Team Epi-Aid helps state investigate public health outbreaks, illness

March 05, 2004

CHAPEL HILL — State officials are regularly calling upon University of North Carolina at Chapel Hill students to help investigate public health concerns close to home, such as the January gastrointestinal outbreak on the UNC campus. The results of their investigations are helping officials out of state, too: The U.S. Centers for Disease Control and Prevention used the students’ analysis of a Buncombe County hepatitis A outbreak to help investigate a possible source for a multi-state outbreak.These students are members of Team Epi-Aid, an initiative of the N.C. Center for Public Health Preparedness, which is based in the UNC School of Public Health’s N.C. Institute for Public Health.

The year-old program comprises 103 graduate students enrolled in the schools of public health, medicine and pharmacy. These students assist the N.C. Division of Public Health and local health departments with outbreak investigations and other short-term public health projects. Since its formation, Team Epi-Aid has helped with nine separate applied public health activities.

When significant numbers of students turned up at the UNC Student Health Service in January with reports of nausea, vomiting, diarrhea and stomach cramps, Team Epi-Aid students were recruited to help Orange County Health Department officials investigate the cause.

“Team Epi-Aid members were responsible for contacting UNC students over the phone and interviewing them about their health, activities and recent meals,” said Nikki Jarrett, a master’s degree student in epidemiology and one of 10 Team Epi-Aid members assisting with the investigation.

In the three weeks following the initial report of symptoms, more than 240 students were diagnosed as having been exposed to noroviruses, a group of viruses that cause gastroenteritis or the stomach flu. Students who had eaten in the upper Lenoir Dining Hall on the UNC campus on Jan. 19 were found to be about five times more likely to have acquired the noroviruses as students who had not eaten there.

Such investigations give Team Epi-Aid students a chance to get hands-on experience in their field of study, said Dr. Pia MacDonald, director of the N.C. Center for Public Health Preparedness, a research assistant professor of epidemiology in the School of Public Health and the program’s founder.

“Students are hungry for applied experience in public health,” MacDonald said. “This is a chance for them to see some of the things they learn about in class in a real-life setting.”

Team Epi-Aid also supports the state in important ways, said state epidemiologist Dr. Jeffrey Engel.

“Before Team Epi-Aid, many outbreaks would not be investigated simply because morbidity was low, numbers were low and-or the outbreak was short-lived and spontaneously abated without a specific public health intervention,” he said.

“Now that the state is able to investigate many of these outbreaks using Team Epi-Aid, state and local public health authorities are better able to plan prevention strategies and learn how to conduct outbreak investigations.”

Michelle Torok, a Team Epi-Aid member who helped investigate a hepatitis A outbreak in Buncombe County last fall, said working on the investigation has given her new perspective.

“It’s one thing to learn about this stuff in class,” said Torok, who is pursuing her doctorate in epidemiology in the School of Public Health, “but it’s a very different experience to go through the process of a real investigation and experience the time pressure to interview people who may have been exposed during an outbreak.”

Sixteen people were diagnosed with hepatitis A during the Buncombe County outbreak, including many who had eaten in an Asheville noodle shop. Team Epi-Aid members worked with state and local officials to determine the source of the outbreak, including designing a case-control study, conducting interviews with people who had become ill and also those who hadn’t, entering and analyzing data, and writing a summary report.

Contaminated produce may have been the illness source. Study results, with contributions by Team Epi-Aid members, will be presented at the 53rd Annual Epidemic Intelligence Service Conference in Atlanta, this April. Team Epi-Aid’s analysis was also used by the CDC for comparison with reports of other hepatitis A outbreaks that occurred during the same time frame in Georgia, Tennessee and Pennsylvania to determine if a common source caused the multi-state outbreak. In at least one of the other states, contaminated produce was determined to be a probable cause.

Other activities in which Team Epi-Aid has participated in the past year include an HIV cluster investigation, a SARS investigation and response, a hepatitis B outbreak investigation, a food-borne illness surveillance study, a study of adverse events in response to smallpox vaccinations, and a rapid needs assessment of counties affected by Hurricane Isabel.

Students have also staffed the state’s Public Health Command Center at the Division of Public Health during emergencies when it is opened.

“Team Epi-Aid has been a wonderful way for me to gain experience in applied epidemiology, meet and network with students and experts in the field, and help others,” Jarrett said. “It’s rewarding to know that my work might prevent others from becoming ill.”

Note: MacDonald can be reached at (919) 843-3415 or pia@email.unc.edu.

N.C. Institute for Public Health contact: Beverly Holt, (919) 966-6274 or bev_holt@unc.edu UNC School of Public Health contact: Lisa Katz, (919) 966-7467 or lisa_katz@unc.edu UNC News Services contact: Deb Saine, (919) 962-8415 or deborah_saine@unc.edu