Council of State and Territorial Epidemiologists

See schedule oinfectious disease:cste helps support cdc's respiratory virus hospitalization surveillance networks for influenza, covid-19, and respiratory syncytial virus (rsv), collectively referred to as resp-net. We provide cdc funding to selected State and local health departments to collect data on laboratory-confirmed respiratory virus-associated hospitalizations among children and adults. For the 2022-2023 respiratory virus season, cste funded seven sites to conduct influenza hospitalization surveillance, four sites to conduct covid-19 hospitalization surveillance, and two sites to conduct rsv hospitalization surveillance. Data gathered from the cste-supported sites are combined with data from cdc's emerging infections program. This forms a robust network that provides key data for understanding the burden and characteristics of these viruses in the population, which helps public health better respond to and prevent these serious infections that cause substantial impacts on the u.s. population each year.data are submitted to cdc with hospitalization rates presented on the resp-net interactive dashboard, which can be used to follow trends and compare covid-19, influenza, and rsv-associated hospitalization rates in different demographic groups including by age, sex, race and ethnicity, and across seasons. Resp-net provides critical information on respiratory virus-associated hospitalizations to help public health professionals understand trends in virus circulation, estimate disease burden, and respond to outbreaks. Collecting demographic and clinical information for hospitalizations allows cdc and health departments to better understand how well vaccines are working, which people are at high risk, and whether a certain strain of a virus is resulting in more severe illness or deaths. These findings can be used to communicate important prevention information to the public to help people stay healthy and safe.

See schedule osurveillance / informatics:this year saw the launch of cste stories from the field, a multimedia project highlighting the great work of cste members and other Epidemiologists across the country who've efficiently leveraged data modernization funding and principles to improve public health at the jurisdictional level through meaningful and innovative use of data.cste launched the website, stories.cste.org, in march as a one-stop shop to view and read nearly 180 tales of epi innovation. The stories showcase innovative ways public health departments are working to get better, faster, actionable insights for decision-making at all levels of public health. The project highlights not only technological innovations but also the Epidemiologists who have researched and implemented data modernization solutions in areas such as electronic case reporting (ecr), interoperable data systems, syndromic surveillance, and more.much of this work was done under great stress and provides examples of "triumph in the face of adversity" during the global response to the covid-19 pandemic, while the u.s. public health infrastructure and workforce were stretched to the limit.the initiative was funded by cdc's office of public health data, surveillance, and technology (ophdst). Cdc director dr. mandy cohen praised the project and featured Epidemiologists, saying "public health is a team sport and this is a great example of us working together to protect health and improve lives. These stories highlight critical components of how communities are improving their readiness to investigate and respond to disease threats. Cdc and public health partners such as our State Epidemiologists are putting data and evidence into action to help people and communities stay healthy. "additional themes of the stories include laboratory data exchange, public health data science workforce, partnership and innovation, interoperable data systems, and enterprise approach to data systems modernization. These data modernization efforts represent a significant return on the investment of funding, staff, time and resources into data modernization to improve public health in jurisdictions across the country. and that impact is not over; many of the initiatives featured in cste stories from the field will continue, be expanded or generate other efforts going forward and in preparation for future threats.

See schedule oenvironmental health / occupational health:every year, over 3.5 million of the 167 million workers in the u.s. are injured on the job or become ill as a result of exposure to health hazards at work. These work-related injuries and illnesses result in substantial human and economic costs for workers and employers and for society at large; it has been estimated that the direct and indirect costs of work-related injuries and illnesses exceed $170 billion annually.in partnership with cdc's national institute for occupational safety and health (niosh) and State occupational health programs, the cste occupational health subcommittee help to quantify the burden of such injuries and illnesses through the occupational health indicators (ohis). Ohis are 25 measures of health (work-related disease or injury) or factors associated with health (workplace exposures, hazards, or interventions) that allow a State to compare its health or risk status with that of other states and evaluate trends over time. The cste occupational health subcommittee provides ongoing review, guidance and collaboration for annual State reporting of ohis. Data from the 29 states that calculate ohis for their State are posted on the cste website at httpswwwcsteorgpageohindicatorsta... This year's review included a new, updated document, "occupational health indicators: a guide for obtaining and tracking occupational health conditions and their determinants, an analysis of 2020 ohi data," to help states continue to develop priorities for workplace injury and illness prevention. This "how-to" guide assists states in building capacity for occupational health surveillance. "the how-to guide provides detail of how to collect and analyze the data, and the required interaction with other state/federal partners shows the health department the partners it needs to assure the sustainability of the effort," said ken rosenman, md, chief, division of occupational and environmental medicine at Michigan State university, and co-chair of the cste occupational health subcommittee.the indicators complement other State and national goals to improve population health and are intended to be used in conjunction with other guidelines for state-based surveillance of occupational injuries and illnesses, such as the guidelines for minimum and comprehensive state-based public health activities in occupational safety and health httpswwwcdcgovnioshdocs2008148pdf... process of obtaining the data for these indicators is intended to raise awareness and build capacity for using available data and to open dialogue among occupational health partners within the State. "the occupational health indicators are a great way for a State health department to begin to assess the burden of occupational injuries and illnesses in their states," said rosenman.

