My Career Pathway as a Public Health Veterinarian at CDC

Transcription

1 My Career Pathway as a Public Health Veterinarian at CDC Stephanie R. Ostrowski, DVM, MPVM, ACVPM CAPT (Retired, 2010) USPHS Food Safety Resident I, CAHFS UC Davis

2 I started out as a child (Bill Cosby) How old were you when you knew you wanted to be a veterinarian? 5 acres; rural southern Maryland Dogs, cats, horses, goats Rural, non-farm Worked for local small animal vet high school Role model was our large animal practitioner Calm and knowledgeable

3 Black Beauty, James Herriot and Vet School DVM 1980 University of Georgia st experience with cattle USDA Brucellosis eradication Herd health, Intro to epi, Large Animal Medicine /Surgery Atlanta Humane Society (1 st job)

4 Rural Practice, Here I come! 1981/82 Food Animal Internship Caldwell, Idaho (WOI) 1982 (~6 mos) Ranch practice Elko, Nevada Small Animal Practice Atlanta, GA area Herd Health Residency UC Davis

5 After Internship, Residency + MPVM CDC? (Hmmm this is not rural practice, is it?) Practice opportunities limited Wanted to solidify epi skills Applied to CDC s Epidemic Intelligence Service got accepted (Yikes!) EIS matching program EIS spring conference + interviews Not quite what I was expecting, but.

6 EIS Officer at NCEH (National Center for Environmental Health), CDC Division of Environmental Hazards and Health Effects (EHHE) DVM/ EIS Alum studying animals as sentinel species at Superfund sites. OH NO! My mentor left for another CDC job! Lead poisoning became the focus Community/ childhood lead screening - Alaska, Hawaii, Tennessee Occupational Health / Community exposures - With NIOSH in Jamaica

7 Getting back to veterinary practice Worked hrs/ week at a small animal emergency clinic while in EIS But I really missed herd health/ food animal practice left CDC for Dairy Practice Texas Father was diagnosed with pancreatic cancer in Florida; left TX practice after 6 months to help / be there for him. No temp license in FL! 1990 FDA CVM in Rockville, MD 6 months as target animal toxicity reviewer for use of bovine somatotrophin in dairy cows

8 Returned to Atlanta; late 1990 Temp/ Part time Small Animal work Re-hired by Emergency Clinic ~ 18 mo April 1991 CDC EIS Conf/ job fair -- Hired! : ATSDR -- Agency for Toxic Substances and Disease Registry; Div. of Health Assessment and Consultation Public Health Assessments Superfund Sites -- One Health Great boss, great colleagues, real issues of importance to communities across U.S.

9 Division of Quarantine, NCID Staff Veterinary Epidemiologist 42 CFR Part 71. Foreign Quarantine Immediate aftermath of Ebola Reston Non-human primate import program Approx. 90% of importers could not meet import quarantine biosafety standards. Inspections: quarantine facilities and shipments Miscellaneous vector species Imported Dogs and cats rabies vaccination Egyptian fruit bats revised live bat permit requirements (science, conservation only) Exotic pets: rodents monkeypox, hantaviruses

10 Translocation One Health One Medicine Encroachment Introduction Spill over & Spill back Wildlife Human encroachment Ex situ contact Ecological manipulation Human behaviors Agricultural Extensive Production Domestic Animal Human Global travel Urbanization Biomedical manipulation Food processing/distribution Technology and Industry After Daszak P. et.al. Science :443

11 Monkeypox Outbreak, 2003 Weekly June 13, 2003 / 52(23); Multistate Outbreak of Monkeypox --- Illinois, Indiana, and Wisconsin, 2003 CDC has received reports of patients with a febrile rash illness who had close contact with pet prairie dogs and other animals. The Marshfield Clinic, Marshfield, Wisconsin, identified a virus morphologically consistent with a poxvirus by electron microscopy of skin lesion tissue from a patient, lymph node tissue from the patient's pet prairie dog, and isolates of virus from culture of these tissues. Additional laboratory testing at CDC indicated that the causative agent is a monkeypox virus, a member of the orthopoxvirus group. This report summarizes initial descriptive epidemiologic, clinical, and laboratory data, interim infectioncontrol guidance, and new animal import regulations.

