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My Career Pathway as a
Public Health Veterinarian
at CDC
Stephanie R. Ostrowski, DVM, MPVM, ACVPM
CAPT (Retired, 2010) USPHS
Food Safety Resident I, CAHFS – UC Davis
• How old were you when you knew you wanted to be
a veterinarian?
• 5 acres; rural southern Maryland –
• Dogs, cats, horses, goats
• Rural, non-farm
• Worked for local small animal vet – high school
• Role model was our large animal practitioner –
• Calm and knowledgeable
“I started out as a child …” (Bill Cosby)
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
• Not quite what I was expecting, but ….
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
- With NIOSH in Jamaica
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)
Exotic pets: rodents – monkeypox, hantaviruses
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,
2003
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:
• Adders = 214
• Anacondas = 514
• Boas = 25,516
• Cobras = 136
• Mambas = 44
• Pythons = 45,645
~30,000 baby reticulated pythons
• Vipers = 721
• Other = 7024
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
• Food Chain/ livestock agriculture impact
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
rural communities.
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
AMI Building, Boca Raton, FL
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
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
sheltering for owned pets in previous years
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.
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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
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
• Slaughter of all hogs in Egypt (bad policy)
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 DepartmentAssigneesReproductive Health
Injury prevention/NIOSH
Office of the Director
AIDS/STD
Infectious Diseases
Immunizations
Environmental Health
Laboratory AnimalMedicineEIS 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
in Egypt
EISO Kristy Murray, DVM (1998 – 2000) Looking for Ebola reservoir species -- Collecting bats in the
Philippines. (Also was on my Bangladesh STOP Polio team)
Public Health Veterinarians in the
Federal Government
90 85115
1200
670
40
6
439
90 1210
111620
2
82
HHS-CDC
HHS-NIH
HHS-FDA
USDA-FSIS
USDA-APHIS
USDA-ARS
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
Veterans Benefits: GI Bill (education)
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
40
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
41
Veterinarians at CDC
As of December 2008
0
10
20
30
40
50
60
Ep
idem
iolo
gis
tL
ab
/rese
arch
Path
olo
gy
AP
TR
Fell
ow
Ed
itor
Com
mu
nic
ati
on
s
Oth
er
Job Activity
19
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
37
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 30th of your Junior year
38
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
E. coli E. coli
Malaria Malaria
Cryptosporidiosis Cryptosporidiosis
Legionnaires'
Disease/Norwalk virus Copper in drinking water Copper in drinking water
Norwalk Virus
Hanta Virus Hanta Virus
TB in immigrants TB in immigrants
Lead screening Lead screening
Cyclosporiasis Cyclosporiasis
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
36
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
39
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
Take home messages 42