May 2015 - The Epidemiology Monitor by The Epidemiology Monitor

WHO Calls End Of Ebola Transmission In Liberia A “Monumental Achievement” Agency Identifies Success Factors The World Health Organization declared Liberia free of Ebola virus transmission in early May after 42 days without a laboratory confirmed case. In describing the achievement, WHO provided one of the most vivid accounts of the impact of the outbreak as it occurred during August and September 2014 when Liberia was reporting 300-400 new cases every week.

months, the capital city Monrovia was the setting for some of the most tragic scenes from West Africa’s outbreak: gates locked at overflowing treatment centres, patients dying on the hospital grounds, and bodies that were sometimes not collected for days... …Flights were cancelled. Fuel and food ran low. Schools, businesses, borders, markets, and most health facilities were closed. Fear and

Vivid Description - WHO continues on next page

In This Issue -3FREE Interactive Resource For Teaching Epi -5Contest Winners Announced -7African CDC -8Top 10 Causes of Death

According to WHO, “During those 2

Bringing Research Findings To The Policy Table Has No Clear Pathway and Many Challenges, Say Investigators An academic and government research team examining the interface between researchers and policy makers note that “…the peer reviewed public health literature has devoted little attention to understanding and improving the ways in which researchers get their work into policy pathways.” To address this shortcoming, the team, led by the University of Washington’s

Jennifer Otten undertook a series of interviews with public health nutrition and obesity researchers known for being highly involved in communicating research to policy makers. The team, reporting in Preventing Chronic Disease on April 30 found a wide variation in communication practices and even - Policy continues on page 6

-10Marketplace Jobs, Books & Events

May 2015 Volume Thirty Six Number Five

-WHO continued from page 1 The Epidemiology Monitor ISSN (0744-0898) is published monthly (except August) by Roger Bernier, Ph.D., MPH at 33 Indigo Plantation Rd, Okatie, SC, 29909, USA. All rights reserved. Reproduction, distribution, or translation without written permission of the publisher is strictly prohibited. 2015 Advertising Rates All ads listed below also include a banner ad on our website and in our EpiGram emails. Full Page $1,195 7.5”w x 10” h Half Page $895 7.5”w x 5” h Quarter Page $695 3.75”w x 5” h Stand Alone Website Ad Bundle $495 / mo. Multi-month discounts available upon request. Advertising Sales Ron Aron 770.670.1946 ron.aron@epimonitor.net All checks must be in U.S.D, drawn on a bank with a U.S. address on the check.

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uncertainty about the future, for families, communities, and the country and its economy, dominated the national mood… …Though the capital city was hardest hit, every one of Liberia’s 15 counties eventually reported cases. At one point, virtually no treatment beds for Ebola patients were available anywhere in the country. With infectious cases and corpses remaining in homes and communities, almost guaranteeing further infections, some expressed concern that the virus might become endemic in Liberia, adding another – and especially severe – permanent threat to health… …It is a tribute to the government and people of Liberia that determination to defeat Ebola never wavered, courage never faltered. Doctors and nurses continued to treat patients, even when supplies of personal protective equipment and training in its safe use were inadequate. Altogether, 375 health workers were infected and 189 lost their lives.” Halting transmission According to WHO, four key factors explain Liberia’s success in halting transmission. 1. The president’s leadership which made the response a priority for multiple branches of government. 2. Health officials and their partners were quick to recognize the importance of community engagement

3. Generous support from the international community, including financial, logistical, and human resources. 4. Strong coordination of the international and national response. Getting to Zero Cases In order to get to zero cases in the three most affected countries of Liberia, Sierra Leone, and Guinea, the WHO action plan for 2015 is focused on the following elements: 1. Further strengthen district surveillance, risk assessment and response operations, and ensure that each district has a flexible plan specific to their epidemiological situation and social / anthropological context 2. Active surveillance and contact tracing are to continue with “zero weekly reporting” of suspected Ebola cases through integrated disease surveillance at public and private health facilities as well as community event-based surveillance in areas of particular risk. 3. Mainstreaming community engagement within service delivery, for example through the training of frontline staff in trust building and communication skills, and reorientating social mobilization activities to address service uptake must be a priority. 4. Case management capacity, triage and infection control procedures need to be optimized to increase survival rates as well as to reduce the number of health workers becoming infected with the disease. ■