12 Emerging and Re-emerging Zoonoses, or relatively rare events? Cryptosporidiosis West Nile Virus Hantavirus pulmonary syndrome Lyme Borreliosis Leptospirosis Venezuelan Equine Encephalitis Reston virus Lassa fever Recent outbreaks Rabies / Angola and Indonesia E.coli Marburg O157 / Uganda Rocky Mountain Spotted Fever/ Mexico Nv-CJD Salmonella / USA Tularemia / USA, Kosovo Yellow fever / Ivory Coast Brucellosis / Mongolia Multidrug resistant Salmonella E.coli non-o157 Brucellosis West Nile E. coli 0157 / Canada Hantavirus / US BSE-vCJD/ UK Yellow Nipah fever virus / Malaysia Avian Influenza / Hong Kong Ebola West Nile / USA, Canada Ebola / Gabon, Congo BSE /Canada Monkeypox / DRC/ US SARS / Global Avian Influenza H5N1 Rift valley Fever Monkeypox Equine morbillivirus Hendra virus E.coli O157 NV-CJD Influenza A(H5N1) Reston Virus Nipah Virus Ross River virus

13 Trying to advocate for a One Health perspective before One Health was cool Miami Port of Entry Inventory Totals At least 3 federal agencies have jurisdiction. (USDA, CDC, USFWS) Importation of most wildlife and products to USA as items of commerce (e.g., pet trade) is still largely unrestricted. Strip-mining of foreign ecosystems Mammals = 6976 Sugar Gliders = 4342 Monkeys = 452 Rodents = 1182 Reptiles = 1,078,656 Caimans = 15,023 Lizards = 935,307 Snakes = 79,770

14 1996 Miami Q.S. Inventory Totals Snakes: Adders = 214 Anacondas = 514 Boas = 25,516 Cobras = 136 Mambas = 44 Pythons = 45,645 ~30,000 baby reticulated pythons Vipers = 721 Other = 7024

15 N.J. Cobra bite victim recovering as probe of snake purchase continues (Thursday, February 3, 2011)

16 ATSDR Division of Toxicology Emergency Response/ Consultation Team Emergency Planning and Response (CDC) Consultative veterinary support for ATSDR s 10 Regional Offices Lead Office at CDC for industrial chemical emergencies; interfaced with EPA and USCG HAZMAT spills 24/7 phone consultation Food Chain/ livestock agriculture impact

17 Polio Eradication, Bangladesh

18 Detailed to USDA / MAFF (UK) for FMD Surveillance, May/June 2001 Surveillance of FMDunaffected farms in Cumbria Permit normal activities, lift quarantine in infected areas. DVMs are trusted agents in rural communities. Recognized far-reaching economic and psycho-social impacts on farmers and rural communities.

19 Sept 11, 2001 New York City

20 And then came 9-11, Anthrax attacks, Response, and Recovery Assisted with staffing CDC Emergency Operations Center : Emergency Bioterrorism Response Coordinator for ATSDR Technical / science support for Twin Towers environmental hazard assessment Anthrax Technical Sampling Teams U.S. Postal Facilities, Congressional Offices How clean is clean enough? Level B HAZMAT Response Team/ FBI AMI Building, Boca Raton, FL

21 ATSDR, NCEH, and NIOSH environmental health scientists and environmental engineers Anthrax Investigation in Postal Facility, Fall 2001

22 Coordinator for CDC/ATSDR s Chemical Terrorism Response Program CDC s Emergency Response Plan Chemical Weapons of Opportunity Training Program with ACMT >5,000 federal officers, public health, and physicians trained Department of State/ USAID consultation Russian-American Biotechnology & Toxicology projects Developed environmental health Cooperative Agreements with India and Poland

23 Deployed with USPHS to Hurricanes Katrina and Rita, Fall 2005

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25 Following Hurricanes Katrina and Rita, we saw a lot of.. Blaming the victims. Much bad press, unfair assumptions, and misconceptions regarding: Owners, Animals, State Animal Health Authorities Discrediting of previously successful evacuation strategies and experiences Louisiana State Pet Evacuation Plans Good record of successful evacuation sheltering for owned pets in previous years

26 Response to Hurricanes Katrina and Rita, 2005

27 Pet Owner Behavior in Disasters Studies indicate that pet-owning households are significantly less likely to evacuate during mandatory orders than households without pets (AJE : ); The more pets, the less likely household will evacuate. Owners will frequently go to great effort and risk personal loss or injury to protect or rescue the animals they love. Why? A sense of personal responsibility for the lives entrusted to our care is a hallmark of ethical human beings.

28 The Federal PETS Act of 2006 and PKEMRA -- What a Difference a couple of Laws Make! Federal Coordination of Response Resources for Household Pets and Service Animals to States and Local Governments CAPT Stephanie R. Ostrowski, DVM USPHS Veterinary Category NCEH/ATSDR CDC, Atlanta, GA FEMA Special Liaison for Animal Activities, 2005/2006 PETS Mission Area Lead for Evacuation Planning 2006 Companion Animals Management Unit, FEMA LA Warm JFO, AVMA Annual Conference July 21, 2008

29 Hurricanes Katrina and Rita, 2005 Livestock at Risk; Animal Carcasses

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31 Avian Flu and Swine Flu Preparedness and Response Pandemic Flu Preparedness (decades) Avian Flu in Nigeria; 2006 (CDC, WHO ) CDC Technical Consultative Mission Abuja, Nigeria. Epi, lab, programmatic aid ($$) Virulent strain; Avian cases; loss of commercial parent and grandparent stock Swine Flu H1N1 2008/09 relatively mild Mass vaccination US 2009 Flu season Human cases only; swine not affected Slaughter of all hogs in Egypt (bad policy)

