ASU global health students gain firsthand experience in outbreak response

It’s Friday morning, and Arizona State University students Daniela Ledesma and Hanna Maroofi head to the Arizona Department of Health Services in downtown Phoenix. After checking in with their supervisor, a foodborne epidemiologist, they begin their day in a conference room conducting phone interviews. They’re calling people who have suspected or confirmed food or waterborne illnesses like salmonella or E. coli.

Ledesma and Maroofi ask questions about the person’s recent behavior. They gather information about current or previous symptoms, and determine a food history, asking what was eaten and where, or where groceries were purchased. They also ask the person about any recent travel or animal exposure, and their occupation.

Next, they enter this data into an ADHS database to help public health workers recognize patterns or determine if there are any unusual spikes in cases. Ledesma and Maroofi are conducting case investigations, the hallmark of epidemiology, as members of the Student Outbreak and Response Team, a training program offered through the School of Human Evolution and Social Change at ASU.

In the afternoon, they listen in on a weekly conference call that ADHS food and waterborne illness investigators have with either the Maricopa County Department of Public Health or the Centers for Disease Control and Prevention to hear about current outbreaks and how agencies can coordinate their response. Last November, for example, Ledesma recalls hearing a lot about the national romaine lettuce E. coli outbreak. 

They’ll finish the day working on data-cleaning and entry projects. Some Fridays they get to participate in question and answer sessions with public health workers in other departments at ADHS — like the vector-borne, vaccine-preventable, infections and Valley Fever departments. Maroofi said it was eye-opening to hear from so many health professionals and get to ask them questions about how they got to where they are today. 

The Student Outbreak Response Team

Associate Professor Megan Jehn oversees both undergraduate and graduate students on the Student Outbreak Response Team, an upper-division course that prepares students for careers in the public health field. 

“Too often students who are interested in health fall into a trap in which they think the only career paths are medicine or nursing,” Jehn said. “I was one of them, having spent most of my undergraduate career as a pre-med student at ASU because I didn’t know that other health-related career paths existed. A chance meeting with a fabulous professor opened my mind to the possibility of graduate school in public health.”

Jehn created SORT in spring 2017 and describes it as a unique hybrid of a service-learning public health course and a field epidemiology training program. SORT students provide surge capacity for state and local health departments while receiving valuable field experience, making future career contacts and becoming socially embedded in the community.

Students have attended local sporting events alongside Mayo Clinic staff to conduct disease surveillance. They’re also trained in contact tracing, emergency preparedness, health communication, analyzing public health data and conducting outbreak investigations.

Training in the field

Maroofi enrolled in SORT because she aspires to become an epidemiologist. She graduated this spring with a Bachelor of Arts in global health and a Bachelor of Science in biomedical sciences. She starts working toward a Master of Public Health at Johns Hopkins University this fall. Maroofi realized she found her calling in global health during her first fieldwork project, which focused on Rocky Mountain spotted fever.

A team of public health officials from ADHS, CDC, San Carlos Animal Control, United States Department of Agriculture and Indian Health Services, along with outbreak response team students, visit communities annually to educate, mitigate and record data about Rocky Mountain spotted fever. This tick-borne illness can be deadly if not treated properly. The team educates people about prevention, symptoms and treatment of the disease. For example, they caution against interacting with stray dogs, and teach residents how to tell if a dog has ticks. While onsite, they also fit dogs with treated collars to repel ticks and record data on how many dogs were and were not collared.

An experience that stood out to Ledesma was participating in a daylong training titled Student Aid for Field Epidemiology Response. It’s hosted annually by ADHS and MCDPH and introduces students to local epidemiologists working in public health, providing opportunities to network and learn about the efforts of state and local public health workers. During this training, Ledesma got to work with master's degree students from the University of Arizona and ask them about their courses of study and research interests.

Ledesma graduated from ASU this spring with a Bachelor of Arts in global health. She starts working toward a Master of Public Health at Johns Hopkins this fall.

The main goal of this course is to prepare students for a career in public health, and so far, it’s going well.

“In my eyes, one of the indicators of the success of SORT is to see students competing for prestigious internships, fellowships and graduate programs,” Jehn said. “Our students are getting accepted to top public health master's or doctoral programs at Harvard, Johns Hopkins, Emory and Columbia.”

Room to grow

Jehn hopes to expand the program. She would like to build a data laboratory and call center on campus, noting that students need secure communication channels to conduct public health interviews due to the sensitive nature of working with health information, and travel to outside facilities can be limiting. Having a secure data facility onsite would also allow SORT graduate students to help supervise undergraduate students, adding layers of experiential learning.

Ledesma also hopes the program will grow and sees the need for young people to get involved with public health, particularly in light of the COVID-19 outbreak.

“This whole pandemic has shown us ways in which we can improve our emergency preparedness,” she said.

ASB 484: Internship, Student Outbreak Response Team is typically offered in the fall and spring semesters to both undergraduate and graduate students pursuing global health degrees. Interested students need the instructor’s permission to enroll and usually need to have completed previous coursework with Jehn. Students interested in a more traditional class without prerequisites can take Jehn’s ASM 201: Epidemics and Outbreaks.