My Career Pathway as a Public Health Veterinarian at CDC

My Career Pathway as a

Public Health Veterinarian

at CDC

Stephanie R. Ostrowski, DVM, MPVM, ACVPM

CAPT (Retired, 2010) USPHS

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DVM 1980 University of Georgia

1977 --1st experience with cattle

USDA Brucellosis eradication

1978-80 Herd health, Intro to epi,

Large Animal Medicine /Surgery

1980-81 Atlanta Humane Society (1st _job)

Black Beauty, James Herriot

and Vet School

Rural Practice, Here I come!

1981/82 Food Animal Internship Caldwell, Idaho (WOI)

1982 (~6 mos) Ranch practice Elko, Nevada

1983-84 Small Animal Practice Atlanta, GA area

1984-87 Herd Health Residency UC Davis

After Internship, Residency + MPVM … CDC?

(Hmmm … this is not rural practice, is it?)

Practice opportunities limited

Wanted to solidify epi skills

Applied to CDC’s Epidemic Intelligence

Service – got accepted (Yikes!)

• EIS matching program

• EIS spring conference + interviews

EIS Officer at NCEH (National Center for

Environmental Health), CDC

Division of Environmental Hazards and

Health Effects (EHHE) 1987-89

• DVM/ EIS Alum studying animals as sentinel species at Superfund sites….

• OH NO! My mentor left for another CDC job!

• Lead poisoning became the focus

 Community/ childhood lead screening

- Alaska, Hawaii, Tennessee

 Occupational Health / Community exposures

Getting back to veterinary practice …

Worked 20 -30 hrs/ week at a small animal

emergency clinic while in EIS

• But I really missed herd health/ food animal practice ….

1989 – left CDC for Dairy Practice – Texas

• Father was diagnosed with pancreatic cancer in Florida; left TX practice after 6 months to help / be there for him. No temp license in FL!

1990 – FDA CVM in Rockville, MD

• 6 months as target animal toxicity reviewer for use of bovine somatotrophin in dairy cows

Returned to Atlanta; late 1990

Temp/ Part time Small Animal work

• Re-hired by Emergency Clinic ~ 18 mo

April 1991 CDC EIS Conf/ job fair -- Hired!

1992-1993:

ATSDR

--

Agency for Toxic

Substances and Disease Registry;

Div. of

Health Assessment and Consultation

• Public Health Assessments

• Superfund Sites -- “One Health”

• Great boss, great colleagues, real issues of importance to communities across U.S.

Division of Quarantine, NCID 1993- 98

Staff Veterinary Epidemiologist

• 42 CFR Part 71. Foreign Quarantine

• Immediate aftermath of Ebola Reston

• Non-human primate import program

 Approx. 90% of importers could not meet import quarantine biosafety standards.

 Inspections: quarantine facilities and shipments • Miscellaneous vector species

 Imported Dogs and cats – rabies vaccination

 Egyptian fruit bats – revised live bat permit requirements (science, conservation only)

Wildlife Domestic Animal Human Translocation Human encroachment Ex situ contact Ecological manipulation Human behaviors Global travel Urbanization Biomedical manipulation Food processing/distribution Technology and Industry Agricultural Extensive Production Encroachment Introduction “Spill over” & “Spill back”

One Health One Medicine

After Daszak P. et.al. Science 2000 287:443

Weekly

June 13, 2003 / 52(23);537-540

Multistate Outbreak of Monkeypox --- Illinois, Indiana, and Wisconsin, 2003

CDC has received reports of patients with a febrile rash illness who had close contact with pet prairie dogs and other animals. The Marshfield Clinic, Marshfield, Wisconsin, identified a virus morphologically consistent with a poxvirus by electron microscopy of skin lesion tissue from a patient, lymph node tissue from the patient's pet prairie dog, and isolates of virus from culture of these tissues. Additional laboratory testing at CDC indicated that the causative agent is a monkeypox virus, a member of the orthopoxvirus group. This report summarizes initial descriptive epidemiologic, clinical, and laboratory data, interim infection-control guidance, and new animal import regulations.

Monkeypox

Outbreak,

Emerging and Re-emerging Zoonoses,

1996–2005 --- or relatively rare events?

