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In this issue:

1. Resource Allocation Plan for County Health Departments Public Health Preparedness and Response for Bioterrorism Surveillance and Epidemiology Capacity

2. Training Opportunity: Regional Epidemiology Seminar

*No Weekly Disease Table due to Technical Difficulties

1. Resource Allocation Plan for County Health Departments Public Health Preparedness and Response for Bioterrorism Surveillance and Epidemiology Capacity

Background: The Florida Department of Health was awarded approximately $40 million by the Centers for Disease Control and Prevention (CDC) as a cooperative agreement for Public Health Preparedness and Response for Bioterrorism. Of those resources, $8 million are allocated for surveillance and epidemiology (identified as focus area B in the cooperative agreement). (A copy of the section of the FDOH application for focus area B is attached). Of the $8 million, $6 million are being made available directly to county health departments.

Of the $6 million allocated for CHDs, $4 million is available for surveillance and epidemiology staff (category #1) and $2 million is available to support the enhancement or development of surveillance and epidemiology systems (category #2).

Resources for staff enhancement, and for surveillance and epidemiology projects or systems will be directed toward the three (surveillance and epidemiology) Critical Capacities and Critical Benchmarks as described by the CDC. They are as follows:

CRITICAL CAPACITY (1): to rapidly detect a terrorist event through a highly functioning, mandatory reportable disease surveillance system, as evidenced by ongoing timely and complete reporting by providers and laboratories in a jurisdiction, especially of illnesses and conditions possibly resulting from bioterrorism, other infectious disease outbreaks, and other public health threats and emergencies.

CRITICAL CAPACITY (2): to rapidly and effectively investigate and respond to a potential terrorist event as evidenced by a comprehensive and exercised epidemiologic response plan that addresses surge capacity, delivery of mass prophylaxis and immunizations, and pre-event development of specific epidemiologic investigation and response needs.

CRITICAL BENCHMARK (2-A): Assess current epidemiologic capacity and prepare a timeline for achieving the goal of providing at least one epidemiologist for each Metropolitan Statistical Area (MSA) with a population greater than 500,000.

CRITICAL CAPACITY (3): to rapidly and effectively investigate and respond to a potential terrorist event, as evidenced by ongoing effective state and local response to naturally occurring individual cases of urgent public health importance, outbreaks of disease, and emergency public health interventions such as emergency chemoprophylaxis or immunization activities.

CRITICAL BENCHMARK (3-A): Prepare a timeline for developing a system to receive and evaluate urgent disease reports from all parts of county on a 24 hour per day, 7 day a week basis.

Note: "Related Strategies" for these Critical Capacities and Critical Benchmarks are attached.

GOAL: County Health Departments (CHDs) will increase their surveillance and epidemiology capacity by increasing staff resources and through systems development or enhancement.

CHDs will be supported to expand their epidemiologic capacity to investigate and mitigate unusual outbreaks of illness that may be the result of bioterrorism, other outbreaks of infectious disease, other public health threats and emergencies. They will also be supported to enhance, design, and/or develop systems for the rapid detection of such outbreaks of illness.

The following options are available for funding. Based on previous deliberations with CHD representatives during the development of the federal grant submission. It is expected that most CHD funds will go into category 1 and most HQ funds will go into category 2.

Funding Requests: County health departments may request staff to support surveillance and epidemiologic activities that address the critical capacities and benchmarks. Examples of the categories of personnel that could be funded in this category include, but are not limited to the following:

1. Surveillance and Epidemiology Staff
2. Physician and laboratory liaison staff
3. Florida Epidemic Intelligence Service (FL EIS) Staff
4. Epidemiology DIS Staff (must be assigned to the epidemiology staff)
5. On-call pay for existing staff
6. Answering service or other systems to increase availability of existing staff

Funding guideline for Category 1: Funding for surveillance and epidemiology staff support will be based on an allocation guideline of $.23 per capita. Counties should not submit proposals or expect to receive funds beyond that amount.

Note for CHDs with limited populations: Using the per-capita formula, some counties would receive allocations that would not be sufficient to support any staff enhancement. Counties in this category can elect to:

1) Work with existing or new consortia to pool resources. Only one submission form is required but must designate a lead CHD and clearly document all participating CHDs and respective roles of each.

2) Receive direct staff assistance from the Bureau of Epidemiology by way of support from a regional epidemiologist. CHDs should document specific services requested of this staff member. CHDs should make that request on the "Bioterrorism Surveillance/Epidemiology Staff Request" form.

