Summer Reading: “Deadly Outbreaks”!

Summer time, hot weather, (almost) everyone on vacations… Well, not me! But during the weekends I choose to hang out at the terraces of nice cafes, enjoying the good weather with some friends. I could tell you I usually drink water and natural juices in these occasions but I would be lying: a glass of red wine or some nice sangria are my options on these relaxed afternoons.  It is the perfect timing to read a nice book, too. The last one I read was “Deadly Outbreaks” by Alexandra Levitt(1) and was result of a purchase on the internet, while searching for books on public health issues.

Before going to medical school, I was already working in infection control area at a 400 bed hospital, where epidemiological surveillance is an important component of our functions and, I must admit, one of my favorites. During these 13 years of work at this hospital, I already had to deal with few outbreaks but it was the one in the summer of 2006 I remember the most, when I was still a “freshman” in the Infection Control Committee. At the time, the microbiology laboratory gave us an alert: multidrug-resistant (MDR) Acinetobacter baumannii was isolated in sputum of a trauma patient transferred from a central hospital some days before.  After a first assessment we found out he was located in the Surgical Intermediate Care Unit, a small pos-op infirmary “packed” with 6 patients, where the distance between beds was roughly 1,5 meters and in which “our” patient was frequently coughing and in need of nursing care. This microorganism was not part of our local ecology, so this was considered an infection control “code blue”! The patient and the unit were immediately put in contact isolation, while the lab confirmed other two positive patients for MDR A. baumannii. An outbreak was officially declared and, with the support of the hospital management, rigorous infection control measures were taken: all contacts with this patient were identified and put in contact isolation, an epidemiological line list was done and an active surveillance protocol was implemented. The unit was closed to new admissions, environment hygiene measures were reinforced, patients were stratified by risk level and a cohort of healthcare workers (HCW) was put in place (specific teams of HCW took care of “confirmed”, “suspected” and “negative” patients). Meanwhile, the hospital that transferred the index patient warned us that they were experiencing problems with this microorganism but this information came to us too late… After eight months, 15 cases (8 of which died), 61 patients put in isolation and surveillance, and a lot of effort (and costs) for the hospital, HCW’s and patients, the outbreak was finally controlled. As a consequence of it, a surveillance protocol for MDR A. baumannii was implemented (applied for all patients transferred from other hospitals). In my opinion, one of the “lessons to be learned” from this outbreak is the importance of communication between and within healthcare units to be able to minimize infection control risks, related to patients mobility. Twelve years have passed and, today, this and other hospitals have a risk evaluation procedure that is applied to all admitted patients.

But back to the book: if you liked this outbreak description, you will LOVE “Deadly Outbreaks”1 and you won’t be able to sleep until you end it! The author, Prof. Alexandra Levitt, is an expert on emerging diseases and other public health threats and worked for the Center for Disease Control and Prevention (CDC). She dedicates this book to all field epidemiologists that “save lives threatened by killer pandemics, exotic viruses and drug-resistant parasites”. The book describes, in an exciting and pedagogical way, seven public health mysteries occurred in the United States of America between 1976 and 2006, through the learn-by-doing approach of the “medical detectives” of CDC´s Epidemic Intelligence Service. In the “author’s note”, three advices are given, namely: “be prepared for the unexpected” (when it comes to infectious microorganisms); “we are all in it together” (with the phenomena of globalization, wherever we live, we are all at risk) and the importance of participating in a strong public health system, in the pursuit of prevention of disease spread among the community.

In one outbreak described in the book, investigating the mysterious death of several infants at a Children´s Hospital, several epidemiological tools were used, including the “epi-curve” and the “relative risk of death” associated with each nurses’ shifts, estimating the risk of a baby dying when a specific person was on duty. The study concluded that the hospital should strengthen central control of medicines and implement a monitoring system of deaths, by time and place, within the hospital. (2)

Did you know that, as a consequence of an outbreak in a Philadelphia hotel affecting middle-aged Legionnaires, CDC fielded one of the biggest investigative team ever but couldn´t find its etiological agent for several months? In fact, it was a young microbiologist of CDC that discovered it when, later on, decided to review and explore the finding of some rods that he, first, assumed were contaminants of his cultures (“be prepared for the unexpected”, remember?). Did you know that, after its discovery in 1976, Legionella pneumophila was retrospectively implicated in cases as far as 1943?

More recently, did you know that an epidemiologic outbreak investigation, affecting abattoir workers exposed to porcine brain, led to the discovery of an immune-mediated polyradiculoneuropathy? (3)

Throughout the book, these and many other epidemiological and infectious diseases facts are given, engaging the reader to explore the scientific method, by testing various hypotheses through the use of the technologies available at the time of the outbreak. At the end of each chapter, the author reviews the main facts to illustrate the lessons learned. Did I catch your attention? Hope so! Despite the book portraying the modus operandi (and available associated resources) of the North-American reality, it’s full of interesting facts that, in my opinion, will enrich our knowledge in public health area. A “must-read”!