Interactive Resource For Teaching Epidemiology Now Available Free Of Charge

- ActivEpi Web

New Spanish Version Released ActivEpi has been called “an electronic teaching tool”, “a multimedia electronic textbook”, and “a multimedia learner-interactive course”. It has been used by instructors all over the world for both online and lecture classes since 2003. However it is described, ActivEpi teaches the fundamentals of epidemiology and is now available for the first time on the web at no cost as ActivEpi Web. Developed in 2001 in English by David Kleinbaum, professor of epidemiology at Emory University’s Rollins School of Public Health, the teaching tool was first presented on CD-ROM with a companion textbook and a shorter pocket guide written by Kleinbaum and colleagues Kevin Sullivan and Nancy Barker. In an email to The Epidemiology Monitor, Kleinbaum called the new ActivEpi Web a unique multimedia text covering basic and intermediate concepts and methods of epidemiologic research. He added, it is a “uniquely teachable” means of learning about basic epidemiology as well as how health science and

mathematics education are intimately connected. Description ActivEpi uses a range of multimedia effects to motivate, explain, visualize, and apply epidemiologic concepts, integrating video, animation, narration, text, and interactive question and answer sessions. As individuals differ in their learning skills, the ActivEpi and the Companion Textbook offer different, but nevertheless intertwined options on how to learn epidemiology. ActivEpi’s multimedia interactive approach is particularly useful for selfstudy or for short courses in epidemiology, either in a traditional classroom setting or in a distance learning setting. ActivEpi can be used as the primary text for a standard lecture course or alternatively for individualized learning. For individual learning, ActivEpi explains both fundamental and complex epidemiological concepts by allowing the users to study at their own pace

“...it is a uniquely teachable means of learning about basic epidemiology..."

"ActivEpi can be used as the primary text for a standard lecture course or alternatively for individualized learning. "

- Active continues on page 4

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-Active continued from page 3 and repeat the material using different "learning while doing" approaches. The website link for free access to ActivEpi Web is: http://activepi.herokuapp.com Once you click on this link, readers can sign up for ActivEpi Web. Specific details on the sign-up procedure and how to get oriented to this electronic text are provided at www.activepi.com. Readers who wish "The web version is to purchase the supporting textbook and pocket guide in English will have the primary instructional text or to purchase them from Springer Publishing. The web version is the teaching [Type a quoteresource from the document or the summary of an interesting point. primary instructional text or teaching since it is resource since it is multimedia and multimedia and interactive, according to Kleinbaum.

interactive..."

Spanish Versions Now Available ActivEpi and its supplements have been translated into Spanish as ActivEpi Español software and Companion textbook and are now freely downloadable. The multimedia software for the Spanish version works only on Windows computers. ActivEpi Español is not directly available as a CD-ROM disk, but rather the contents of the CD-ROM can be downloaded, all 340 MB of it in a large zip file, to the hard drive of your computer or a thumb drive.

The Spanish translation and initial programming for ActivEpi Español were funded through a grant from Higher Education for Development (HED) with funding from USAID/Paraguay. The project was completed with support from the Pan American Health Organization,

which has also made the electronic distribution of the product possible through its website. The interactive software and an ebook ActivEpi Español are available as a single zip file and can be downloaded using the following link: https://tinyurl.com/ks87c7s Instructions for downloading and installing the software are included in the above download but can also be found separately in the following web page: https://tinyurl.com/kr5dlk4 ■

For more information please contact: Ron Aron, Director of Advertising 770.670.1946 ron.aron@epimonitor.net

On The Light Side Winners Selected For “Best Advice From An Epidemiologist” Contest We received multiple entries in our contest to submit the most clever double-entendre pieces of advice from an epidemiologist’s perspective.

1) 2)

Professional Epidemiologist Do not attempt this at home or This Girl Loves Her Epidemiologist

Sayings from the Earth, Sun, and Moon trading company such as these below inspired us to create our contest.