All requests for funding surveillance and epidemiology staff should be made on the "Bioterrorism Surveillance/Epidemiology Staff Request" form (attached). The form should be submitted to Don Ward in the Bureau of Epidemiology, by mail, e-mail or fax. Proposals for the initial round of funding must be received in Tallahassee not later than August 31, 2002.

A review panel selected by the Bureau of Epidemiology will review all projects submitted by CHDs and will include CHD and regional preparedness representation.

Project Review Criteria: The criteria to be used in the ranking of county projects is as follows:

• Description of the relationship of the position to a Critical Capacities and Critical Benchmarks—25 points

• Projected capacity of the staff assignment to enhance surveillance for potential bioterrorist events at the county level—25 points

• Projected capacity of the position to serve as a member of a statewide response effort—25 points

• Impact of this position on the county’s surveillance and epidemiology infrastructure by the end of the funding period—25 points.

Funding requests: County health departments are invited to submit requests for funding to support the development or enhancement of county-level surveillance and/or epidemiology projects to accomplish the objectives defined in the Critical Capacities, "Critical benchmarks" and/or "Related Strategies."

All requests for funding of surveillance and epidemiology projects should be made on the "Bioterrorism Surveillance and Epidemiology Project Proposal " form (attached). The project form should be submitted to Don Ward in the Bureau of Epidemiology, by mail, e-mail or fax. Projects for the initial round of funding must be received in Tallahassee not later than August 31, 2002.

A review panel selected by the Bureau of Epidemiology will review all projects submitted by CHDs and will include CHD and regional preparedness representation.

Funding Limitations: Projects with projected total costs of more than $100,000 should not be submitted and will not be reviewed.

Project Review Criteria: The criteria to be used in the ranking of county projects is as follows:

• Description of the relationship of the project to a Critical Capacities and Critical Benchmarks—25 points

• Projected capacity of the project to enhance surveillance for potential bioterrorist events at the county level—25 points

• Potential for the project to serve as a model for replication in other counties—20 points

• Potential for interface with statewide systems such as Merlin and EpiCom—20 points

• Budget justification—10 points

• A multi-hospital syndromic surveillance system with 24/7 ability to respond to signals and includes follow-up and an evaluation component
• Development of a county–level 24/7 disease reporting system
• A project to enhance awareness about BT agents in the provider community
• A project to automate further analysis of Merlin data
• For additional examples, see attached document "Related Strategies for Critical Capacities and Critical Benchmarks"

• Projects that replace or provide "work-arounds" for the Merlin or EpiCom systems
• County–level projects for electronic laboratory reporting
• IT projects that are largely research and development
• Most funding projects that "pass-through" funds to non-DOH entities

County health departments may also elect to participate (as co-developers and pilot counties) in a number of state level bioterrorism surveillance projects. For those counties indicating a wish to do so, the Bureau will form a consortium and negotiate costs. Resources for these activities will be available only after CHD projects are reviewed and funded. State/county cooperative projects include:

• Development and implementation of medical examiner BT surveillance

 Evaluation of syndromic surveillance systems (with Bureau of Epi and CDC).

Attachments to Resource Allocation Plan:

2. Training Opportunity: Regional Epidemiology Seminar

Melanie Black, MSW, Professional Training Coordinator, Bureau of Epidemiology

The Bureau of Epidemiology is pleased to announce the next training program for county health department staff members, which will be held in Sarasota County on Thursday July 18^th & Friday July 19^th, 2002 The target audiences for the regional training programs are county health department staff members and partner agencies who are involved in epidemiology. County health directors and administrators are welcome to attend.

This program will provide an overview of epidemiologic principles such as disease reporting, disease surveillance and communicable disease outbreak investigation. On-line registration is now available through Friday, July 12, 2002 and can be accessed through the Internet site-http://www.doh.state.fl.us/disease_ctrl/epi/conf/training/index.htm. Space is limited so please register as soon as possible.

Additional information will be provided in the Epi Update and on the Bureau of Epidemiology Web page. We intend to offer training programs in other regions of the state this year. If you are interested in hosting one of the training sessions or have questions related to this program, please feel free to contact Melanie Black, the Professional Training Coordinator for the Bureau of Epidemiology. She can be reached at (850) 245-4444, ext.2448 or SunCom 205-4444,ext. 2448.

We are truly excited about the potential this program offers for improving disease prevention in Florida.