Outbreak and aberrant disease
investigation: Epidemiological
skills development programme
PROGRAMME OUTLINE
26 June 2008
ESR Epidemiological Skills Development Programme
Contents
In this
document
This document outlines a proposed epidemiological skills development
programme. The purpose of the programme is to strengthen the capacity of
the New Zealand public health workforce to identify investigate and control
outbreaks of infectious and aberrant disease.
This document contains the following topics.
Topic
Skills development programme at a glance
Skills development programme overview
Description of Modules
Level 1: Foundations of outbreak investigation
Overview
Module 1.1: Epidemiological concepts
Module 1.2: Effective case investigation
Module 1.3: Introduction to outbreaks
Level 2: Training for outbreak practitioners
Module 2.1: Outbreak investigation and response training
Module 2.2: Using EpiData and Epi Info™ for outbreak
investigation
Module 2.3: Making the most of the laboratory
Module 2.4: Outbreak investigation: on line case study
Level 3: Advanced outbreak investigation
Module 3.1: Advanced outbreak investigation
Module 3.2 Special topic
Module 3.3: Effective case investigation trainers module
Module 3.4: Facilitating case studies
Level 4: Specialist field epidemiology expertise
References
Glossary
Consultation
and sources
Page
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Thanks to all those who attended the ESR NCBID needs assessment
workshop – many of the ideas in this document are a result of the workshop.
The document also draws on:
 a review of the literature on current practice and trends in applied
epidemiology and outbreak investigation training
 feedback from ESR NCBID staff and public health service staff
 consultation with representatives from CDC, the Public Health Agency of
Canada. Ministry of Health and OzFoodNet
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ESR Epidemiological Skills Development Programme
Skills development programme at a glance
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ESR Epidemiological Skills Development Programme
Skills development programme overview
Introduction
This document outlines a proposed epidemiological skills development
programme. The purpose of the programme is to strengthen the capacity of
the New Zealand public health workforce to identify investigate and control
outbreaks of infectious and aberrant disease.
Figure 1: The proposed programme to strengthen outbreak and aberrant disease investigation
Goals
The goal of the programme is to build the professional capacity for outbreak
investigation and response in New Zealand.
Continued on next page
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ESR Epidemiological Skills Development Programme
Skills development programme overview, Continued
Level of
expertise
supported
The ‘gold standard’ for developing applied epidemiology expertise is a Field
Epidemiology Training programme (such as the MAE programme in
Australia), which typically provides two years of intensive training supported
by mentored field experience. This programme, built around shorter courses
cannot achieve this level of skill. However shorter course programmes can
offer a viable intermediate step (Lescano, Salmon-Mulanovich, Pedroni, &
Blazes, 2007). The table below shows competence each level of the
programme will support.
Level
1
2
3
4
Approach
Simple
investigations
Will know about
Can carry out
Complex Investigations
Awareness
Growing
Can collaborate on with
competency
support from expert advisors
Skilled
Can lead
Expert advisor (not offered through this programme)
The main features of the programme are
 A focus on the particular expertise offered by ESR NCBID, in partnership
with local staff skilled in the practical aspects of outbreak investigation
 Complementing rather than duplicating existing training
 Competency based
 An applied, practical approach based on adult learning principles.
 Partnerships with training institutions
ESR NCBID
expertise
ESR NCBID will offer expertise in the following areas:
 Investigating individual disease cases of enteric disease
 Investigating disease outbreaks
 Disease surveillance tools (e.g. Episurv and Early Aberrant Reporting
System - EARS)
 Public health analytical software
 Laboratory expertise
 Field epidemiology
Relationship to
other training
Competency
Other providers also offer training in competencies that support outbreak
investigation (e.g. academic providers, Southern Monitoring Services, (SMS)
and the New Zealand Food Safety Authority (NZFSA). The proposed will
programme will supplement this existing training rather than duplicate it.
The programme supports the following key competencies, which were identified
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ESR Epidemiological Skills Development Programme
based
through a needs assessment (Roseveare, 2007). The table below shows which
level of training addresses the competencies. The shaded areas show which
competencies are addressed at each level of training.