Nipah Virus

Hendra virus Multidrug resistant Salmonella

Lyme Borreliosis West Nile Cryptosporidiosis Reston virus Venezuelan Equine Encephalitis E.coli O157 E.coli O157 Lassa fever Yellow fever Ebola Monkeypox Influenza A(H5N1) Rift valley Fever NV-CJD Ross River virus Equine morbillivirus Nv-CJD E.coli non-O157 West Nile Virus

Reston Virus Brucellosis Hantavirus pulmonary syndrome Leptospirosis Recent outbreaks

Rabies / Angola and Indonesia Marburg / Uganda

Rocky Mountain Spotted Fever/ Mexico

Salmonella / USA Tularemia / USA, Kosovo Yellow fever / Ivory Coast

Brucellosis / Mongolia

E. coli 0157 / Canada Hantavirus / US

BSE-vCJD/ UK Nipah virus / Malaysia Avian Influenza / Hong Kong

West Nile / USA, Canada Ebola / Gabon, Congo

BSE /Canada Monkeypox / DRC/ US

SARS / Global Avian Influenza H5N1

Trying to advocate for a “One Health”

perspective before “One Health” was cool….

1996 Miami Port of Entry Inventory Totals

• At least 3 federal agencies have jurisdiction. (USDA, CDC, USFWS)

• Importation of most

wildlife and products to

USA as items of commerce (e.g., pet trade) is still

largely unrestricted. • “Strip-mining” of foreign ecosystems Mammals = 6976 • Sugar Gliders = 4342 • Monkeys = 452 • Rodents = 1182 Reptiles = 1,078,656 • Caimans = 15,023 • Lizards = 935,307 • Snakes = 79,770

1996 Miami Q.S. Inventory Totals

Snakes:

 ~30,000 baby reticulated pythons

• Vipers = 721

N.J. Cobra bite victim recovering as probe of snake purchase continues (Thursday, February 3, 2011)

ATSDR Division of Toxicology 1998-2001

Emergency Response/ Consultation Team

• Emergency Planning and Response (CDC)

• Consultative veterinary support for ATSDR’s 10 Regional Offices

• Lead Office at CDC for industrial chemical

emergencies; interfaced with EPA and USCG

• HAZMAT spills – 24/7 phone consultation

Detailed to USDA / MAFF (UK) for FMD

Surveillance, May/June 2001

Surveillance of

FMD-unaffected farms in

Cumbria

• Permit normal activities, lift quarantine in infected areas.

• DVMs are “trusted agents” in rural communities.

• Recognized far-reaching

economic and psycho-social impacts on farmers and

And then came 9-11, Anthrax attacks,

Response, and Recovery……

Assisted with staffing CDC Emergency

Operations Center

2001 – 2003: Emergency Bioterrorism

Response Coordinator for ATSDR

• Technical / science support for Twin

Towers environmental hazard assessment

• Anthrax Technical Sampling Teams

 U.S. Postal Facilities, Congressional Offices

 “How clean is clean enough?”

• Level B HAZMAT Response Team/ FBI

Anthrax Investigation in Postal Facility, Fall 2001

ATSDR , NCEH, and NIOSH environmental health scientists and environmental engineers

Coordinator for CDC/ATSDR’s

Chemical Terrorism Response Program

CDC’s Emergency Response Plan

Chemical Weapons of Opportunity Training

Program with ACMT

• >5,000 federal officers, public health, and physicians trained

Department of State/ USAID consultation

• Russian-American Biotechnology & Toxicology projects

• Developed environmental health Cooperative Agreements with India and Poland

Deployed with USPHS to

Following Hurricanes Katrina and Rita,

we saw a lot of …..

Blaming the victims ….

• Much bad press, unfair assumptions, and misconceptions regarding:

 Owners, Animals, State Animal Health Authorities

Discrediting of previously successful

evacuation strategies and experiences

• Louisiana State Pet Evacuation Plans

• Good record of successful evacuation

Pet Owner Behavior in Disasters

Studies indicate that pet-owning households are significantly less likely to evacuate during mandatory orders than

households without pets (AJE 2001 153:659-665);

The more pets, the less likely household will evacuate. Owners will frequently go to great effort and risk personal loss or injury to protect or rescue the animals they love. Why? A sense of personal responsibility for the lives

entrusted to our care is a hallmark of ethical human beings.

http:

//abcnew

s.go.

The Federal PETS Act of 2006 and PKEMRA -- What a Difference a couple of Laws Make!

Federal Coordination of Response Resources for Household Pets and Service Animals to States and Local Governments

CAPT Stephanie R. Ostrowski, DVM USPHS Veterinary Category

NCEH/ATSDR CDC, Atlanta, GA

FEMA Special Liaison for Animal Activities, 2005/2006 PETS Mission Area Lead for Evacuation Planning 2006 Companion Animals Management Unit, FEMA LA Warm

JFO, 2007

2008 AVMA Annual Conference July 21, 2008

Hurricanes Katrina and Rita, 2005

Avian Flu and “Swine Flu” 2006-2009

Preparedness and Response

Pandemic Flu Preparedness (decades)

Avian Flu in Nigeria; 2006 (CDC, WHO…)

• CDC Technical Consultative Mission

• Abuja, Nigeria. Epi, lab, programmatic aid ($$)

