support activities. The clinics are promoted through the Columbus Public Health website, direct mail, community information and training. Columbus Public Health redefined an existing dependable revenue stream, the proceeds from monthly rabies vaccination clinics. Those generated funds are redistributed into a special project fund that has been dedicated to ART for acquisition of emergency support tools, and equipment/supplies needed for targeted basic surveillance of direct and vector borne zoonotic pathogens. ART has documented the availability and quantity of services and supplies from more than 400 community participants which would be provided during a community emergency on an on-call, in-kind basis. Additionally, ART has received a $15,000 grant from the State of Ohio for the year of 2010 to use toward equipment and supplies to increase response capabilities. Implementation1. Added training to the rabies vaccination clinics, 2. Utilized the ART volunteers to help staff the clinics, 3. Used the clinics to solicit/enlist more ART volunteers, 4. Created a special purpose fund from the vaccination clinic proceeds to support the ART as well as its' activities, 5. Began training on animal disease (vector borne, direct and EID) surveillance as well as the usual response activities, and 6. Offered all of these activities and results back to the general public, community partners and other CPH internal programs, 7. Surveyed private providers to identify available animal services, supplies and equipment(done on an ongoing basis), 8. Regular stakeholder meetings to identify emerging issues and operational challenges. The initial needs and original provider survey was conducted in October 2006 culminating in the creation of ART in February 2009. Outreach to stakeholders and providers proceed as an ongoing continuous responsibility of the LHD. Volunteers are trained at regular vaccination clinics monthly.
Goal: To increase awareness and elicit support from the public to identify, assess and reduce the risk of existing and emerging zoonotic pathogens/vectors during community emergencies. To expand the public health capacity for surveillance of animal disease outbreaks and response to the identified needs of people and animals in an emergency.To increase the number of regularly attending volunteer attendees at monthly ART trainings/meetings/sessions preceding each monthly rabies vaccination clinic to enhance their knowledge of zoonotic animal diseases and the necessary reporting requirements.Track who attended the training and what training topic was completed using a sign in sheet and a log showing training session associated with each date. Sign in sheet and log are supplied by trainer and recorded in an updated LHD program master file. The qualifications and background of the individual volunteers in attendance coupled with the retention level of those volunteers at subsequent meetings are used as a general guideline/gauge for the depth of the material to be developed and subsequently presented at future meetings. Volunteer interaction with the trainer remains enthusiastic and motivated using the pre-developed topics. They have requested longer training sessions. A recent move to an alternate City facility allowed expansion of the training sessions/meetings to three hours.To promote collaboration between individual citizens, not-for profit/community organizations and governmental agencies through effective community partnerships. Create a list of all animal providers and resources in the community using the internet/yellow pages and invite them to participate in the formation of an animal response team. Establish, advertise and conduct regular (monthly) low cost rabies vaccination clinics in cooperation with local veterinarian(s)/Animal Response Team. Set aside a percentage of the rabies vaccination clinic proceeds in a special purpose fund established for equipment purchases and/or laboratory fees associated with locally chosen animal populations and/or vectors. Establish accounting system to be used for the vaccination clinic proceeds.Meet with LHD epidemiology, vector, and communicable/infectious disease programs to decide which animals, vectors and associated zoonotic animal diseases will be targeted for trapping, collection and submission of samples using criteria such as historical data as well as likely/suspected endemic diseases.Funds have been collected and deposited into a Columbus Special Purpose Fund since February of 2009. Collection of samples for testing in our area is to be coordinated with our seasonal vector control activities starting with the upcoming spring 2010 vector borne disease season.It is recognized that all test result data, whether positive or negative, for diseases tested is significant in the development of epidemiological reports pertaining to local disease levels or absence of disease. Long term collection of data will increasingly support local predictions/decisions necessary concerning the capacity needed for local zoonotic disease response. This will ultimately drive the choice of zoonotic diseases chosen to present to the ongoing combination of rabies vaccination clinics and Animal Response Team trainings. Provide continuous training for community volunteers in disease surveillance and emergency response activities. Interactions and discussions with our Vector, Epidemiology and Infectious/Disease programs as well as with our BioWatch Action Committee highlighted the initial focus for zoonotic diseases included and/or scheduled for incorporation into the training sessions with our Animal Response Team. The rabies vaccination clinics serve as hands on response drills/exercises, and when properly coordinated, documented and submitted, qualify for State liability protection under the Citizen Corps/Medical Reserve Corps umbrella.The initial trainings as shown in “Logistics” below, are still ongo
The Columbus Public Health Department and City of Columbus have committed to necessary outreach activities, facilities, resources, monthly vaccination clinics to enlist new volunteers from the general public and participating organizations while blending the ART with mandated regulatory government animal agencies. This project is predicated on the command of an existing modest revenue stream to maintain and build an emergency capacity over time. We're using modest funds, we're using volunteers, we're engaging private providers and we're organizing public stakeholders precisely because this emergency capacity is not sustainable if bought off the shelf by a single agency.
 
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