The Shadow
The mission of the Epidemiology Division of the Roanoke City & Alleghany Health Districts (RCAHD) is to monitor and investigate emerging communicable diseases, investigate outbreaks, and provide guidance to stop the further spread of communicable diseases for our community’s wellbeing. To put it more simply, epidemiologists are “disease defenders” who use data to answer questions like: Who is getting sick and why? Where is the problem occurring? Why are some people more affected than others? How can we prevent more people from getting sick?
To optimally protect the public’s health, healthcare professionals and laboratories are required to report over 70 diseases or conditions in Virginia. In 2023, the RCAHD epidemiology (epi) team, which includes professionals with advanced public health degrees as well as clinical nurses with epi training, investigated over 690 incidences of reportable diseases, excluding COVID-19 and sexually transmitted infections (STI). Since 2020, the team has also included a dedicated group of COVID case investigators. The COVID team investigated and managed over 9,600 local cases in 2023, including 59 outbreaks. In addition, about 2000 STI were reported locally in 2023, including almost 100 reports of syphilis.
Much of the epi team’s work is behind the scenes, carefully following up on each new case reported by local healthcare providers, analyzing and investigating each disease as needed to protect our communities and prevent further spread. They also provide guidance on topics such as testing for communicable diseases or sharing best practices to protect additional people from getting sick after a diagnosis is made. Our team of epi nurses investigate and manage cases of rabies exposures as well as cases of elevated lead levels in blood, a condition that is particularly concerning in children. There is also a team of experts dedicated to respond to cases of tuberculosis.
The epi team has been vital in helping to protect the community’s health during several notable outbreaks in recent years. Working alongside our environmental health team of restaurant inspectors, the epi team investigated the 2021 restaurant-associated outbreak of hepatitis A, where over 50 people were sickened. As the community continued to see a high number of community-acquired hepatitis A cases in 2022, the epi team helped identify common risk factors involved with the spread, noting a higher incidence among people who used injection drugs.
The epi team has also been instrumental in monitoring an ongoing increase in cases of community-acquired invasive group A strep (iGAS) since 2022, and the rise of hospital associated infections both here and across the country. The team assists facilities such as nursing homes, long term care facilities and jails with best practices to prevent infections to protect staff and vulnerable residents from outbreaks.
Recently this summer, the team has noted an uptick in local foodborne illnesses. While the increased number of salmonella and campylobacter infections do not all share a common source, investigations determined that some cases were linked to a nationwide recall of cucumbers in June, and other cases may be linked to consuming unpasteurized eggs from backyard flocks. As always, washing hands and surfaces often is also key to everyday prevention.
Not all aspects of the job are spreadsheets and data, according to district Epidemiologist Hope White. She and the team also enjoy the satisfaction of direct contact with residents and opportunities to build trust, such as when she brought books to share with the children of a newcomer family receiving follow-up care from the health department. The combination of RCAHD staff efforts to build trust with residents and broader advances in epidemiology have contributed to the more than 20-year increase in life expectancy since the early 1900s and have helped to make the community a healthier place to live.
