In your role as Minnesota’s state epidemiologist, how do you work with others to slow or prevent the spread of infectious disease?
Protecting the public’s health is a holistic endeavor which needs participation and collaboration from the public, clinical practitioners and public health staff at the local, state and federal levels. Certain disease are reportable to the Minnesota Department of Health (MDH) through clinicians, infection preventionists and laboratorians. Staff at MDH will conduct surveillance for these diseases, including abstracting medical records for demographic, clinical and outcome information. An isolate from the laboratory (depending on the disease) will undergo confirmation and characterization at the MDH public health laboratory (PHL). Sometimes case-control studies will be done to determine risk factors for disease. This information is then used to develop infection prevention and control measures that can be put into place, such as intrapartum antibiotic prophylaxis to prevent neonatal group B streptococcal (GBS) disease or conjugate vaccine to prevent pneumococcal disease in young children. Studies can then be done to assess the impact of these measures, and inform improved measures. For example, moving to a screening-only approach to prevent neonatal GBS (initial guidelines were risk-based or screening-based), or moving from a 7-valent pneumococcal conjugate vaccine to a 13-valent pneumococcal conjugate vaccine. It is also useful to partner with media to inform the public about infectious diseases and measures that individuals can take to minimize their risk of exposure.
Infectious diseases can emerge or re-emerge and it is essential to have a close partnership with clinicians who may recognize that something different is occurring. A number of years ago, a pediatrician reported a case of encephalitis that was investigated by MDH and found to be due to Powassan virus, an arbovirus transmitted by ticks and previously not recognized to occur in Minnesota. Subsequently, the PHL developed the diagnostic ability to test specimens and we have detected cases most years, and have developed and disseminated messages regarding the transmission of this virus by ticks and the importance of tick prevention measures.
What is one disease that has significantly less impact on Minnesota children today than their parents’ generation?
There are many, but I would like to single out Haemophilus influenza serotype B, because I remember so clearly children who had Hib meningitis or epiglottitis during my residency and the horror and impact of these infections on children. In particular, I remember a beautiful toddler who needed several trips to the operating room to have an epidural empyema drained. Also the anxiety and challenge of ensuring that a secure airway be placed calmly but promptly in a child with epiglottitis. There were cases of periorbital cellulitis and septic arthritis due to Hib, as well as bacteremia and pneumonia. Invasive Hib disease occurred at an estimated rate of 1 in 200 young children, prior to the introduction of Hib vaccine in the late-1980s. Hib is an extremely rare infection in young children today. In 2012, CDC reported 30 cases nationally in children under 5 years of age.
What do you enjoy most about your role at MDH?
Collaborating with dedicated people, both at MDH and external to MDH who really care about improving the health of the public. It is especially wonderful to work in Minnesota, because there is such interest and engagement from clinicians and academicians in collaborating around public health, and the public and policy makers are well informed and generally supportive of advancing public health.
If you could send one message to pediatricians, what would it be?
Get to know your public health partners. There is much we can learn from each other and strengthen our joint efforts to promote the health and well-being of the youngest members of our population.
Which pediatric infectious diseases are you most troubled by and why?
Measles. We have an extremely effective and safe vaccine against measles, and widespread use led to the elimination of endemic measles in the United States in 2000. However, large outbreaks of measles have occurred in the United States in recent years. Cases occur because a susceptible person is exposed either abroad in an endemic location, or is exposed in the United States to an imported case or to an outbreak-related case. A susceptible person who has face to face contact with an infected person has a 90 percent likelihood of developing measles. In Minnesota in 2011, we had 21 related cases, of which 14 were hospitalized. Nine of 16 unvaccinated cases were age-eligible for vaccine. A number of months later, an unrelated case in a young child occurred that required prolonged respiratory support. Measles can be a deadly disease. Measles vaccine has an undeserved image that could result in the re-establishment of measles circulation in the United States.
What are you hoping to accomplish through your involvement on AAP’s Committee on Pediatric Infectious Diseases?
I am hoping to bring a broad public health perspective to the Committee, which has a lot of academic and specific expertise. I have had the pleasure of working on vaccine effectiveness studies, outbreak investigations and developing policies for infection prevention and control on a wide variety of infectious diseases. I am also very interested in antimicrobial stewardship. The Committee is planning to increase their focus in this area, and I am looking forward to helping in these efforts.
What’s one thing most people are surprised to learn about you?
That I came into public health through the channel of infectious diseases, rather than having formal training in public health. I completed a pediatric infectious disease fellowship, including bench research. For the next five years, I attended at Massachusetts General Hospital doing in-patient pediatric infectious disease consults, had an outpatient clinic, and had a part-time position at the Massachusetts State Lab where I was involved in newborn screening for congenital toxoplasmosis. In 1997, my husband and I moved to Minnesota (Mike is from Minnesota and was aching to return), and I began working at MDH on a group B Streptococcus project as part of the Emerging Infections Program, and have stayed ever since.