BACKGROUND: As a decentralized state, the burden of enteric disease investigations in Indiana resides with each of the state’s 93 local health departments (LHD). In 2014, Indiana investigated 730 reported cases and 44 clusters/outbreaks of salmonellosis alone. Given that exposure histories are quickly forgotten, timely follow-up is critical for thorough investigations. However, due to the multitude of disease investigations burdening LHDs, timely investigation of salmonellosis is not always feasible, resulting in unidentified cases and sources of exposure.
METHODS: The Indiana State Department of Health (ISDH) and the Indiana University Richard M. Fairbanks School of Public Health (RMFSPH) developed a team of public health graduate students to investigate cases and outbreaks of salmonellosis. LHDs were selected on a volunteer basis and given the opportunity to suggest program needs. A three-month pilot program was implemented to assess the effectiveness of utilizing the student epidemiology response team, IU-SERT. Four students, selected by the RMFSPH, comprised the initial IU-SERT. A satisfaction survey was sent to all participating pilot LHDs to evaluate program success. Student’s t-test was used to evaluate investigation timeliness before and after implementing IU-SERT.
RESULTS: Fifteen LHDs volunteered to allow the IU-SERT to conduct salmonellosis investigations for their jurisdiction. The IU-SERT satisfaction survey had a response rate of 80% (12/15) with 75% (9/12) of these LHDs stating they would recommend the program to other LHDs without changes. LHD suggested improvements focused on enhancing communication opportunities between the IU-SERT and the LHD. The number of days to complete a salmonellosis investigation from mid-May to December, comparing the LHD in 2014 and the IU-SERT in 2015, significantly decreased from 15.38 (±22.23) days to 8.13 (±8.76) days, p-value = 0.006.
CONCLUSIONS: Overall IU-SERT has been well received by the LHDs and improved the timeliness of salmonellosis investigations. Successful implementation enabled us to begin recruiting additional LHDs and expanding the program beyond enteric disease investigations.