Workforce:this year, cste's data science team training (dstt) program helped give the madison & dane county health department in Wisconsin a major "upgrade" in data collection skills. Dstt is a team-based, on-the job training program to promote data science upskilling at stlt public health agencies and participants work collaboratively on a project that addresses a current agency need related to data modernization. When kat grande, public health supervisor at public health madison and dane county, saw an email promoting the dstt program, she immediately thought of a project that would make a great fit. At the height of the covid-19 pandemic, grande and her team built a covid data dashboard that was well received by the public and was viewed over half a million times. "we framed a dstt project on how to expand [the dashboard] to include the breadth of respiratory illnesses and make it easy to understand," she said. "you did not need extensive training in epidemiology to interpret it. We used plain language, simple visualizations strategies for communicating to the populations most impacted." To help with building this new dashboard, the dstt program allowed grande and her team to take courses in software like r and saas. Instead of googling and watching youtube videos, the team attended a formal class with live instructors. The comprehensive training allowed grande's team to build not just a standard dashboard, but an innovative one that pulls in multiple data streams. "one thing that sets ours apart is that we used the traditional public health data that you see on the cdc and other health department dashboards," she said. "but also made some really deliberate partnerships with our university researcher partners and tried to apply some of the research that they were doing on things like air surveillance. "in addition to air surveillance, another innovative feature of their dashboard was to incorporate school absenteeism into flu surveillance. "the ability to have the time, the space, and the creative encouragement from the dstt structure so that we could make some of those innovations, on top of a traditional disease-related dashboard, was really additive," grande said.

Public health law:during the covid-19 pandemic, cste's leadership in some areas was quite visible, from updating Epidemiologists nationwide on the latest information from cdc sometimes multiple times a day to supporting virtual gatherings for best practice sharing while many areas were still in lockdown. However, another area in which we also offered guidance and support was less visible and is perhaps less well recognized as part of cste's expertise: public health law.created in 2021, the cste public health law subcommittee provides a forum for Epidemiologists, public health attorneys, and other health and legal experts to collaborate on legal issues related to surveillance, epidemiology, and public health practice.the subcommittee offered much needed expertise to public health officials and Epidemiologists in response to legal questions and challenges on aspects of the covid-19 pandemic, including vaccines, quarantine, and other issues. The controversies surrounding these issues, as well as rapidly changing public health needs, meant that applying related laws was not always clear.to provide information and guidance, the subcommittee presented a three-part webinar series on legal issues related to the pandemic, helping advise public health officials of their legal standing in these areas. The first discussed students returning to school after widespread school closures, quarantine and other k-12 legal issues, including whether schools could require quarantine of infected students. The second focused on threats to the authority of public health and the legal avenues available to ensure that sound public health guidance was provided in response to the pandemic. The third webinar provided a legal analysis of indoor air quality and the measures being taken to manage that to prevent the spread of covid-19.in addition to this series, the subcommittee is working to present quarterly webinars going forward, to continue advising and supporting cste members and public health organizations on pertinent legal issues. The subcommittee will continue in its mission to design and implement practical legal solutions to complex public health challenges and use the tools of law and policy to advance public health efforts.