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References:

  1. Levitt, Alexandra M (2015) Deadly Outbreaks. 2nd edition. New York: Skyhorse Publishing.
  2. Buehler JW, Smith LF, Wallace EM, Heath CW Jr, Kusiak R, Herndon JL (1985) Unexplained deaths in a children’s hospital – An epidemiologic assessment. N Engl J Med; 313(4):211-6.
  3. Holzbauer SM, DeVries AS, Sejvar JJ, et al. (2010) Epidemiologic investigation of immune-mediated polyradiculoneuropathy among abattoir workers exposed to porcine brain. PLoS One. 5(3):e9782.

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David Peres
Public Health Resident
Public Health Unit – Community Health Center Group of Povoa de Varzim / Vila do Conde (Portugal)

What do you think #PublicHealthLooksLike? An unusual (but rewarding) PH resident attachment

In my experience it’s not very often that you get to combine your public health work with your hobbies, particularly when your outside interests include the arts as mine do. However, in my current role I am for the first time being able to do both daily, which has been exciting, rewarding and challenging!

For the last two months I have been working with the UK Faculty of Public Health (FPH) communications and policy team. They cover a lot of ground and I’m involved in several workstreams, but the main piece of work that I ‘own’ is the planning, implementation and promotion of their photography competition #PublicHealthLooksLike.

As the name suggests, the competition is aiming to improve the way FPH represent their members (i.e. the public health workforce) by showcasing what public health work really looks like in the UK and around the world, rather than using stereotypical ‘stock photo’ images of attractive models with stethoscopes. They’re offering some great prizes including £250 and a year’s free membership, but most importantly they’re planning an exhibition in London featuring the top ten photographs to celebrate the amazing diversity of public health.

Although the competition has only been running for six weeks and doesn’t close till October 19th, it’s already been incredibly inspiring to see both the engagement from public health professionals and the early entries coming in. I suppose we all know in the abstract that public health is a broad church, with people working in so many different areas, but there’s a big difference between knowing that and actually seeing it visually. We’ve had photos of anything and everything, from people supervising walking groups in the sunny English countryside to members hosting immunisation clinics in the Middle East.

From a personal point of view, I’ve loved being able to engage with potential entrants online, encouraging them to recognise their talents and the incredible work that they do every day without probably realising how interesting and engaging that might be to other people. It’s made me think seriously about how little I talk about or share my own public health work, and try to (slowly) increase the amount of personal and professional engagement I do on Twitter and other social networks. We should all talk more about what we do, because it’s often only by hearing and seeing the experiences of others that we become inspired to seek out new challenges – that’s partly why networks such as Euronet are so important.

The competition is still running, and I would definitely recommend Euronet members enter to showcase the work that we all do on a daily basis across Europe! You can enter up to five photos through the competition website. If you’re on Twitter it would be fantastic if you could take 10 seconds to RT this tweet to publicise the competition across Europe more widely, and if you fancy following either @FPH or me personally you can find us there as well.

I look forward to seeing your entries! If anyone is interested in hearing more about the competition or attachments with FPH, please just drop me an email at rachel.thomson8@nhs.net.

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Rachel Thomson
Public Health Resident
UK Faculty of Public Health, London

EuroNet MRPH Winter Meeting


Dear friends!

Slovenian public health residents joined EuroNet MRPH in November 2016. Since then we have enjoyed attending every meeting and it is high time for us to organise one ourselves. We hope to take our collaboration to new heights both literally and figuratively. Thus, following on the heels of the EPH Conference in Ljubljana we will be hosting the EuroNet MRPH Winter Meeting on the spectacular alpine plateau of Velika Planina.

Our venue Velika Planina rises to 1,600m offering fantastic views of the surrounding mountains and is just a short drive, cable car and chairlift out of the capital – don’t worry we are organising transport. It is one of the last high alpine herdsmen’s villages in Europe with the plateau dotted with cute wooden huts though we’ll be staying in more comfortable lodgings than the herdsmen of the past (imagine saunas and outdoor wooden hot tubs;). It will be the perfect escape from the city’s public health hazards of noise and air pollution. Enjoying the clean air of the alps and with no distractions around we will be able to focus our energy on networking and the inner workings of EuroNet MRPH.

The General assembly will be hosted at the Zeleni rob restaurant, a snowball’s throw away from the cottages, with plenty of delicious traditional Slovenian food. As public health residents we think we can also be trusted to responsibly enjoy a drink together, just enough to facilitate the exchange of stories from past meetings as well as share our work and new ideas.

A winter fairy-tale is coming and we hope you are going to join us! Don’t forget to apply before October 7th!!
More info at: http://euronetmrph.org/velikaplanina-meeting-2018

Velika Planina, Slovenia 2018

Association of Public Health Residents of Slovenia

The Turkish association of residents in Public Health joins EuroNet MRPH

During the Summer Meeting in Valencia, Turkey joined EuroNet MRPH. With a population of more than 80 millions people, Turkey is one of the biggest countries of the European continent. In this country Public Health is listed as a clinical discipline and it has several challenges to face. It is expected that around 2400 public health specialist will be needed in 2023 to answer to the Turkish population’s needs*.

