Written by Eleanor Peters, epidemiology manager in the Division of Communicable Disease Control Services at the St. Louis Country Department of Public Health.
The functions of a health department vary by region based on the priorities of the citizens it serves. Some functions are mandated by state government whereas others are considered best practices and implemented for that reason. The Communicable Disease Control Services division (CDCS) of the Saint Louis County Department of Health has many mandated functions but tries to accomplish everything it does with an eye towards best practices.
Some of what CDCS does is very visible. For example, when there is a foodborne disease outbreak, the division is often called upon to engage with television or radio news outlets to speak about current risks, signs and symptoms of the disease at hand, and the best ways to avoid getting sick. However, much of what CDCS is tasked with doing is the behind the scenes work that ensures the continuity of good health in the community.
Three hundred and sixty five days a year the program performs syndromic surveillance in all county emergency departments to keep an eye on a few key indicators that could be indicative of larger problems.
The epidemiology program is one of CDCS’s most important. There are over one million residents in St. Louis County and just three epidemiologists tasked with investigating and describing the “who, where, and when” of infectious diseases in the county. Some of the diseases the program works on include E. coli, Gonorrhea, Hepatitis A and B, Influenza, Malaria, Salmonella, Shigella, Syphilis, Tuberculosis, and West Nile. For these diseases and others, the program puts out reports on a weekly, monthly, and annual basis. All these reports are available to the public and can be found in the Report Center.
The epidemiology program also works on diseases of special concern. The disease that captured the most attention in late 2014 and early 2015 is Ebola. Although there have only been a few cases of Ebola in the US, there has been a tremendous amount of effort put towards ensuring that the country remains in a non-outbreak mode. Every individual returning or coming to the US that has spent time in Sierra Leone, Guinea, or Liberia needs to be monitored for temperature and signs or symptoms of Ebola for 21 days after his or her departure from these three nations. CDCS nurses handle the initial intake evaluation of each incoming or returning traveler and then CDCS epidemiologists handle the 21 days of monitoring.
In addition to this special and specific type of surveillance, the epidemiology program conducts other more routine and established forms of surveillance. Three hundred and sixty five days a year the program performs syndromic surveillance in all county emergency departments to keep an eye on a few key indicators that could be indicative of larger problems. These indicators include fever, GI problems, neurologic problems, rashes, and respiratory problems (among others). During the summer the program conducts surveillance for hyperthermia in county hospitals whenever the National Weather Service issues a heat warning, heat advisory, or heat emergency. From October through March, the program monitors a network of surveillance sites that furnish CDCS with influenza case counts used for influenza surveillance.
There are many other duties performed by the epidemiology program and community collaborations in which it participates; however, all of them serve one purpose: supporting the department’s vision of promoting the health of St. Louis County citizens by utilizing innovative strategies and research to improve health information and policies.