Honorable Mention

Advice From a Tree  Stand tall and proud

Honorable mention is given to several other readers whose advice was selected to be in the Top Ten

Advice From a Snowman  Stay cool

4. For stronger relationships, make valid assumptions

Advice From a Spider  Make good connections

Submitted by Paulyn Claro

Best Advice From An Epidemiologist Try to make a difference in the world, or at least detect one. Submitted by Peter Oh, California Department of Public Health

Second Best Advice From An Epidemiologist 2. Eat dessert first; and eat the potato salad never. Submitted by Daniel Westreich, UNC Chapel Hill

5. A positive interaction will modify your confidence Submitted by Samrat Yeramaneni, Cincinnati Children’s Hospital 6. It matters not the number of friends you have, but the person-time you contribute Submitted by Anthony Nguyen 7. Don’t try to control every variable Submitted by Daniel Westreich 8. Control your bias 9. Set no limits on being normal

Third Best Advice From An Epidemiologist 3. Don’t forget to invest in your Roth, man. Submitted by Anthony Nguyen The winner of the contest receives a $300 cash prize and the second and third place winners will each have a choice to receive a T shirt with one or the other of the following slogans:

10. Make your associations strong All submitted by Richard Danila Minnesota Dept of Public Health

Readers are invited to send us their ideas for our next contest. Send suggestions to the editor at epimon@aol.com ■

-Policy continued from page 1 mixed beliefs about whether and when researchers should engage with policy makers. This split ideology is one that has permeated the epidemiology community for many years.

"I was tired of doing research and not having it go anywhere or lead to anything.”

Facilitators Among the factors that facilitated a productive exchange between researchers and policy makers were requirements to engage laid down by funders, recognition of the researcher's policy work by academic institutions, personal desires to make a difference on the part of researchers, and training and mentorship. Some of these factors are illustrated by quotes from the interviewees who said “ a foundation pushed me to do it [learn how to communicate with policy makers] and another who said “I learned how to do it out of impatience. I was tired of doing research and not having it go anywhere or lead to anything.” Barriers To Making A Difference

“...the academic culture does not highly value participation in policy making."

According to the report, interviewees consistently noted that the academic culture does not highly value participation in policy making. This is reflected in promotion processes that count publications and grants much more heavily than policy related work. Even researchers themselves are not of one mind about the value of engaging with policy. Some do not understand the potential value; others think it should be done only by a subset of researchers skilled or interested in policy matters. Still others believe that doing good science is more important than figuring out what policy makers need.

Other barriers included lack of training in policy related matters, the difficulty of measuring the actual benefits of participating in policy related work because of multiple inputs, and insufficient time to engage meaningfully. Suggestions Despite these challenges, participants made suggestions to improve the situation, including more training, using intermediaries between researchers and policy makers who are more familiar with the ins and outs of policy making, and cultivating relationships between researchers and policy makers over time. ■

CDC Atlanta Agrees To Help Create African CDC The multiple lessons learned from the Ebola epidemic in West Africa are still being tallied, but one positive consequence appears to be the creation of a new Centers for Disease Control and Prevention in Africa.

in place, these volunteers and others can be organized to form a deployable force ready to serve Member States during future health emergency responses on the continent.

In an April press release, the Atlantabased CDC announced the signing of a memorandum of agreement between US Secretary of State John Kerry and Nkosazana Dlamini Zuma, the chairperson of the African Union Commission, an organization designed to spearhead Africa’s development and integration.

Collaborating Centers

According to CDC Director Tom Frieden, “The West African Ebola epidemic reaffirmed the need for a public health institute to support African ministries of health and other health agencies in their efforts to prevent, detect, and respond to any disease outbreak. This memorandum solidifies the commitment by the United States to advance public health across Africa and global health security.” According to a CDC press release, the African CDC is slated to launch later this year with the establishment of an African Surveillance and Response Unit, which will include an Emergency Operations Center. The Unit will provide technical expertise and response coordination during emergencies. Through the AU Support for Ebola Outbreak in West Africa (ASEOWA) mission, the African Union sent over 800 medical volunteers and public health responders to fight the Ebola epidemic in Guinea, Liberia, and Sierra Leone from September 2014 to February 2015. With the African CDC

The African CDC will identify five Regional Collaborating Centers in the five AU geographic regions to work with the African CDC Coordinating Center in Addis Ababa, Ethiopia. Field epidemiologists will be among the technical staff supporting both the Regional Collaborating Centers and the African CDC Coordinating Center. The field epidemiologists will be responsible for disease surveillance, investigations, analysis, and reporting trends and anomalies.