Competency
1
Awar
eness
Level
2
3
Growi Skilled/
ng
Leaders
compe
hip
tence
1. Surveillance/assessm
ent
2. Epidemiological
concepts
3. Investigation skills
4. Epidemiological
analysis
5. Communication
6. Reporting
7. Prevention and
control
8. Project management
and leadership
Learning
approach
The training will be applied, active and practical with considerable use of
case studies based on topical international and New Zealand examples. It will
offer a ‘blended learning approach’ combining face to face courses, work
place training and on-line options.
Workforce
development
ESR NCBID will build on the expertise in public health services to develop a
network of regional trainers as will as drawing on ESR staff, and a network of
international trainers.
Partnership
with training
institution
ESR NCBID will investigate collaborating with a training provider to deliver
some of the modules (e.g. train the trainer, on-line options).
Certification
ESR NCBID will investigate the possibility of creating a certificate that is
recognised as part of the national qualifications framework.
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ESR Epidemiological Skills Development Programme
Level 1: Foundations of outbreak investigation
Overview
Introduction
Contents
Modules offered at the entry level are for staff working in public health
services who have been in the job less than 6 months. They will provide a
foundation in analytical epidemiology and good practice in disease
investigation.
Level 1 includes the following modules:
Code
Module
1.1
Epidemiological
concepts
Outcomes
1.2
Foundation
investigation
skills
1.3
Foundations of
outbreak practice
Main purpose
Delivery
 To provide a solid
 Online
foundation in applied
epidemiology as a prerequisite to
understanding analytical
epidemiological studies
 To establish consistent
 1-2 day workshop
good practice in
investigating single
cases of disease, to build
the foundations for
effective field work in
outbreak investigations.
 To introduce
 Half day workshop
participants to a typical
outbreak investigation
through a realistic table
top exercise.
After completing this level (along with relevant experience in the workplace
and associated professional development) staff will have a good awareness of
outbreak investigation and be able to support aspects of an investigation
under supervision
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ESR Epidemiological Skills Development Programme
Module 1.1: Epidemiological concepts
Overview
This module would provide an overview of epidemiological principles and
practices as a foundation for outbreak investigation practice. It is intended to
provide a foundation for those who have not previously studied epidemiology
(or as a refresher for those who have).
Learning
outcomes
At the end of this module participants will be able to:
 Define epidemiology and describe the historical development of the field.
 Identify the various uses of epidemiology in public health practice.
 Describe different theories of disease causation in communities.
 Illustrate how agent, host and environment variables interact to affect health
in communities.
 Identify and describe the stages of the natural history of a disease primary,
secondary and tertiary prevention.
 Understand the meaning of public health surveillance and explain the use of
surveillance data in public health practice.
 Identify the steps of the surveillance cycle.
 Explain ethical principles underlying the uses of epidemiology in public
health practice.
Competencies
supported
Surveillance
Epidemiological concepts
Length
25-30 hours
Delivery
On line
How often
Twice a year
Assessment
On line test
Provider
ESR NCBID to investigate modifying an on line module such as the Public
Health Agency of Canada Epidemiological concepts, for New Zealand
(Public Health Agency of Canada, 2007b).
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ESR Epidemiological Skills Development Programme
Module 1.2: Effective case investigation
Overview
This course would be for participants who have worked in public health for
less than six months and likely to be involved on outbreak investigations in
the future. It would provide the opportunity to refresh knowledge of
important public health diseases and develop and practice the investigation
skills required in single sporadic case of disease. It would also provide the
foundation for skills that will be used in outbreak investigations.
Learning
outcomes
At the end of this module participants would be able to:
 Apply a standard operating protocol for case investigation
 Follow a pre-prepared standard investigation questionnaire
 Effectively gather and collate accurate, relevant information about the risk
factors for a disease
 Provide accurate information about simple control measures to prevent
spread
 Have a basic understanding of laboratory investigation and sample taking
 Think of cases as part of a potential outbreak
Competencies
supported
Investigation skills
Length
One – two days
Delivery
Regional courses
How often
Once a year
Assessment
To be determined
Provider
Experienced Public health service staff. NCBID to coordinate a train the
trainer package to support staff to deliver this module.
