As the mission of Delaware’s Division of Public Health (DPH) is to protect and promote the health of all people in Delaware, DPH functions as the only government-based public health entity in Delaware with jurisdictional responsibility over localized and statewide events. The priority infectious diseases in Delaware that are centered in this Epidemiology and Laboratory Capacity (ELC) Cooperative Agreement application are based on their incidence rates, as well as their impact on morbidity and mortality. Over the recent years, infectious diseases with the highest incidence rates include chlamydia, influenza, Lyme disease, and chronic Hepatitis B. Moreover, campylobacteriosis, salmonellosis, and Streptococcus pneumoniae infections represent the leading causes of morbidity among Delaware residents. Influenza and pneumonia were among the top ten leading causes of death in 2017; otherwise, the mortality rate for the entire population is very low in general for infectious diseases with high case-fatality rates due to low incidence. Based on current trends, infectious diseases such as measles, mumps, and Hepatitis A are expected to rise given the outbreaks in nearby jurisdictions as well as increases in high-risk, susceptible populations.
As the new medical director of DPH, I had the opportunity to assess the current capabilities of epidemiology, laboratory and health IT. Although there is effective collaboration among the three functions, there are gaps within the individual areas that can be addressed with the new ELC Cooperative Agreement through the three core areas of surveillance, detection and response; prevention and intervention; and communications, coordination and partnerships. Specific areas for improvement within our jurisdiction involve resiliency to perform routine functions during investigations and outbreak response, standardization of operational and technical processes and procedures, infectious disease surveillance data collection and analysis, and quality assurance of outcomes, with opportunities to enhance epidemiology, laboratory and health IT collaboration and alignment of personnel skill sets with tasks to improve overall operational efficiency.
As the first competitive year in a five-year cooperative agreement, we would like to develop a strategic plan over the entire cooperative agreement period. Given our experiences with outbreaks in-state, regionally, and nationally, we need to address short-term goals to have an effective public health workforce in epidemiology, laboratory and health IT prepared to respond to infectious disease threats, to conduct surveillance of infectious diseases, and to form partnerships and collaborations. Subsequent years will focus on mid-term outcomes such as improved understanding of the epidemiology and incidence of infectious diseases, improved surveillance, and enhanced coordination on prevention and control of infectious diseases between partners, and on long-term outcomes such as more efficient and accurate public health reporting, more effective investigation efforts, and improved use of data to improve public health practice and to inform program and policy development.
Our primary challenge is to have the staff capacity for investigations and outbreak response while performing daily functions related to other infectious diseases. We have identified gaps in staffing specifically in crosscutting epidemiology/laboratory capacity, ELC management/administration, health information systems capacity, cross-cutting emerging issues, foodborne/waterborne/enteric/environmentally transmitted diseases, healthcare-associated infections and antibiotic resistance/stewardship, vector-borne diseases, enhanced VPD, and influenza surveillance; as a result, additional funding for personnel costs and contractual services will be requested given our current challenges maintaining routine surveillance activities while responding to outbreaks.