32 State and Local Response: H1N1 Lessons Learned CAPT Stephanie R. Ostrowski, DVM, MPVM, DACVPM Acting Program Director Career Epidemiology Field Officer (CEFO) Program Coordinating Office for Terrorism Preparedness and Emergency Response July 7, 2009

33 Veterinarians at CDC AVMA Directory, State Health Department Assignees Reproductive Health Injury prevention/niosh Office of the Director AIDS/STD Infectious Diseases Immunizations Environmental Health Laboratory Animal Medicine EIS office Total: ~94

34 Diane Gross, DVM, PhD 1. Avian Flu CDC/ WHO human/ animal interface issues (lead for Africa and Asia) 2. Cost-effectiveness of Brucella vaccination of cattle in Egypt

35 EISO Kristy Murray, DVM ( ) Looking for Ebola reservoir species -- Collecting bats in the Philippines. (Also was on my Bangladesh STOP Polio team)

36 CDR Jennifer McQuiston, DVM Oral Rabies Vaccine Effectiveness

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38 Public Health Veterinarians in the Federal Government HHS-CDC HHS-NIH HHS-FDA HHS-FDA USDA-FSIS DOD- Army USDA-APHIS USDA-ARS Coop State Research, Ed, Ext DOD-Army DOD-Air Force USDA- APHIS USDA- FSIS 1200 Environmental Protection Agency DOI-USGS DOI-Fish and Wildlife 670 DOI-National Park Service DO Commerce DOS/USAID Total: ~2,800 DOI/Forest Service USDA-ORACBA DHS

39 USPHS Job Benefits Military Pay Scale and Increases 30-days vacation annually + holidays Special Pays Basic Allowance for Housing (non-taxed) Board-Certified Pay (taxed) TriCare (military) Health Coverage On/off base (Emory University in ATL) No premium or co-pay for officer; v. affordable for family Retirement-eligible at 20 years Veterans Benefits: GI Bill (education)

40 How do I find a federal job? 40 Many jobs are not designated for veterinarians Make contacts at meetings Entry or advancement often requires advanced education and/or board certification in a specialty MPH, MS, MPVM, PhD Preventive medicine, lab animal medicine FSIS short 100 veterinarians now and ~ in the next 5 years no additional training needed for many of their positions

41 Summary Exciting career opportunities in public health exist for veterinarians Training programs are important entry points ~ 0.5% of U.S. public health workforce; 2.8% of federal workforce A large % of federal public health veterinarians expected to retire in coming years The need for public health veterinarians is growing 41

42 Veterinarians at CDC As of December Job Activity 0 Epidemiologist Lab/research Pathology APTR Fellow Editor Communications Other

43 Student experiences 37 State and local health departments Opportunities with USDA, FDA University of Maryland program Public Health Service co-step program CDC - Summer student employment CDC Epidemiology elective

44 Epidemiology elective 38 September through June 6-8 weeks Defined project, often a chance to assist with outbreak investigations Deadline: May 30 th of your Junior year

45 What is the EIS Program? 20 Epidemic Intelligence Service (aka Disease Detectives ) Established in 1951 Mission: To prevent & control communicable diseases A 2 year training program in applied epidemiology Domestic and International Service Respond to Requests for Epidemiologic Assistance

46 Where do EIS Officers Train? 21 State and Local Health Departments E. coli TB in immigrants Lead screening Copper in drinking water Cryptosporidiosis Legionnaires' Disease/Norwalk virus Forest Fires West Nile Virus/Anthrax Bombing Hanta Virus Malaria Hurricanes Hurricane Hugo Cyclosporiasis Norwalk Virus

47 How do I find out more about EIS? officers, 6-9% are veterinarians Application process begins in May for the following year s class Additional training or experience in public health encouraged prior to application

48 Post-DVM opportunities 39 Fellowships Emerging Infectious Diseases fellowship Through APHL American Teachers of Preventive Medicine Fellowship Master s of Public Health Work study through CDC for Emory students

49 Take home messages 42 There is growing public concern regarding food safety, zoonotic diseases, environmental health issues, bio- and agro-terrorism Veterinarians are broadly trained and uniquely prepared to address these challenges Critical shortage of public health and food safety veterinarians projected in next 5-10 years

50 Acknowledgments 45 Nina Marano, CDC, HHS Jennifer McQuiston, CDC, HHS Diane Gross, CDC Jennifer Wright, CDC Kathryn Feldman, University of Maryland Steve McLaughlin, CDC Stephanie Ostrowski, CDC Marta Guerra, CDC John Dunn, Tennessee Department of Health Matt Schech, NIH