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ESR Epidemiological Skills Development Programme
Module 1.3: Introduction to outbreaks
Overview
The module would provide an introduction to an outbreak investigation
through a 2-4 hour facilitated table top case study. It would be taught by
experienced Public Health Service staff within the workplace who had been
through a train the trainer course to introduce them to the case studies.
Learning
outcomes
At the end of this module participants would be able to:
 Differentiate an outbreak from background disease
 Understand the concept of investigation triggers
 Understand the main procedures used in an outbreak investigation
 Understand the purpose of an analytical epidemiology study
Competencies
Supported
Surveillance (Confirmation and assessment)
Investigation skills
Analytical epidemiology
Length
Half a day
Delivery
At the workplace
How often
Once a year
Who
Experienced Public health service staff. NCBID to coordinate a train the
trainer package to support the facilitation of appropriate case studies in the
workplace e.g. (Centres for Disease Control and Prevention, 2007; Klaucke &
Vogt, 2005; Morrow & Novick, 2005).
Assessment
This would be an optional module. If there is interest in this option ESR
NCBID to explore the potential of having the completion and facilitation of
this workshop recognized for credit (CME or HPO continuing competency).
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ESR Epidemiological Skills Development Programme
Level 2: Training for outbreak practitioners
Introduction
The modules in level 2:Training for outbreak practitioners would be
designed for staff working in public health services who have been in the job
from 6 months – 3 years. They are intended to prepare students to
competently carry out the epidemiological investigation of a ‘straightforward’
outbreak of infectious disease such as a common event outbreak in their local
area.
Contents
At this level the following modules will be offered:
Code
Module
2.1
Outbreak
investigation and
response training
workshop
2.2
Using EpiData
and Epi Info™
for outbreaks
Outcomes
2.3
Making the most
of the laboratory
2.4
Outbreak
investigation on
line case study
Main purpose
 To strengthen the ability to
detect and respond to outbreaks
at the local level
Delivery
 3-4 day
workshop
 To teach the use of EpiData and
Epi Info™ to support the
analytical epidemiological
component of an outbreak
investigation.
 To develop expertise in
managing in the laboratory
aspects of an outbreak
investigation.
 2 day
workshop
 1-2 day
workshop
 To provide an alternative for
 On line
those unable to attend the face
to face Outbreak investigation
and control workshop that could
also be used as a refresher
subsequent to the workshop
Combined with on the job experience and related professional development,
completing level two training will enable participants to carry out local
outbreak investigations and support national investigations
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ESR Epidemiological Skills Development Programme
Module 2.1: Outbreak investigation and response training
Overview
The Outbreak investigation and response training would be for staff working
in public health units who have been in the job from 6 months – 3 years. It is
intended to prepare students to identify, investigate and control a
‘straightforward’ outbreak of infectious disease typically dealt with by a
public health service, such a common event outbreak in their local area.
The workshop will include pre-reading, and some lectures but the emphasis
will be on practical application of theory to a case study. Learning from the
course would be reinforced by completing a project.
Learning
objectives
Topics
By the end of the course students will be able to
 Understand the importance of outbreak investigations, as well as the
decisions resulting from such investigations.
 Identify a potential outbreak.
 Plan and execute all the necessary steps of an outbreak investigation.
 Understand the importance of the laboratory component of an investigation
 Identify and conduct control and response measures
Topic
1. Current international context
2. Identifying an outbreak and steps
of an investigation
3. Case definitions
4. Transmission chain
5. Epidemic Curves
6. Designing field investigation
7. Specimens and samples
8. Analytical Epidemiology Studies
9. Control measures
10. Preparing an outbreak report
Competencies supported
Surveillance
Basic public health science
Field Investigation
Epidemiological Analysis
Control
Reporting
Length
4 – 5 days
How often
Annually
Delivery
Face to face workshop
Assessment
Brief exam
Completion of an outbreak report based on a work place example
Continued on next page
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ESR Epidemiological Skills Development Programme
Module 2.1: Outbreak investigation and response training,
Continued
Work based
component
NCBID to explore:
developing an additional on line phase after the face to face workshop, to
support students in completing a written report of an actual outbreak
investigation after they have returned to work Lescano et al (2007) report
using this successfully in their outbreak investigation training.