"This memorandum solidifies the commitment by the United States to advance public health across Africa and global health security.”

Input From Atlanta The U.S. CDC will provide technical expertise for the African CDC Surveillance and Response Unit, as well as advise African CDC leadership in strategic planning for future development. Specifically, two public health experts from the U.S. CDC will be co-located at the African Union to serve as long-term technical advisors to the African CDC. Additionally, the U.S. CDC will support fellowships for 10 African epidemiologists to help staff the African CDC Coordinating and Regional Collaborating Centers.

"...the African Union sent over 800 medical volunteers and public health responders to fight the Ebola epidemic..."

The African CDC will seek ongoing collaboration of other public health entities across the African continent and globally to elevate health - CDC continue on page 9

Top Ten Causes Of Death In The US Approximately how many deaths occur in the US each year? What are the top ten causes of death? What percentage of total deaths is caused by the top 10 causes? By the top 3 causes? To learn not only about the top causes of death but also how many actual deaths are caused by these diseases or injuries, and what percentage of all deaths they cause, we consulted figures from a National Center for Health Statistics Data Brief published in December 2014 entitled “Mortality in the United States, 2013” A total of approximately 2.5 million deaths (2,596,993) took place in 2013. There were 1.5 times as many births (3,932,181) as deaths in 2013. The top 10 causes of death accounted for almost three-quarters of all deaths (73.6%). The percentage of all deaths for each cause is listed in the table below. Strikingly, some of the top ten causes account for a relatively small percentage of total deaths. Also, the largest category of deaths is not from the largest single cause-- heart disease (611,105)-- but rather from the category of residual causes beyond the top ten causes (686,682). Table 1. Cause of death All causes Heart disease Cancer Chronic lower resp disease Accidents Cerebrovascular disease Alzheimer’s Diabetes Influenza and Pneumonia Kidney disease Suicide All other causes

# of deaths 2,596,993 611,105 584,881 149,205 130,557 128,978 84,767 75,578 56,979 47,112 41,149 686,682

% of all deaths 100 23.5 22.5 5.7 5.0 5.0 3.3 2.9 2.2 1.8 1.6 26.4

The actual adjusted death rates are presented below. They remain essentially unchanged in 2013 compared to 2012, but there has been a 15.8% decrease in the age adjusted death rate between 2000 and 2013 falling from 869.0 to 731.9 deaths per 100,000 standard population. Life expectancy was 78.8 years in 2013 up from 76.6 years in 2000.

- Top 10 continues on next page

-Top 10 continued from page 8 Figure 3. Age-adjusted death rates for the 10 leading causes of death: United States, 2012 and 2013

NOTES: Causes of death are ranked according to number of deaths. Adapted from CDC/NCHS, National Vital Statistics System, Mortality. â&#x2013;

-CDC continued from page 7 outcomes for all African citizens. Partners may assist by implementing activities, supporting the establishment of the Regional Collaborating Centers, advising the African CDC leadership and staff, or by providing technical assistance. African CDC partners may also strategically support professional associations to coordinate programmatic activities across the public health domains. â&#x2013;

The Fiscal Year 2015 (FY15) Defense Appropriations Act provides $20 million to the Department of Defense Gulf War Illness Research Program (GWIRP) to support innovative, high-impact Gulf War illness research. This program is administered by the US Army Medical Research and Materiel Command (USAMRMC) through the Office of Congressionally Directed Medical Research Programs (CDMRP). In FY15, the GWIRP will include a focus on epidemiological studies. Proposals are being solicited for hypothesis-driven or discovery-based epidemiology research aimed at characterizing patterns of mortality, morbidity and symptomatology over time specifically in Veterans deployed in the 1990-1991 Persian Gulf War and afflicted by Gulf War illness. While symptoms experienced by individual Gulf War Veterans can vary, the types of symptoms reported typically include some combination of widespread pain and headaches, fatigue, cognitive impairment, gastrointestinal symptoms, and skin abnormalities. A greater understanding of patterns of health and disease in these Veterans is needed to improve Gulf War illness case definitions and better inform health care. Pre-applications must be submitted by July 9, 2015. FY15 Program Announcements and other application information can be found at http://cdmrp.army.mil/funding/gwirp.shtml .

