2019 Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases (ELC)
IDPH and local public health partners investigate nearly 9,000 infectious diseases cases and 200 outbreaks in partnership with local public health departments. IDPH serves as the lead in all infectious diseases outbreak investigations and administers the majority of outbreak-associated interviews. Vectorborne diseases are becoming and increasing concern for Iowans. In 2018, the highest number of West Nile virus infections were reported in Iowa since the disease first became established in our state (in 2003). Lyme disease case reports have been increasing annually as Ixodes scapularis expand their range across Iowa. Iowa has one of the highest enteric disease burdens and has identified several large interstate outbreaks in the last year (including a chicken salad outbreak that sickened 265 people from eight different states- see attached impact analysis and Cyclospora contamination salads served at McDonalds). IDPH and SHL have identified several unusual resistant organisms. In 2018, there were 109 CRE reports, 11 KPC reports, 2 OXA reports, and an unusual frequency of organisms with an IMP-27 (N = 17) resistance mechanism. So far in 2019, there have been 3 reported NDMs. As stated above, Iowa leads the nation in production of pork and eggs. Since pigs and poultry are reservoirs / mixing vessels for influenza, there is greater potential for evolution of a novel strain of flu in our state.
Iowa is technically a decentralized state, but functions more like a centralized state for infectious disease outbreak investigations. This hybrid structure presents some capacity challenges at both the state and local level. There are 99 counties and 100 local health departments in Iowa, all with highly variable capacity. While local public health departments in our more populated counties are well staffed; most of our rural counties are not (some may only have one part-time staff person). IDPH has bolstered the state’s capacity to conduct infectious disease case and outbreak investigations by establishing as student interview team. In 2018, the IDPH student interview team conducted case interviews for Campylobacter (~1,500 cases), Giardia (~225 cases), Salmonella (~1100 cases), and Lyme (~270 case) disease reports. The student interview team also processed over 500 foodborne illness reports and administered outbreak questionnaires in the majority of the 187 outbreak investigations conducted in 2018.
Leadership for the ELC grant falls to IDPH and the State Hygienic Laboratory (the designated state public health laboratory). As discussed in multiple areas of this application, IDPH and SHL are geographically separated by over 100 miles. This geographic separation presents some communication and coordination challenges, but IDPH and SHL have implemented some novel approaches to overcome this limitation. These novel approaches are discussed throughout Iowa’s ELC grant application and include weekly all-staff joint webinars and assigning an IDPH epidemiologist to work at SHL each day. Additional challenges are outlined in the problem statement of Attachment A: Cross Cutting Epidemiology, and include staffing capacity within IDPH and SHL, as well as translation services.
Over 90% of the IDPH acute infectious disease program budget comes from federal funding (70% from ELC and 21% from PHEP), therefore the program is highly dependent on the ELC grant for sustainment. Management of the ELC grant has become herculean as the grant has grown significantly over the past several years. The inclusion of Attachment B: Leadership, Management, and Administration will be extremely helpful in supporting the capacity needed to administer the grant, oversee budgets and execute contracts.