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ESR Epidemiological Skills Development Programme
Module 2.2: Using EpiData and Epi Info™ for outbreak
investigation
Overview
This course is for staff who want to develop further competency in the
analytical aspects of an outbreak investigation. It is a practical workshop that
teaches the use of EpiData and Epi Info™ to support the analytical
epidemiological component of an outbreak investigation.
Learning
outcomes
 At the end of this module participants will be able to:
 Use EpiData to generate a questionnaire for an outbreak investigation
 Use EpiData to enter outbreak investigation into a record suitable for
analysis in Epi Info™
 Use Epi Info™ to support an epidemiological study
Competencies
supported
Analysis
Length
2 days
How often
Twice a year
Delivery
On site at the workplace
Delivered by
ESR staff. NCBID to develop a resource and training programme to support
public health staff to deliver this course
Assessment
To be developed
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ESR Epidemiological Skills Development Programme
Module 2.3: Making the most of the laboratory
Overview
This module is designed for public health staff who want to develop expertise
in managing the laboratory aspects of an outbreak investigation.
Learning
outcomes
At the end of this module participants will be able to:
 Follow protocols for specimen and sample collection
 Identify the appropriate tests needed for diagnosis of a disease
 Interpret the diagnostic and epidemiological significance of reports from
laboratory tests
 Communicate effectively with the laboratory team
 Organise the laboratory component of an outbreak investigation
Competencies
supported
Investigation
Communication
Public health science
Length
1 – 2 days
Delivery
Face to face workshop
Delivered by
ESR laboratory staff
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ESR Epidemiological Skills Development Programme
Module 2.4: Outbreak investigation: on line case study
Overview
This would be an option for teaching some of the knowledge covered in the
face to face Outbreak investigation and control workshop (2.1) that could
also be used as a refresher subsequent to the workshop. There are several
online options for teaching outbreak investigation via case studies that have
had promising evaluations that could be used as models (Public Health
Agency of Canada, 2007a; Stehr-Green & Gathany, 2005)
Learning
outcomes
To be developed
Competencies
supported
To be developed
Length
6 – 8 modules
Delivery
On line
Delivered by
If there is support for this concept, ESR NCBID to work with a training
provider to develop a pilot programme
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ESR Epidemiological Skills Development Programme
Level 3: Advanced outbreak investigation
Overview
These courses are designed for people who have been in the job for at least
three years. They will offer opportunities to
 Reflect on professional practice
 Keep knowledge current
 Work through issues likely to arise in more complex investigations.
 Provide training on more specialised topics
 Take on a teaching or leadership role in outbreak investigation
Module
overview
The table below describes each course and its main purpose:
Code
Course
3.1
Advanced Outbreak
investigation
3.2
3.3
3.4
Outcomes
Special topic modules
e.g. specialised
laboratory methods or
advanced analysis
techniques
Train the trainer
Investigating a case of
disease
Train the Trainer
Case study facilitation
Main purposes
 To explore issues arising
from a complex outbreak
investigation through a
facilitated case study or
simulation
 To develop additional
expertise in investigation
and analysis
Delivery
 Face to face
workshop
 To develop regional
facilitators of the
investigating disease
outbreak module
 To develop and support
staff to facilitate
epidemiological case
studies
 To be
determined
 Face to face
workshop
Combined with on the job experience and related professional development,
completing level three training will enable participants to take a lead role in
local outbreak investigations, support national outbreak investigations and to
share their expertise with others.
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ESR Epidemiological Skills Development Programme
Module 3.1: Advanced outbreak investigation
Overview
The Advanced Outbreak Investigation training is designed for staff working
in public health units who have been in the job at least three years and have
experience investigating outbreaks of infectious disease. The workshop will
explore issues arising from a dispersed outbreak through a facilitated case
study or simulation such as CDC’s A multistate outbreak of E.coli 0157:H7
Infection (Communicable Disease Centres, 2007). It will offer the
opportunity to reflect on professional practice as well as working through
investigation and analysis issues likely to arise in more complex
investigations.