EuroNetters are extremely happy to welcome their Turkish colleagues and are looking forward to meeting them all as soon as possible. The road for a better “health for all” is still long, but together we are stronger!

Please, find attached to this post the presentation of Turkish residency programme. More information will be soon updated on the website.

Public Health Residency Turkey

 

*http://dergipark.gov.tr/download/article-file/152999

A road map for professionalisation: the ASPHER/WHO/CoP meeting at the Imperial College of London

In mid-June, we had the opportunity to strengthen once again our partnership with ASPHER.
As you may know, EuroNet has been working with ASPHER and the WHO on the professionalisation of the public health workforce. This project has three main areas of work:
· The Professionalisation Road Map
· The Competencies framework
· The Accreditation work
A Working Group led by Jo McCarthy has been giving opinion and advice on the first two areas of work.
As a key stakeholder, EuroNet was invited to the expert meeting held on the 19th of June in London. In there, different experts and stakeholders from across Europe discussed the way in which the public health workforce can achieve the same degree of professionalization than other medical specialties. We also discussed the common framework of competences that a public health professional should achieve and what would the accreditation process.
Three Euroneters (Damiano, Damir and Alberto) participated in the key discussions led by ASPHER and WHO senior public health professionals, such as Katarzyna Czabanowska, Anna Chichowska or Jose María Martín Moreno. It was a very productive meeting in which we were strengthened our commitment with this project.
Alberto had the opportunity to share his insights as a key note listener at the end of the day. Also, Damir Ivankovic, as a member of ASPHER’s executive board, stayed in London for the rest of the week participating in the ASPHER retreat.
As usual, we used our visit to London to visit euroneters around the world. In this case, we had the opportunity to visit Diogo, from Portugal; and to share stories, views and public health opinions whilst enjoying a pizza in central London.

Promoting Public Health – EuroNet workshop in Catania

On Friday the 15th of June, we had the opportunity to present a workshop at the “Giornate degli Specializzandi di Igiene e Medicina Preventiva”. This is an annual congress that brings together all the public health residents in Italy. This year it took place in the beautiful city of Catania, Sicily.
The workshop was organised on the second day of the congress. Alberto, EuroNet’s president, and Spela, E-RECT’s working group lead, presented the session. During the workshop, both euroneters described the network to our Italian colleagues, as well as the work that we do in relation to improving the public health training programmes in Europe.
After a couple of short presentations, the Italian residents were divided in groups and asked to give their opinion about how public health could be promoted as a popular specialty among medical students; and about the good and not so good aspects of their residency programmes. Their responses were discussed and collected, so that they can inform future work of the network.
The workshop proved to be popular, generating useful discussions which prove the importance of the topic.
We were also able to see old euroneters who we hope to see soon and to meet new residents, some of which have been gifted with EuroNet’s party spirit (to be continued in Valencia). We really enjoyed the Sicilian hospitality, which included a large amount of aubergines and late parties.
We want to thank specially Robin Thomas, who was “in charge” of us. He really did a fantastic job and we are very grateful to him.
We hope this is only the beginning of EuroNet’s involvement in national events such as this one. By being present in this type of congresses, we ensure that our work is aligned with the interests of public health residents across all European countries.
Once again, grazie per tutto EuroNet Italy!

EuroNet MRPH Spring Meeting – Nancy 2018

EuroNet Spring Meeting will take place in Nancy from 8th to 10th March!
The main theme will be prevention. Join us and discover the many ways of promoting prevention policies!

On the first day, we’ll start by our working groups. Then, the official inauguration will take place at 13.30 (don’t miss it, there might be surprises!). Afterwards a round table of experts will discuss local prevention policies in a city. How do a metropolis, a city, a regional health agency all interact to develop prevention policies on a territory in France?

Then you’ll see two examples of prevention projects, lead by different actors: a company and an association.

On the second day, we’ll talk about prevention in hospitals. How to educate patients? But also, how to reach healthcare professionals with prevention?

In the afternoon, a very exciting part: a member of the French parliament will talk about France’s view on Europe and public health, on how to develop a social Europe and how to better European health policies. Then two members of the ETHIK IA group of reflexion (a national group of experts on Artificial Intelligence) will discuss the impact of big data and AI on the future of Public Health in Europe.

Finally, Saturday will be of course our traditional EuroNet day.

You like the program? You’ll like the social events even more!

From typical French breakfasts (hello baguettes and croissants), to lunches in typical restaurants, your stomach surely will be happy!

And  in this beautiful and very festive city (can you imagine, 50.000 students for 100.000 inhabitants??) I promise you will remember the trip ; )

So stop hesitating, fill in the registration form and book your flight/train right now!

Welcome to NANCY!

Hélène
Organizing Committee