Shigellosis outbreak: Lessons learned from a local public health agency response in milwaukee, wi

The surveillance and control of reportable communicable disease (CD) by local public health agencies (LPHAs) is a core public health function and essential public health service. While much attention has been drawn to novel and emerging infectious disease response models, advances in CD reporting combined with funding trends have resulted in LPHAs increasingly being unable to support basic public health services including follow-up of commonly reported diseases. The unpredictablity and potential magnitude of CD outbreaks along with often a lack of adequate staffing reserves have negatively impacted LPHAs' abilities to assure rapid and effective community mitigation.

During 2007, the City of Milwaukee Health Department recorded a five-fold increase in shigellosis primarily associated with transmission in childcare and family settings. The subsequent impact on agency epidemiological, nursing, laboratory and support personnel during an eight month period created substantial agency stress. While disease severity was not excessive, many initial specimen isolates were found to be antibiotic resistant. Laboratory turnaround times slowed as specimen volume exceeded capacity. Backlog in epidemiologic follow-up and nurse case charting further hindered the timeliness of surveillance data and increased overall response time.

During prolonged CD outbreak response, LPHAs must contend with resource depletion, staff fatigue, public apathy and reprioritization of internal assets. Models incorporating cost-effective, team-oriented and evidence-based decision-making for strategic resource prioritization are lacking. LPHAs must pre-plan for routine and emerging CD occurrence and develop action plans in advance that leverage both resources and partnerships in creating realistic staffing contingencies while not compromising core public health operations.