• Virulent strain; Avian cases; loss of

commercial parent and grandparent stock

“Swine Flu” H1N1 2008/09 – relatively mild

• Mass vaccination – US 2009 Flu season

• Human cases only; swine not affected

State and Local Response:

H1N1 Lessons Learned

CAPT Stephanie R. Ostrowski, DVM, MPVM, DACVPM Acting Program Director

Career Epidemiology Field Officer (CEFO) Program

Coordinating Office for Terrorism Preparedness and Emergency Response

July 7, 2009

Veterinarians at CDC

AVMA Directory, 2006

State Health Department Assignees

Reproductive Health Injury prevention/NIOSH Office of the Director AIDS/STD Infectious Diseases Immunizations Environmental Health Laboratory Animal Medicine EIS office Total: ~94 18

Diane Gross, DVM, PhD

1. Avian Flu – CDC/ WHO human/ animal interface issues (lead for Africa and

Asia)

2. Cost-effectiveness of Brucella vaccination of cattle

EISO Kristy Murray, DVM (1998 – 2000)

Looking for Ebola reservoir species -- Collecting bats in the Philippines. (Also was on my Bangladesh STOP Polio team)

CDR Jennifer McQuiston, DVM

Public Health Veterinarians in the

Federal Government

Coop State Research, Ed, Ext DOD-Army

DOD-Air Force

Environmental Protection Agency DOI-USGS

DOI-Fish and Wildlife DOI-National Park Service DO Commerce DOS/USAID DOI/Forest Service USDA-ORACBA DHS Total: ~2,800 USDA-FSIS USDA-APHIS DOD-Army HHS-FDA 11

USPHS Job Benefits

Military Pay Scale and Increases

30-days vacation annually + holidays

Special Pays

• Basic Allowance for Housing (non-taxed)

• Board-Certified Pay (taxed)

TriCare (military) Health Coverage

• On/off base (Emory University in ATL)

• No premium or co-pay for officer; v. affordable for family

Retirement-eligible at 20 years

How do I find a federal job?

http://www.usajobs.opm.gov/

Many jobs are not designated “for veterinarians” Make contacts at meetings

Entry or advancement often requires advanced education and/or board certification in a

specialty

• MPH, MS, MPVM, PhD

• Preventive medicine, lab animal medicine

FSIS short 100 veterinarians now and ~ 100-200 in the next 5 years – no additional training

needed for many of their positions

Summary

Exciting career opportunities in public

health exist for veterinarians

Training programs are important entry

points

~ 0.5% of U.S. public health workforce;

2.8% of federal workforce

A large % of federal public health

veterinarians expected to retire in

coming years

• The need for public health veterinarians is growing

Veterinarians at CDC

Student experiences

State and local health departments

Opportunities with USDA, FDA University of Maryland program

Public Health Service co-step program CDC - Summer student employment CDC – Epidemiology elective

Epidemiology elective

http://www.cdc.gov/eis/applyeis/elective.htm

September through June

6-8 weeks

Defined project, often a chance to assist with

outbreak investigations

Deadline: May 30

of your Junior year

What is the EIS Program?

Epidemic Intelligence Service (aka “Disease Detectives”)

Established in 1951

Mission: To prevent & control communicable diseases

A 2 year training program in applied epidemiology

Domestic and International Service

• Respond to Requests for Epidemiologic Assistance 20

State and Local Health Departments

Copper in drinking waterCopper in drinking water

Norwalk Virus Hanta VirusHanta Virus

TB in immigrantsTB in immigrants Lead screeningLead screening

CyclosporiasisCyclosporiasis

Bombing

Hurricane Hugo

Where do EIS Officers Train?

West Nile Virus/Anthrax Forest Fires Hurricanes 21

How do I find out more about EIS?

http://www.cdc.gov/eis/about/about.htm

55-75 officers, 6-9% are

veterinarians

Application process begins in May

for the following year’s class

Additional training or experience in

public health encouraged prior to

application

Post-DVM opportunities

Fellowships

• Emerging Infectious Diseases fellowship

 Through APHL

• American Teachers of Preventive Medicine Fellowship

Master’s of Public Health

• Work study through CDC for Emory students

There is growing public concern

regarding food safety, zoonotic

diseases, environmental health issues,

bio- and agro-terrorism

Veterinarians are broadly trained and

uniquely prepared to address these

challenges

Critical shortage of public health and

food safety veterinarians projected in

next 5-10 years

Acknowledgments

Jennifer McQuiston, CDC, HHS Diane Gross, CDC

Jennifer Wright, CDC

Kathryn Feldman, University of Maryland Steve McLaughlin, CDC

Stephanie Ostrowski, CDC Marta Guerra, CDC

John Dunn, Tennessee Department of Health Matt Schech, NIH