Learning
outcomes
After completing this workshop participants will have a greater understanding
of
 Determining the most efficient study design to test hypotheses
 Approving the selection of investigative processes
 Analysis issues in control studies
 Traceback investigations
 Collaborating on a complex investigation involving more than one
jurisdiction
Competencies
supported
Surveillance/assessment
Epidemiological Concepts
Investigation skill
Epidemiological analysis
Prevention and Control
Length
1 – 2 days
Delivery
Face to face workshop
Delivered by
Specialised training partners
Prerequisite
CIMS level 2
Outbreak investigation and response 2.1
Experience of an outbreak investigation
Frequency
Offered every two years
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ESR Epidemiological Skills Development Programme
Module 3.2 Special topic
Overview
These workshops would be designed to develop additional expertise in
investigation and analysis methods such as traceback investigation, modeling
or more advanced laboratory methods or interpreting findings
Learning
outcomes
Dependent on the topic
Competencies
supported
Investigation skills
Epidemiological Analysis
Delivery
One day special topic modules offered as options as part of the advanced
outbreak workshop or independently on alternate years.
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ESR Epidemiological Skills Development Programme
Module 3.3: Effective case investigation trainers module
Module 3.4: Facilitating case studies
Overview
These courses would be ‘train the trainer’ courses designed for people who
wish to take on a teaching or leadership role in outbreak investigation in the
workplace.
Effective case
investigation
The Effective case investigation module would support public health
practitioners to lead a workshop for staff in their own or other public health
services on effective investigation of single cases of disease
Facilitating
case studies
The Facilitating case studies model would support public health practitioners
to introduce others to a typical outbreak investigation through facilitating a
realistic table top exercise.
Delivery
ESR NCBID to work with a training provider to develop a pilot programme
for the train the trainer modules. The content is likely to include several
modules covering





Familiarisation with the resources and their objectives
Likely issues arising from participants
Facilitation skills
An opportunity for participants to practise alongside an experienced
facilitator
Feedback
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ESR Epidemiological Skills Development Programme
Level 4: Specialist field epidemiology expertise
Overview
ESR NCBID is investigating opportunities to develop and support a pool of
New Zealand staff skilled in applied epidemiology including support for
training courses, work experience placements and secondments. In the interim
they will use the following strategies to ensure a high quality of technical and
training expertise.
Strategies
The strategies used will be
1
2
3
Description
Recruitment of a field epidemiologist
Links with international agencies to ensure access to overseas
experts
Partnerships with New Zealand training institutions and public
health agencies to draw on local specialised expertise.
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ESR Epidemiological Skills Development Programme
References
Centres for Disease Control and Prevention. (2007). Epidemiologic Case studies. Retrieved
October 30, 2007, 2007, from http://www2a.cdc.gov/epicasestudies/htm
Klaucke, D., & Vogt, R. (2005). A case exercise: outbreak investigation at a Vermont
community hospital. Journal of Public Health Management and Practice, 11(4), 301305.
Lescano, A. G., Salmon-Mulanovich, G., Pedroni, E., & Blazes, D. (2007). Outbreak
investigation and response training. Science, 318, 574-575.
Morrow, C. B., & Novick, L. F. (2005). A case exercise in public health preparedness: A
community outbreak of influenza-like illness. Journal of Public Health Management and
Practice, 11(4), 306-310.
Public Health Agency of Canada. (2007a). Skills enhancement for public health. Retrieved June
2007, from http://www.phac-aspc.gc.ca/php
psp/core_competencies_for_ph_index_e.html
Public Health Agency of Canada. (2007b). Skills enhancement for public health - module
description. Retrieved 30 October, 2007, from http:/www.phac-aspc.gc.ca/sehsacss/module_description_e.html#ms
Roseveare, (2007). Outbreak and aberrant disease investigation: epidemiological skills
development programme: Competency framework and preferred design
Stehr-Green, J., & Gathany, N. (2005). Training in outbreak investigation through use of an
online discussion group. Journal of Environmental Health, 68(4), 9-13.
Glossary
CDC
CIMS
CME
EARS
MAE
NZFSA
SMS
Centres for Disease Control and Prevention
Coordinated Incident Management System
Continuing Medical Education
Early Aberrant Reporting System
Masters of Applied Epidemiology
New Zealand Food Safety Authority
Southern Monitoring Services
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