Alternative Career Pathways John D. Tilden, DVM, MPH Food Safety Epidemiologist Michigan Department...
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![Page 1: Alternative Career Pathways John D. Tilden, DVM, MPH Food Safety Epidemiologist Michigan Department of Agriculture.](https://reader035.fdocuments.in/reader035/viewer/2022081514/56649f0d5503460f94c21d25/html5/thumbnails/1.jpg)
Alternative Career Pathways
John D. Tilden, DVM, MPH
Food Safety Epidemiologist
Michigan Department of Agriculture
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“We must be architects of change and not it’s victims”
Don Gingrich, Iowa pork producer
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Overview
• My Career Pathway
• The Information Explosion
• Field Epidemiology Investigations
• Lessons Learned
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Graduation Day: My Plans
• Large animal herd health
• Maybe some mixed animals
• Definitely no:– pigs– poultry– research– more schooling
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Timeline
• 1983 MSU
• 1983-1985 Mixed Animal Practice, Frederick, MD
• 1985-1986 School of Aerospace Med., San Antonio, TX
• 1986-1989 United States Air Force (MI)
• 1989-1990 Johns Hopkins University (MD)
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Timeline (continued)• 1990-1991 USDA, APHIS, Washington, DC
(Food Safety Policy)
• 1991-1993 USDA, APHIS, Puerto Rico(International Development,)
• 1993-1995 Epidemic Intelligence Service, CDC
• 1995-1996 Pseudorabies Eradication, S.W. Michigan
• 1996-Present Food Safety Epidemiologist
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Emerging Threats and the Information Explosion
• Data saturation
• Tendency to specialize
• Potential career springboard– funding source for further
education– Positions created to address
newly identified needs
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Food Safety Disciplines
• Biology
• Epidemiology
• Microbiology
• Public Health
• Animal Health
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Laboratory Evidence:PFGE Analysis
* * * * * * * * * *
* * * * * * * * * *
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Epidemiology
• The study of the distribution and determinants of diseases and injuries in populations.
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Dr. John Snow, September, 1854
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Exposure
+
+
-
- Total
9 0
0 3
9 3
9
3
12
Fisher’s Exact p value = .005
Disease
Statistical Evidence
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The Centers for Disease Control and Prevention
• Part of the U.S. Department of Health and Human Services
• Initiated in the 1940’s to control malaria in southern states
• Grew and evolved– disease outbreaks– effective treatment– education– prevention strategies
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Current CDC Structure• National Center for Infectious Diseases
• National Center for Health Statistics
• National Center for Environmental Health• National Center for Injury Prevention and Control• National Institute for Occupational Safety and
Health (NIOSH)
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Why Conduct Field Investigations?
• Increase understanding of disease
– “natural experiments”
• Assist prevention efforts
• Political pressure
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Or Tip of an Iceberg?
Isolated Snow Flake?
Checking out apparently isolated cases:
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6/27 8/2 9/6 10/11 11/15 12/20 1/24 2/27 4/30123456789
101112
Date
Nu
mbe
r of
Pat
ien
ts
Recall Usual listerosis incubation period
Fatal
Non-fatal
Multistate Outbreak of Listeriosis, United States, 1998-1999
PlantConstruction
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Disease Investigations
• Citizens• Private practitioners• Local department of public
health
• State government
• CDC
• Universities
Numberof
Cases
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Thum
bnail sketch of field epidem
iologic investigations
1. Receive rep ort of disease
2. Con fi rm
diagn osisC
ase Stu
dy
3. Determ
ine i f i ncrease d potent ial fo r disease t ransmission ex ists
4. Interve nt io n warra nted?
5. Further in vest igat io n w
arra nted?
6. Add it ion al case finding
Case S
e rie s
•Fo rm
ulate a case d efin it ion•D
escript ive analysi s of cases (person -p la ce-time)
•Hypo thesi s g enerat ion
7. Interve nt io n warra nted?
8. Test h ypo th esis vi a ana ly ti c epide m
io lo gic stu dies
•cohort stu
die s (exam
ple: foodb orne i l ln ess o utbreak s)•case -c on
tro l stud
ies (example: rare d ise ase in vest igat io ns)
9. Interve nt io n warra nted?
10 . Di ssem
ina te informat ion
•Prese ntat io ns
•Pu bl icat io ns
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Cryptosporidium• 1907: First described• 1976: First human case• 1981: First AIDS patient diagnosed• 1983: Person-to-Person transmission• 1984: Waterborne transmission (Well)• 1987: Waterborne transmission (Surface)• 1988: Waterborne transmission (Pool)• 1993: March 1993 - 403,000 ill in Milwaukee• 1993: August - 7 ill in Madison, WI
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Non-Foodborne Routes of Disease Transmission
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E. coli 0157:H7• 1982: First recognized as a foodborne pathogen
• 1984: Person-to-person transmission
• 1985: Association with HUS Documented
• 1990: Waterborne transmission
• 1991: Acid tolerance: apple cider
• 1992: Most common cause of bloody diarrhea
• 1993: Heat resistance
• November 1994 - 17 ill in Seattle, WA
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Lessons Learned
• If its not fun, its not epidemiology
• Ride the Funding Waves
• Never Say Never
• Stick to What You Care About
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Lessons Learned
• Freedom to change is important
• Keep your options open
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“Progress is the activity of today that ensures a tomorrow”
Ralph Waldo Emerson
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