PROFESSOR AND DIVISION HEAD DIVISION OF EPIDEMIOLOGY AND COMMUNITY HEALTH SCHOOL OF PUBLIC HEALTH, UNIVERSITY OF MINNESOTA The University of Minnesota’s School of Public Health (SPH) is conducting an open and national search for a tenured Professor and Head for the Division of Epidemiology and Community Health (EpiCH) to provide strategic and academic leadership for the Division’s 52 primary faculty, more than 300 graduate students, 400 staff, and approximately $25 million annually in sponsored projects research on the etiology and prevention of disease. Visit http://sph.umn.edu/epi for more information on the Division. Reporting to the Dean of the School of Public Health, the Professor and Head will:        

serve as the chief administrator of the Division and as a member of the SPH Executive Team, building and nurturing its strategic vision and resources to achieve its missions in collaboration with SPH leadership; supervise, prepare, implement and monitor the Division budget that encompasses all funding sources and ensures compliance with grant, legislative, and institutional guidelines as well as effective management of Division resources; be responsible for advancing and participating in the Division’s diverse spectrum of interdisciplinary research, teaching, and service by leveraging and expanding the Division’s, School’s, and University’s strengths; support collaborative activities that cut across the University and community; recruit and retain excellent faculty, particularly those from underrepresented backgrounds, and encourage their development with strong and effective mentorship; foster a learning environment that attracts a diverse student body; strengthen collegial and collaborative culture that is inclusive, diverse, supportive, and values strong faculty governance; and maintain an active scholarship portfolio including external funding and peer-reviewed publications.

Candidates must have a Ph.D., Sc.D., M.D., or equivalent degree in a health-related related field and credentials commensurate with appointment as a tenured full professor in the SPH. Candidates are expected to have a nationally/internationally recognized record of research and scholarship, including external funding; demonstrated excellence in graduate program teaching; and documented experience in mentorship, leadership and management in a large diverse academic institution. This national search will continue until the position is filled. External applications are strongly encouraged. To apply for the position, please submit a cover letter, CV including publications list, and a list of at least three referees on-line using the following link: http://employment.umn.edu/applicants/Central?quickFind= 126753. Reference requisition number 196055. Salary will be competitive and commensurate with qualifications and background.

NIH/NIEHS Epidemiology Postdoctoral Fellowships

Training Program Quantitative Population Sciences in Cancer

The NIH/NIEHS Epidemiology Branch is seeking talented motivated individuals with doctoral degrees and epidemiology training and experience to participate in ongoing research programs. Several large multi-outcome cohort studies, and a large Repository of biological and environmental samples from completed and ongoing studies offer opportunities for a wide range of add-on studies and analyses: http://tinyurl.com/p7negpw

The Training Program for Quantitative Population Sciences in Cancer, a postdoctoral training/career development program designed to cross-train scientists in bioinformatics, biostatistics and epidemiology for cancer research in the biomedical sciences, invites applicants with a PhD, PhD/MD, or MD degree in one of the three core disciplines (bioinformatics, biostatistics and epidemiology) to apply.

The NIEHS is located in Research Triangle Park, North Carolina near the University of North Carolina at Chapel Hill, North Carolina State University and Duke University, with opportunities for interactions and collaborations. Salary and benefits are highly competitive; commensurate with experience and accomplishments. Initial appointments are 2 years with additional years possible depending on productivity and availability of funds. Submit the following to epifellowships@niehs.nih.gov: • Letter describing areas of research interest • Curriculum vitae with bibliography • Copies of 1-2 recent publications • Contact information for 3 individuals serving as references The NIH is dedicated to building a diverse community in its training and employment programs.

Applicants must be citizens or non-citizen nationals of the U.S., or must have been lawfully admitted to the U.S. for permanent residence. Individuals on temporary visas are not eligible. Candidates are appointed for at least 2 years and can be supported for up to 3 years. Applicant materials should include a letter describing background and interests, curriculum vitae, and names and contact information for three references, and be e-mailed to: Vicki.Sayarath@Dartmouth.edu Dartmouth is an Equal Opportunity and Affirmative Action Employer. We welcome applications from and will extend equal opportunity to all individuals without regard for gender, race, religion, color, national origin, sexual orientation, age, disability, handicap or veteran status.

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