Chronic disease / maternal and child health:facilitating the creation, approval, and implementation of standardized case definitions and recommending which conditions should be on the nationally notifiable condition list are core functions of cst. Each year at our annual conference, the cste membership votes on position statements describing these definitions and recommendations. This process is essential for impacting standard practices and policy to improve public health nationwide.in june 2023, the position statement "update to the neonatal abstinence syndrome (nas) standardized case definition" was approved, addressing a growing issue in maternal and child health. The opioid crisis in the united states has continued to intensify in past years, including increased opioid and polysubstance use during pregnancy, which can result in withdrawal signs in newborns, known as nas. This critical position statement update is built from years of collaborative work to improve the original 2019 nas definition, clarifying interpretation and consistency in reporting across jurisdictions and addressing concerns identified by public health organizations.after the original definition was adopted, cste funded six jurisdictions to pilot implementation from 2020-2023 and provide data and feedback Arizona, Florida, Georgia, Massachusetts, Tennessee, and philadelphia. They found that the original definition was sometimes difficult to implement in a standardized manner and simplification was needed in the case classification structure. "to have a common surveillance case definition for neonatal abstinence syndrome allows for measures that can be compared more accurately and to evaluate the impact of surveillance and intervention programs," said luigi garcia saavedra, mph, birth defects epidemiologist supervisor for the new mexico department of health and co-chair of the cste maternal and child health subcommittee. "i think the revisions were very useful to improve the case definition. "to address the lessons learned and recommendations from the pilot, cste convened a leadership group to spearhead revisions, which included pilot project teams, other jurisdictions that have been conducting nas surveillance, subject matter experts from cdc's national center for birth defects and developmental delays, the cste maternal and child health subcommittee, and the cste nas workgroup.cste has now funded four of the pilot sites to continue, using pilot data to conduct analysis projects to explore the feasibility of longitudinal surveillance among infants born with nas and support referral services to families impacted by the condition. The nas workgroup is also developing an implementation guide to support jurisdictions that are beginning nas surveillance and will continue to assess responses needed to improve the health of mothers and children in communities nationwide.

Injury, substance use, and mental health:in the last two decades, the number of drug overdose deaths in the u.s. has quadrupled, rising from 16,849 in 1999 to over 70,000 in 2019 more than 840,000 in total. To address this crisis, public health must coordinate with first responders, community harm reduction programs and treatment providers. However, defining an unusual increase in overdose deaths such as an outbreak or cluster can vary and depends on circumstances in the local community. This can make it difficult to determine and mount a public health response.in august 2022, the cste overdose spike alert advisory workgroup launched the cste overdose anomaly toolkit to help communities meet these complex and ever-growing challenges. With funding through cdc's overdose data to action (od2a) cooperative agreement, workgroup members from cdc, State and local health departments, cste staff and consultants created the toolkit to provide public health response teams with a comprehensive approach to conducting a timely and effective investigation into notable increases in a city, county or region.the toolkit helps communities improve the use of their overdose surveillance data to empower prevention and response. With guidance, tools and techniques from the toolkit, they can determine and define what needs a response and at what level that should be made to deliberately react to changes in the community. This helps communities plan and utilize their resources more effectively.the toolkit is organized around three activity areas in an iterative model: plan, act and evaluate. These feature real examples of jurisdiction-based activities that can be used to help public health responders better prepare for, detect and respond to drug overdose outbreaks.at this stage in the overdose epidemic, communities understand there is a baseline of events in their jurisdictions and have implemented prevention programs. But they often need tools to understand what changes in overdose levels warrant additional action and what steps can be taken when that action is required. The cste overdose anomaly toolkit provides guidance for communities that may not have the experience, resources or time to create the needed response when an overdose spike or cluster occurs.

Tribal epidemiologywhat began as a workgroup project in 2020 to understand the challenges many native americans faced in accessing covid-19 vaccinations, testing and personal protective equipment (ppe) ultimately evolved into a 2023 manuscript publication in the journal of health disparities research and practice. Along the way, the effort illustrated how communities are better served when better quality data is used, as well as how cste, our subcommittees and our workgroupsuse the power of epidemiology to foster those types of improvements.the manuscript, "covid-19 severity among american indians and Alaska natives in 16 states - january 1, 2020, to march 31, 2021," is the second article to be published by the cste tribal subcommittee. The collaborative group of over 20 tribal epidemiology center (tec) and State public health staff members initially published findings in a cdc morbidity and mortality weekly report in 2020 and followed that up with additional data collection in 2021. "we knew the limitations of the mmwr, which focused on the burden of disease, and we wanted to do something deeper," said jessica arrazola, cste director of educational strategy and one of the manuscript's authors. "so, we looked more at severity of disease, co-morbidity, hospitalizations and deaths. The disparities were not related just to having the disease, but the outcomes were much worse for the native american population. "many states were collecting data on native american communities differently, and some didn't have separate data for this community or included those identifying themselves as multiracial only as hispanic. Through collaboration with tecs, the cste subcommittee had more commonality in case reporting definitions and data, allowing for better and more rigorous analysis. Being able to utilize improved data helped lead to one of the main conclusions of the article, that "covid-19-related health burdens among ai/an persons warrant improved access for ai/an communities to medical countermeasures and healthcare resources. "since publication, the manuscript has been downloaded more than 110 times, illustrating the importance of the research and findings. "this collaboration is a great example of people who truly care about their communities using data to inform action that will protect and care for those communities," said arrazola.