Introduction to Forensic Epidemiology

Goals

Describe forensic epidemiology and the groups that may be involved in a forensic epidemiology investigation.

Explain how forensic epidemiology is used in the courtroom and in the field.

Provide examples when forensic epidemiology might be used.

Definition of Epidemiology “The study of the distribution and

determinants of health related states or events in populations, and the application of this study to control health problems”

The basic science of public health

Goals of Epidemiology

Examples: Identify individuals at high risk for

disease Recognize and control epidemics Monitor rates of disease and

exposures in populations

Types of Epidemiology

Examples: Occupational Infectious Disease Cardiovascular Cancer Nutrition Environmental Injury

Epidemiologic Studies of Naturally Occurring

Phenomena

Historical examples dating to 1747 Modern examples:

Fluoride use and dental caries Cigarette use and lung cancer Tampon use and Toxic Shock

Syndrome HPV exposure and cervical cancer

Epidemiology in Health-Related Crime Investigations

Examples: Deliberate poisoning Bioterrorism

Need unlikely partners to work together

Epidemiology can link disciplines Goal is to protect health of public

Forensic Epidemiology

Application of public health methods in a potential criminal investigation Litigation of health-related incidents

Examples: silicone breast implants, E. coli infections, toxic shock syndrome, tobacco use

Field-based investigations with law enforcement

Example: intentional anthrax release in 2001

Epidemiology in the Courtroom

Investigative experts Interview case-patients

Consulting experts Understand scientific principles Understand statistical principles

Testimony experts Present data

Differences between Science and Law

Science Ever-changing, open to peer review Disease in populations Evidence for association only

Law Final Disease in individual Requires causal link

Field-Based Forensic Epidemiology

During the investigation

Disciplines involved: Local and state health

departments Police and firefighters State bureaus of

investigation Emergency

management services Hospitals and health

clinics State laboratories Pharmacists

Federal Bureau of Investigation National Guard and other

military units Centers for Disease Control

and Prevention Federal Emergency

Management Administration United States Department of

Agriculture Department of Homeland

Security Attorney General’s Office

Field-Based Forensic Epidemiology-Bioterrorism

Two key groups: Public health and law enforcement Common goals:

Protect the public Prevent/Stop the spread of disease Identify the responsible individual/party Safeguard those involved in investigation

Field-Based Forensic Epidemiology-Bioterrorism Law enforcement contributions:

Public health criminology expertise Forensic laboratory collaboration Law enforcement connections

Public health contributions: Medical expertise Laboratory expertise Public health connections

Examples of Confirmed Health-Related Criminal

Cases Rabbit hemorrhagic disease virus; 1997 Shigella dysenteriae type 2; 1996 Bacillus anthracis, botulinum toxin,

sarin; 1990-1995 Salmonella typhimurium; 1984 Ricin; 1978 Curacit; 1977-1980 Ascaris suum; 1970

Conclusion

Forensic epidemiology has been used for many years; 2001 terrorist events have increased attention on field

Public health and law enforcement can learn from each other

Public health and law enforcement can successfully work together